Hcr 230 Week 3 Welfare Reform Assignment

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Assignment: Welfare Reform Act

Traci Holmes

May 29th, 2011

HCR 230

Week 3

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) enacted in 1996 set forth three legislative goals: 1) to reduce dependence; 2) to reduce child
poverty; and 3) to reduce illegitimacy and strengthen marriage. The reform has been effective
in meeting each of these goals. ( Robert Rector)

While the welfare reform law did not change how Medicaid delivers health care nor alter its

entitlement status, it reduces the number of people covered and lowers federal expenditures.

Medicaid is the joint federal-state health insurance program for low-income families, senior

citizens, and people with disabilities. In 1995, 41 million people were insured by Medicaid at a

cost of $151 billion. The Congressional Budget Office (CBO) estimated that the new law

would lower federal spending on Medicaid by about 1 percent in the year 2002 compared to

previous projections, and save a total of $4 billion over six years (1996 to 2002). These

savings will lower the federal deficit and reduce the pressure for further Medicaid spending

cuts. (Leighton Ku, Theresa A. Coughlin)

This policy brief discusses the four principal changes made to Medicaid eligibility by the welfare reform legislation: * Decoupling welfare and Medicaid eligibility;
* Narrowing Medicaid eligibility for disabled children in the Supplemental Security Income (SSI) program; * Terminating access to Medicaid for some legal immigrants because they lose SSI; and * Barring most future legal immigrants from Medicaid. (Leighton Ku, Theresa A. Coughlin)

The new legislation ends the use of individual assessments; children now must
demonstrate one of the "listed" medical impairments to qualify for SSI benefits. The Social

Security Administration estimates 135,000 children will lose SSI grants because of these

changes. However, most of these children (an estimated 80 percent) will still be eligible for

Medicaid through other criteria, such as those for children under the poverty level. (Leighton

Ku, Theresa A. Coughlin)

Among the most important health-related measures in the new law are those affecting

immigrants. Previously, noncitizen immigrants legally admitted to the United States were

entitled to Medicaid coverage on the same terms as native and naturalized citizens. The new

law limits the eligibility of noncitizen immigrants for Medicaid and other public assistance

programs. Policies for immigrants who were in the United States when the law was passed

differ from policies for those who arrive in the future. In addition, the new legislation permits

states to exclude current noncitizen immigrants from all but emergency Medicaid services,

regardless of their categorical need or income. However, we are not aware of any states that

are currently planning to exercise this option. If any state implemented such a provision,

current immigrants would be much more strongly affected. (Leighton Ku, Theresa A.


For most health care providers, welfare reform will have modest effects. Medicaid's

entitlement nature and the form of health care delivery is not altered by the new legislation.

"Safety net providers" (hospitals and clinics that serve a large number of Medicaid and

uninsured patients) will face more serious consequences. Safety net providers include public

and nonprofit hospitals, community health centers, and related public and charitable facilities

that offer free or reduced-price medical care to the poor and uninsured. The most strongly

affected will be hospitals and clinics located in high-immigrant areas. (Leighton Ku, Theresa

A. Coughlin)

While the changes wrought by the welfare reform legislation narrow Medicaid coverage...
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