First create a table comparing and contrasting the eligibility rules of two different programs that

First create a table comparing and contrasting the eligibility rules of two different programs that offer the same type of services as NY Family Health Plus program. Select one governmental program and either a private or faith-based program that offers similar services to address your chosen social problem. The table should look exactly like how the table looks on page 117 of text except your going to only compare and contrast two different programs that offer the same services as the NY Family Health Plus program. Look at Image 6.1 in the text on page 117 to get an idea.Next- Write a brief 250-350 word summary of what you consider the key differences between the eligibility rules of the two agencies.CHAPTER6Who Gets What, HowMuch, and Under WhatConditionsAnalysis of Eligibility Rules“That’s not a regular rule, you invented it just now,†said Alice. “Yes, and that isthe oldest rule in the book,†said the King.—Lewis Carroll, Alice in WonderlandIntroductionISBN: 0-536-12112-5Fifty years ago, textbooks on economics referred to air and water as examples of “freegoods.†So far have we come from that more plentiful time that it is now difficult to citeany example of a free good: free in the sense that it is neither rationed, regulated, norpriced. Because no social welfare benefit is a free good, rules and regulations allocatingsuch benefits abound. Such rules and regulations are not dispensable. As long as the demand exceeds the supply of benefits and services, some rule or principle must be used asa guide for deciding who gets the benefit or service and who does not.Social workers and other human service practitioners need to understand eligibility rules because they work daily within the context of these guidelines and use them atall levels of complexity. For example, the practitioner may need to seek exceptions fromthose rules to meet a client’s/consumer’s special need or need to understand the eligibility rule to decide whether to advise a rejected client/consumer to seek an administrativehearing on the issue. As an agency representative, the practitioner needs to understandthe details of the rule so the applicant has the same chance to receive a benefit as everyother citizen.Practitioners must also live with the fact that they are in the business of denying aswell as qualifying clients/consumers for benefits—a hard fact of life that is a consequenceof scarce resources. In an earlier chapter, the argument was made that finite resources areone reason social policies had to be invented; in an important sense social policies are the109Social Policy and Social Programs: A Method for the Practical Public Policy Analyst, Fourth Edition, by Donald E. Chambers and Kenneth R. Wedel. Published by Allyn andBacon. Copyright © 2005 by Pearson Education, Inc.110P A R T T W O / A Style of Policy Analysisvehicle by which social resources, services, and benefits are rationed when there isn’tenough for everybody under every condition. So, as long as there are insufficient resources for every conceivable social need, every time a benefit or service is given to oneclient/consumer, it takes away the opportunity to give it to another one in need.Eligibility rules are the most important vehicle for rationing benefits and services.On the positive side, they seek to target resources on those who need them or those whoneed them most. If they are off-targeted and go to clients who don’t need them then, atsome point in time, someone who does need them will go without.It is a mistake for practitioners to think they can just “work harder†to deliver services to clients/consumers so that no one will go without. Practitioners’ time is also ascarce and expensive resource, every bit as scarce and expensive as cash. It is temptingto think that a way around this problem is to deliver services via a “first-come, firstserved†eligibility rule. Although that rule has qualities of “rough justice†that aresomehow appealing, the justice involved is probably illusory. Think of how a firstcome, first-served rule gives a not necessarily merited advantage to those who by chancehear of the rule or the service first; there is no particular justice in that. At some point,those who implement that rule will run out of resources, so that denying clients/consumers has only been postponed. First-come, first-served is not inherently a badeligibility rule, but it has no great virtue either—why shouldn’t it be preferable to givepreference to those who are, on some basis, most needy? Indeed, practitioners mayeven be responsible for constructing such rules at some time later in their career and atthat moment there is at stake a professional responsibility for good service to clients/consumers. When a policy does not meet the needs of clients/consumers adequately,neither the exercise of simplistic eligibility rules nor a large dose of moral indignationwill suffice to discharge professional responsibility. Practitioners are responsible for advocating their clients’/consumers’ needs even to their own administrative superiors aswell as to their colleagues in other agencies who have resources that clients/consumersneed. Furthermore, practitioners are responsible for joining with others in pursuinglegislative or judicial advocacy as a remedy.Types of Eligibility RulesThe decentralized disarray of the U.S. welfare system creates literally hundreds of public and private programs that offer welfare services and benefits. Each has a somewhatdifferent set of rules for determining who gets what, how much, and under which conditions. Faced with this bewildering variety, we need to reduce its complexity by some kindof scheme that makes it more understandable. The purpose of the following scheme is togroup together eligibility rules so that we can talk about types of eligibility rules withoutthe trouble of weighty discussions about lightweight differences. Many schemes serve thispurpose—none perfect—so we will borrow heavily from one that seems well suited to thepurpose. It was devised by Richard Titmuss, a student of social policy in the British tradition of Beatrice Webb, Beveridge, and others.1 Titmuss was humble about this analyticscheme: “This represents little more than an elementary and partial structural map whichcan assist in the understanding of the welfare complex today.â€2ISBN: 0-536-12112-5Social Policy and Social Programs: A Method for the Practical Public Policy Analyst, Fourth Edition, by Donald E. Chambers and Kenneth R. Wedel. Published by Allyn andBacon. Copyright © 2005 by Pearson Education, Inc.C H A P T E R 6 / Who Gets What, How Much, and Under What ConditionsIIIIIIII111Prior contributionsAdministrative rulePrivate contractsProfessional discretionAdministrative discretionJudicial decisionMeans testing (needs minus assets and/or income)Attachment to the workforceEligibility Rules Based on Prior ContributionsISBN: 0-536-12112-5Eligibility for many important social welfare benefits is established by rules about howmuch prior contributions have been made to the system that will pay the benefit later. Aprominent example is benefits paid by the U.S. Social Security system: retirement income for workers and survivors (OASI), disability income for workers and dependents(SSDI), and payments for medical care services (Medicare) for both the disabled and theretired. The basic ideas behind the prior contribution method of establishing entitlementare the same principles that lie behind all private insurance schemes: (1) payment in advance provides for the future and (2) protection against the economic consequences ofpersonal disasters is best achieved by spreading the risk among a large group of people.Exactly how much prior contribution is required varies with the age at which benefit is drawn and the type of benefit in question, but some prior contribution is always necessary. In general 40 quarters of coverage (minimally 10 years) is required, although fordisability benefits it is 20 quarters in the 10 years prior to determination of disability,with special insured status for persons who are disabled before age 31. The prior contribution of which we are speaking comes from the worker and the employer and in matching amounts, calculated by a complicated formula and expressed as a percentage ofworkers’ wages written into legislation. As of 2004, 6.2 percent of wages (up to $87,900)were paid by both employee and employer (12.4 percent for self-employed individuals)as a contribution to the Social Security Trust Funds. An additional 1.45 percent of allwages were contributed by employee and employer (2.9 percent for self-employed individuals) to the Medicare Trust Fund. It is from those trust funds that retirement,medicare, and disability benefits will later be paid. Note that some citizens receive benefits not because they made prior contributions but were dependents of those who did:spouses, children, and other legal dependents of contributing wage earners.Unemployment Insurance (UI) represents another program in which eligibilityrules are based on prior contributions. In order to be eligible for benefits, an unemployedworker must have worked in covered employment for a period of time specified in statelaw for eligibility (in most states, the first four out of the last five completed calendarquarters). The insurance is funded by a tax on wages paid by employers3 in covered employment, and funds are credited to each state’s unemployment insurance trust fund(maintained by the federal government). Note that a person who has not yet worked (noprior contribution made on his or her behalf) is not considered unemployed by UI eligibility standards and, thus, not eligible for unemployment cash benefits. A new workrecord must be established by an unemployed worker who has exhausted benefits (an average of 26 weeks) before any additional unemployment cash benefits can be received.Social Policy and Social Programs: A Method for the Practical Public Policy Analyst, Fourth Edition, by Donald E. Chambers and Kenneth R. Wedel. Published by Allyn andBacon. Copyright © 2005 by Pearson Education, Inc.112P A R T T W O / A Style of Policy AnalysisEligibility by Administrative Rule and RegulationAlthough eligibility rules for public social programs may be laid out in some detail in thelaw, seldom are they sufficiently detailed so that no administrative interpretations needbe made. Thus, we will call these administrative rules made to clarify the law. This is anadvantage to client/beneficiaries because it gives social workers and other human service staff members a means by which to administer the benefit or service program evenhandedly and reliably, so that people similarly situated are given similar benefits. On theother hand, administrative rules restrict the freedom of staff members to use their discretion, that is, to judge need for the benefit or service in individual circumstances.There are some eligibility rules that are almost fully spelled out in the law, and the foodstamp program is probably the best example. Almost all of the details necessary to determine whether a citizen is entitled to food stamps are built into the law. The exactamount of assets, as well as income, is specified by family size in the text of the act, alongwith definitions of what constitutes a household. Consequently, no discretion is neededin determining whether (for example) a live-in friend of either sex should be included indetermining household size. The administrative rules for the TANF (Temporary Assistance for Needy Families—the replacement for the old AFDC) program, on the otherhand, are so numerous and concern so many different topics that they are bound intoponderous manuals. These administrative tomes not only include the state and federalstatutes relevant to the program but also (mainly) they address how those laws are to beinterpreted. One reason for the complexity of eligibility rules in the TANF program isthey are means-tested, meaning that eligibility is established by a test of whether a person’s assets and income are greater than some official standard of need for a given family size. Apart from all the administrative rules that concern how to count assets andincome, the TANF program has to be built on numerous administrative rules that tellthe staff who sign the eligibility documents how to interpret the law. For example,should a child’s paper route income be counted as family income or should Aunt Lily’sinherited piano count as an asset? It is in the character of administrative rules that theycan be modified over time; if they are devised by administrators, they can also bechanged by administrators. Therefore, it is important to know whether a certain entitlement rule originates with judicial decision, administrative rule, or individual staff discretion, for on that fact depends the probability for change—staff decisions certainly arechanged more easily than are formal (“manualizedâ€) rules or statutes. Furthermore, asyou might imagine, the method, resources, and time used to effect changes differ foreach rule source. Chapter 7 will discuss the details of administrative appeal hearings thatare required by law for all social programs established under the Social Security Act andfor many programs that receive federal funds.Eligibility by Private ContractStrange as it may seem, it is possible to become entitled to a public benefit through theprovisions of private contracts. The workers’ compensation system is constructed thisway.4 In every state, employers are required to purchase insurance policies from privateinsurance companies (or a state insurance fund) to pay to workers for income and medISBN: 0-536-12112-5Social Policy and Social Programs: A Method for the Practical Public Policy Analyst, Fourth Edition, by Donald E. Chambers and Kenneth R. Wedel. Published by Allyn andBacon. Copyright © 2005 by Pearson Education, Inc.C H A P T E R 6 / Who Gets What, How Much, and Under What Conditions113ical costs to replace what is lost through work injury. There is nothing optional aboutthe law, and employers are subject to substantial fines for noncompliance. In this case,the benefit form is a cash payment plus a voucher for medical expenses.Another source of entitlement to public benefits in which private contracts are involved is purchase-of-service contracting (POSC). In the past decade, more and morewelfare services—counseling, legal advocacy, special education, day care, and some transportation services (e.g., for the elderly and/or disabled)—are delivered by private contractors. In the case of purchased services of various kinds, the state actually pays the bill(or some of it) directly to the private purveyor of the contracted service. Because the stateis the purchaser of services, the state can insert conditions into the contract concerningwho can obtain the service, for how long, and under what circumstances.5 Not only stateand federal governments subcontract for services, but private charitable organizations doso as well.6 For example, private hospitals contract out to private profit-making corporations the operation of psychiatric units—Humana Inc. operates many such units nationwide. Another example is a midwestern private social agency that operates a high-techfoster care program for its state. This program serves severely emotionally disturbedchildren who cannot be cared for in the ordinary family foster home setting. In boththese examples, the entitlement rules embedded in the private contract determine who iseligible for services.Eligibility by Professional DiscretionOne of the most widely used sources of entitlement is the professional discretion of individual practitioners. A common and concrete example is eligibility for medical benefits,which is always contingent on the discretion of the physician (or physician surrogate).Almost every licensed profession controls part of the entitlement to some social welfarebenefit: dental care for TANF children is entitled in part by the judgment of dentists;legal advocacy for low-income people is entitled in part by the judgment of lawyers andjudges; foster care for children is entitled in part by social workers. In each case, the entitling professional whose judgment is necessary is presumed to have some expertiseabout the matter. Social work and human service practitioners must keep in mind thatsuch discretion can be challenged in an administrative or judicial hearing, and whensuch discretion seems prejudicial to their clients, practitioners have a professional obligation to help their clients challenge it. Sometimes professional discretion is the leadingevidence that severs children from parents, as in child physical abuse, sexual abuse, orneglect cases: physicians, clinical psychologists, and social workers are commonly used.No doubt those opinions are important and often accurate, but social workers andhuman service workers should be wary of a blanket assumption about the validity ofthose very difficult judgments.Eligibility by Administrative DiscretionISBN: 0-536-12112-5Another kind of discretion that serves as a source of eligibility for social welfare benefitsis administrative discretion. A common example of this is the policy in some states andSocial Policy and Social Programs: A Method for the Practical Public Policy Analyst, Fourth Edition, by Donald E. Chambers and Kenneth R. Wedel. Published by Allyn andBacon. Copyright © 2005 by Pearson Education, Inc.114P A R T T W O / A Style of Policy Analysiscounties that allows a county welfare worker to distribute small amounts of cash andcredits for food, housing, and utilities to poor people who apply. This kind of policy ischaracteristic of the General Assistance programs (less than half the states and U.S. territories have them). General Assistance is financed by the local government and is usuallyoriented toward short-term emergency budgets. The staff member must account for thefunds only in the fiscal sense; administrative judgment is seldom called to account, andthere is little systematic effort to document its accuracy. However, there are more important examples of administrative discretion. It is indeed widespread and the source ofsuch extensive power throughout modern public organizations that, according toMichael Lipsky and Michael Brown, there may be serious questions as to whether staffmembers at the lowest level or the chief executive actually controls the organizational operations.7,8 All general organizational policies and administrative rules must be interpreted and applied to individual situations, so it is important to understand that suchinterpretation and applications necessarily involve significant personal judgment on thepart of the staff member. For example, a state patrolman sees a person stopped at the sideof a highway and diligently applying a newspaper to the bare rear end of a five-year-oldchild. In a hairbreadth, the patrolman is dutybound to make a serious decision aboutwhether to stop and make inquiries. His decision is essentially administrative because itcomes out of the role he fills as protector of persons. Later, he may have to make an evenmore serious decision. Was what he saw simply a child who had tried the parent’s patience and was being disciplined within acceptable bounds? Or was it a cruel physical attack that will leave black-and-blue bruises or break the skin of a child too young to defendhimself? The discretion entailed here concerns interpretation of the state child abusestatute. Does this instance, and the data selected to report it, constitute an example ofwhat the statute delineates? The statute will not reveal to the patrolman what rules heshould use for its interpretation; it will not say how inflamed the bruises should be—oreven whether black-and-blue rather than red bruises count. Nor will it always protect theofficer from consequences if the parent claims illegal detainment or false arrest. Thesame situation is faced by the social worker and the physician while examining a hospitalemergency room patient. Here, however, it is professional discretion that is being askedfor. Their task is to render a professional opinion about the matter, and they are preparedby training and experience and specifically empowered by law to make that judgment.The difference between professional and administrative discretion is the source of authority of each: Professionals exercise discretion because of the authority of their professional preparation and training, whereas administrators exercise discretion because theyare appointed by their superiors to do so.There are important examples of administrative discretion gone amok, so thatsocial work and human service professionals should be aware that administrative discretion—as important and humane as it can be—also can be used in ways that work tothe detriment of their client’s/consumer’s welfare. Few cases are so flagrant as the massive disentitlement of the chronically mentally ill from Social Security Disability benefits during the early 1980s’ Reagan administration. Although it is not a common case,it is useful to summarize briefly here to illustrate this point. At that time, the Social Security Administration (SSA), ostensibly concerned about the rising costs of the SocialSecurity Disability system, began a systematic effort to reduce approved benefit claimsISBN: 0-536-12112-5Social Policy and Social Programs: A Method for the Practical Public Policy Analyst, Fourth Edition, by Donald E. Chambers and Kenneth R. Wedel. Published by Allyn andBacon. Copyright © 2005 by Pearson Education, Inc.C H A P T E R 6 / Who Gets What, How Much, and Under What Conditions115and to terminate the benefits of the chronically mentally ill whom the SSA believed tobe unable to prove their illness. Some 150,000 beneficiaries had their benefits canceledduring those few years. Not only the mentally ill were disadvantaged; there are documented cases of rejected applicants with severe, disabling cardiac conditions who diedin the waiting rooms of Social Security offices.The mechanisms by which this was accomplished included changes in the standards used for mental disabilities and attempts to impose a quota on SSA hearing judgesfor benefit denials—judges were expected to hand down a constantly increasing numberof benefit denials. If the quota was not met, they were subject to considerable harassment:reassignment or mandatory attendance at lengthy “educational seminars,†for example.The Association of Social Security Administrative Law judges appealed these measureson the grounds that they constituted unlawful interference in the fair-hearing appealssystem established by the Social Security Act as independent of administrative authority.The association won on those grounds, after showing that indeed there were systematic,illegal, plainly political attempts to influence the outcomes of the fair-hearing system.Thousands of appeals of disability denials ensued, sizable proportions of which were successful. It is clear from the data available that disabled beneficiaries who persevered inchallenging the administrative decisions of the SSA increased their chances of a favorabledecision to nearly 80 percent. The higher the federal appeals court rendering the decision, the more likely was a decision against the SSA.9 Only through the efforts of bothlegal advocates and social work and human service advocates were these reversals accomplished. This example should give heart to practitioners that advocacy can succeed and,when conditions warrant, should be a part of their daily work.Practitioners who advocate in these matters should understand that the most important issue in these cases was whether the SSA had followed its own rules in denying disability claims. That is the standard required by administrative law, and it is the mostcommon ground for appeals. The law requires that when specific criteria are establishedfor public benefits, the agency must adhere to them and apply them equitably among applicants. If rules change, the changes must be made public and published in certain ways.In a very concrete way, administrative rules are the “rules of the road,†and justice requires that citizens know about them so that they can equitably pursue claims to whichthey may be entitled. On that account many (though not all) rules of due process apply:due notice, opportunity to know the grounds for denial, opportunity to present testimony in a fair hearing, and the like. (Some of these rules will be discussed in Chapter 7.)Eligibility by Judicial DecisionISBN: 0-536-12112-5Judicial decisions are important sources of eligibility, virtually ruling applicants in or outof program benefits and services. (So important is it that all of Chapter 2 was devoted tothe issue of the judiciary as a source of public policy.) After a program has been in operation over a period of time, it is very likely that a contention will arise about whether theenabling legislation or whether an administrative rule or discretionary judgment wasfaithful to the spirit and intention of the law under which the program or policy was established. Appeals to the judiciary for clarification of the law are routine and in the endthey can become as important as the legislation or administrative rules themselves.Social Policy and Social Programs: A Method for the Practical Public Policy Analys…