Medicare

Maternal and Child Health Services

Comprehensive Public Health Services

Comprehensive Health Planning

Crippled Children Services

Family Planning

Emergency Medical Services

Immunization Program

Infant Death Program

Specific Disease Programs

Health Professions Programs

HUMAN SERVICES

Within the broad area of human services, the Governors made a number of specific suggestions. These proposals are summarized below.

CONSOLIDATIONS

At present, a multitude of assistance programs with different requirements and different levels of assistance are directed to the same families or individuals. Because of statutory prohibitions or administrative resistance, the relationship of one program to another has not been analyzed in any but a perfunctory way. The result is ineffective and wasteful delivery of services.

The narrowness of programs and competition among them create duplication and confusion in service delivery and program administration. Many programs have their own eligibility workers, accounting services, and planning groups which produce an annual service plan intended in part to ensure adequate coordination among programs. Unfortunately, coordination is often difficult to achieve at the state level because programs are organized in an entirely vertical system from federal agency to special client group.

Problems also are created when a federal agency undertakes a "reorganization" that does not seek to reduce or eliminate duplicative administrative procedures and costs. One Governor cited the example of the recent reorganization of the federal Social and Rehabilitative Services (SRS): "The recent reorganization in the guise of improved efficiency, has created many more demands upon us and an apparent increase in the size of the federal bureaucracy. When HEW's Division of SRS existed, the Medicaid, AFDC, and Title XX programs were monitored by the single SRS organization. One regional staff person,

for example, processed our grant awards. We now have, under the reorganization, four different systems. Such reorganization doesn't always bring about improvements and consolidation, and, if not planned correctly, could create as many problems as it solves."

Reasonable program consolidation services could improve and reduce costs in the following areas:

Title XX

A number of Governors had suggestions for including categorical
programs under the Title XX quasi-block grant. Programs suggested for
inclusion are: Developmental Disabilities Act, Child Welfare Social
Services, Vocational Rehabilitation, Alcohol and Drug Abuse, and
some Community Services Act and older Americans Act programs.

Family Planning Programs

Under the general family planning head, states may be funded under
two federal acts and four titles. One Governor suggested that "services
could be increased in family planning by one-third if these programs
were consolidated and we had more latitude. Conversely, we could cut
the costs of these programs by one-third and still have the same level
of operation."

Governors recommended a basic federal block grant program for mental health. They also supported the major consolidation proposal for the alcohol and drug abuse programs. There was also a suggestion for block grants to states to fund community mental health centers rather than individual grants to each center.

Welfare and Other Transfer Programs

Short of complete overhaul of the welfare system, suggestions were received for consolidations aimed at reducing administrative overhead. One Governor proposed a consolidation of several categorical programs into four basic areas: income assistance, energy conservation and utility assistance, nutrition, and medical assistance.

Environmental Health Programs

Water, air, and solid waste programs should be consolidated
into a single environmental block grant to states to provide
flexibility to meet individual states' most pressing needs.
In addition, Governors suggested that the meat and poultry inspection
program be combined with the interstate food inspection program to
allow for some efficiencies and greater state flexibility.

Crippled Children Programs

One Governor recommended that the current programs could be combined to provide flexibility and efficiency with no loss in services.

ADMINISTRATIVE REFORMS

Most Governors participating in the survey suggested reforms and changes in the administration of federal human service programs. The following are excerpts from their reponses:

Title XX

"Reducing planning and reporting requirements,"
"Eliminate current eligibility requirements and require that 50%
of individuals served be below the poverty level."
"Arbitrary reduction of Title XX to 1978 federal ceiling limits
states' ability to meet national guidelines for deinstitutionalization."

Day Care

"Day Care programs are fragmented among Title XX, WIN, and Vocational Rehabilitation. Eligibility requirements, subsidy amount, provider standards, and methods of payment all vary, causing confusion and administrative problems."

Food Subsidy Programs

"Continued funding for the basic food stamp program and the WIC program
should be reevaluated in terms of their effectiveness and efficiency.
These programs presuppose a funding mechanism and a program thrust
which ensures that low income clients will receive an acceptable
nutritious diet. However, under the present service delivery system
there appears to be little evidence that these objectives are being
achieved or could even be achieved through these funding sources. Also
there is a question as to whether the federal government can effectively
force clients to spend their income subsidies to achieve national
nutritional goals.

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"Due to the dual eligibility requirements for Food Stamps and AFDC,
a possible reduction of $3,000,000 could be realized if the administration
of both Food Stamps and AFDC could be merged."

Medicaid

"States should be given more latitude in establishing standards for
medical facility certification (especially staffing requirements).
More latitude is also needed in setting reimbursement rates, especially
nursing home rates, major improvements in controls on medical care
facility utilization, new options for providing home health services,
and finally, alternatives to current fee-for-service payment mechanisms."

Federal Mandate of State Administrative Structure

"The federal laws which mandate state administrative structure for
relatively small programs should be changed. Examples are the requirements
for a separate administrative unit in the welfare department for the
WIN program for AFDC recipients, and a separate unit for child
support functions. States should be permitted to administer these
functions in the most cost effective manner, which may well be as
part of a larger related unit, instead of a separate unit,"

Governors also expressed strong support for human services planning reforms. One Governor commented:

"While the merits of providing an overall block grant for alcohol,
drug abuse, mental health administration, etc. are not totally
undebatable, certainly the planning requirements of those various
programs could be consolidated into one state plan which would
provide greater administrative control and less money spent on
planning at the state level."

PROGRAM REDUCTIONS

Some Governors identified specific programs as targets for reduction or elimination. At least one Governor viewed the following programs as duplicative or wasteful:

the state office of economic opportunity program

Title XX training

Sumner youth recreation program of CSA

the Business Enterprise program for the blind

EDUCATION

Programs Included In Review

Grants for Disadvantaged Children

Migrants

In-State Institutions

Bilingual Education

Basic Skills Improvement

Strengthening State Departments of Education

Follow Through

Indian Education

Guidance, Counseling, and Testing

Emergency School Aid

Civil Rights Assistance and Training

School Assistance in Federally Affected Areas

Education for the Handicapped

Special Education Personnel Development

Higher Education and Student Assistance Programs

Vocational Education

Basic Grants to States

Consumer and Homemaking

State Advisory Council

Professional Development

Bilingual Vocational Training

Adult Education