Experiences of Selected Federal Social Welfare Programs and State LIHEAP Programs in Targeting Vulnerable Elderly and Young Child Households
EXPERIENCES OF SELECTED FEDERAL SOCIAL WELFARE PROGRAMS AND
STATE LIHEAP PROGRAMS IN TARGETING
VULNERABLE ELDERLY AND YOUNG CHILD HOUSEHOLDS
This document has been prepared for the Office of Community Services' Division of Energy Assistance by APPRISE Incorporated under contract #HHSP23320070081P. The statements, findings, conclusions, and recommendations are solely those of analysts from APPRISE and do not necessarily reflect the views of HHS.
Table of Contents
A. Needs of Vulnerable Households
B. Need for the Study
C. Other Federal Social Welfare Programs
D. State LIHEAP Programs
II. LIHEAP Targeting Performance
A. LIHEAP Targeting Goals
B. LIHEAP Targeting Rates and Trends
C. LIHEAP Targeting Initiatives
D. LIHEAP Targeting Issues
III. Targeting Overview
A. Targeting Background
B. Current Targeting Trends and Issues
IV. Analysis of Social Programs – Findings and Recommendations
A. Overview of Method
B. General Population Programs
C. Programs Targeting the Elderly
D. Programs Targeting Children
V. Lessons from Review of Other Federal Social Programs
A. Summary of Findings on Barriers
B. Findings on General Outreach and Intake Strategies
C. Specific Enrollment Strategies
VI. Research on State LIHEAP Targeting Procedures
A. Information Objectives
B. Findings for Targeting Elderly Households
C. Findings for Targeting Young Child Households
D. Summary of Findings on State LIHEAP Outreach and Intake Practices
E. Linkages between Program Design and Targeting Outcomes
A. Baseline Assessment
B. General Outreach
C. Specific Outreach and Intake Strategies
Appendix A – Survey Instrument
Listing of Tables
Table 3-1 - Federal Means-Tested Programs’ Targeting Procedures
Table 4-1 - Participation Rates for Individuals by Household Benefit as a Percentage of Maximum Benefit, FY 2005
Table 4-2 - Barriers to Medicaid Enrollment
Table 4-3 - How Respondents Learned about the Medicare Savings Programs
Table 6-1 – Outreach Through Agencies Serving Elderly
Table 6-2 – Outreach Materials Targeting Elderly
Table 6-3 – Outreach Materials with Benefit Amount
Table 6-4 – Outreach to Elderly Program Participants
Table 6-5 – Screen Programs Serving Elderly.
Table 6-6 – Special Application Period for Elderly
Table 6-7 – Special Application Requirements for Elderly
Table 6-8 – Alternative Intake Sites or Procedures for Elderly
Table 6-9 – Application Assistance for Elderly Households
Table 6-10 – Higher Benefit for Elderly Households
Table 6-11 – Outreach Through Agencies Serving Young Children
Table 6-12 – Outreach Materials Targeting Working Families
Table 6-13 – Outreach Materials Targeting Immigrant Families
Table 6-14 – Outreach to Young Child Participants of Other Programs
Table 6-15 – Screen Programs Serving Young Child Households
Table 6-16 – Special Application Period for Young Child Households
Table 6-17 – Special Application Locations for Young Child Households
Table 6-18 – Higher Benefit for Young Child Households
Listing of Acronyms
AARP....................... American Association of Retired Persons
ACF...........................Administration for Children and Families
AOA..........................Area Office on Aging
CCDF........................Child Care and Development Fund
CMS..........................Centers for Medicare and Medicaid Services
CPS-ASEC................Current Population Survey-Annual Statistical and Economic Supplement
DHHS........................U. S. Department of Health and Human Services
ED.............................U. S. Department of Education
EITC..........................Earned Income Tax Credit
FSP............................Food Stamps Program
GAO..........................U. S. Government Accountability Office
GPRA........................Government Performance and Results Act
HUD..........................U. S. Department of Housing and Urban Development
IDEA.........................Individuals with Disabilities Education Act
IRS............................Internal Revenue Service
LIHEAP....................Low Income Home Energy Assistance Program
MSP..........................Medicare Savings Program
NPE..........................Nutrition Programs for the Elderly
OMB.........................Office of Management and Budget
PART....................... Program Assessment Rating Tool
QMB.........................Qualified Medicare Beneficiary
SCHIP.......................State Children's Health Insurance Program
SIPP..........................Survey of Income and Program Participation
SLMB.......................Specified Low-Income Medicare Beneficiary
SSA...........................Social Security Administration
SSI............................Supplemental Security Income
TANF.......................Temporary Assistance for Needy Families
TRACE.....................Tracking, Referral, and Assessment Center for Excellence
USDA........................U. S. Department of Agriculture
WAP..........................Weatherization Assistance Program
WIC...........................Women, Infant, and Children Nutrition Program
The Low Income Home Energy Assistance Program (LIHEAP) Statute requires that grantees “provide, in a timely manner, that the highest level of assistance will be furnished to those households which have the lowest incomes and the highest energy costs or needs in relation to income, taking into account family size” (LIHEAP Statute, Section 2605(b)(5)). The LIHEAP statute identifies “vulnerable households” (i.e., households with at least one member that is a young child, an individual with disabilities, or a frail older individual) as one of two groups of households having the highest home energy needs. To address that mandate, the Administration for Children and Families (ACF), which administers the LIHEAP program, has focused its performance goals and measurement on targeting income eligible vulnerable households --particularly households with at least one member 60 years or older and households having at least one member 5 years or younger.
However, despite outreach and targeting efforts undertaken by ACF, the measured program targeting rates for vulnerable households have declined over the last three years. The purpose of this two-phase study is to develop information that can help State LIHEAP programs more effectively target eligible vulnerable households. The first phase reviewed the experience of other Federal social welfare programs in targeting vulnerable households to assess whether they have identified strategies that are effective in reaching elderly households and/or young child households. The second phase examined the design of the LIHEAP programs in 17 States to assess whether certain program design features were associated with higher targeting rates for vulnerable households.1
Needs of Vulnerable Households
1. Elderly Households
A report by the Federal Interagency Forum on Aging Statistics illustrates the challenges faced by people age 65 and over (Federal Interagency Forum on Aging Statistics, 2006) regarding:
- Poverty: About 9.8 percent of all people age 65 and over lived in poverty during 2004. Poverty rates were 12.6 percent for seniors age 85 and older.
- Housing Costs: For elderly households in the lowest income quintile,(i.e., households in the bottom 20 percent of the income distribution), the percent of income allocated to housing costs increased from an average of 33 percent of income in 1987 to over 40 percent of income in 2002.
- Chronic Health Conditions: In 2004, 50 percent of individuals over age 65 reported having arthritis; 52 percent reported having hypertension; 32 percent reported having heart disease; 21 percent reported having cancer; and 17 percent reported having diabetes.
- Health Care Expenditures: For elderly households (age 65 and older) with income at or below 125 percent of poverty, the percent of income spent on out-of-pocket medical expenses increased from 16 percent in 1987 to 28 percent in 2003.
These statistics demonstrate two important challenges facing elderly households. The share of income that elderly households spend on housing costs and out-of-pocket health care expenditures has increased substantially in the last two decades.
Many research studies have found that the elderly are most at risk for adverse health impacts due to cold temperatures (Kalkstein et al. 1989). Older individuals have the greatest risk for hypothermia because they have a lower metabolic rate that may prevent them from maintaining normal body temperatures. Certain medications make individuals more susceptible to the cold, and the elderly are more likely to take many medications. Additionally, individuals with medical conditions, including congestive heart failure, diabetes, or gait disturbance, have an increased risk for hypothermia. Individuals with these conditions are less able to generate heat (CDC, Morbidity and Mortality Weekly, 2005).
The elderly also are more susceptible to heat stroke (CDC, MMWR, 1996). The elderly are at greater risk because they have a reduced ability to control their body temperature. The poor and the socially isolated are also at increased risk for heat-related fatality (McGeehin et al. 2000). Individuals with diseases including ischemic heart disease, stroke, or respiratory illness are at the greatest risk for heat-related death. This is because during periods of intense heat, the stress on the cardiovascular and respiratory systems increases (Basu et al. 2002).
2. Young Child Households
Statistics from the National Center for Children in Poverty document the economic status of children under age 6 (Douglas-Hall and Chau, 2007):
- Incidence of Poverty: There are about 24.4 million children under age 6 in the United States. About 5.0 million (20%) live in families that have income at or below poverty. About 10.4 million (43%) live in families that have income at or below 200% of poverty.
- Poverty Trends: Between 2000 and 2006, the number of children under age 6 who live in families that have income at or below poverty increased by 18 percent.
- Family Structure: Half of the 10.4 million low income children live in a family with a single parent.
- Residential Instability: About 22 percent of children under age 6 who live in low income families moved in the last year, compared to only 12 percent of children under age 6 in non-low income families.
Similar to the findings for elderly households, studies find that children under one year old are at risk for serious consequences from prolonged exposure to home temperatures that are either too cold in the winter or too hot in the summer. In addition, the Children’s Sentinel Nutrition Assessment Project (C-SNAP) study (Frank, 2006) established an association between energy costs and nutrition for young children. The study concluded that “after adjustment for differences in background risk, living in a household receiving the Low Income Home Energy Assistance Program is associated with less anthropometric evidence of undernutrition, no evidence of increased overweight, and lower odds of acute hospitalization from an emergency department visit among young children in low-income renter households compared with children in comparable households not receiving the Low Income Home Energy Assistance Program.” (Frank, 2006)
Need for the Study
The LIHEAP Home Energy Notebook for FY 2006 reports that 34.4 million households were income eligible for the LIHEAP program in Fiscal Year (FY) 2006, i.e., had income at or below the Federal LIHEAP maximum income standard. In that same year, the LIHEAP program furnished winter heating and crisis benefits to about 5.7 million households, about 17 percent of the income eligible households. Federal funding of LIHEAP is primarily the limiting factor in LIHEAP program participation; in FY 2006, funding for LIHEAP totaled $3.1 billion, and of that amount, States furnished about $2.1 billion in heating and winter crisis benefits with an average benefit of about $368 for the heating and crisis assistance recipients
Given the limitation on Federal LIHEAP funding, the LIHEAP Statute requires LIHEAP grantees to “provide, in a timely manner, that the highest level of assistance will be furnished to those households which have the lowest incomes and the highest energy costs or needs in relation to income, taking into account family size.” (LIHEAP Statute, Section 2605(b)(5)). The LIHEAP Statute identifies two groups of low income households as having the highest home energy needs:
- Vulnerable Households: Vulnerable households are those with at least one member that is a young child, an individual with disabilities, or a frail older individual.
- High Energy Burden Households: High energy burden households are those households with the lowest incomes and the highest home energy costs.
Based on national LIHEAP program goals, ACF has focused its performance goals and measurement on targeting income eligible vulnerable households and income-eligible high burden households. However, performance measurement statistics have shown that the LIHEAP program has failed to meet performance targets during the period from FY 2003 through FY 2006. In fact, the targeting performance measures for both elderly households and young child households declined during that time period.2
ACF needs to develop strategies that can increase the level of LIHEAP participation by vulnerable population groups. This study researched other Federal social welfare programs that have targeted vulnerable population groups and assessed whether the programs developed outreach and/or targeting strategies that increased program participation for vulnerable households. It also examined the design of LIHEAP outreach, intake, and benefit determination for the LIHEAP programs in 18 States to assess what design characteristics, if any, are associated with higher targeting of vulnerable households.
Other Federal Social Welfare Programs
This study of other Federal social welfare programs develops information from two sources: a literature review and interviews with program manager contacts:
The primary analytic procedure employed in this study involved a literature review of outreach and targeting in a sample of means-tested Federal social welfare programs with recipiency groups similar to that of LIHEAP. A variety of sources were consulted including: websites of the major Federal means-tested programs; websites of national organizations that study the needs of elderly households, young child households, and low income households; and academic journals.
This study included literature on the following two types of means-tested programs.
- General Population Programs – Some programs, like LIHEAP, are available to all income-eligible households. For these programs, the literature review looked at whether the program targeted vulnerable households and whether any national or State-level initiatives have been effective at increasing targeting of households with elderly members or young children. It also considered whether any general outreach initiatives have increased the participation rate of households with elderly members or young children, even if the rate did not increase as much as for other types of households.
- Targeted Programs – Other programs are only available to households with elderly members or children, including some that are only available to households with young children. For those programs, the literature review determined whether the program has attempted to increase program participation rates and whether any specific strategy has been effective at increasing participation among households with elderly members or young children.
Not all social welfare program statistics and initiatives are documented in the literature. Once the literature review was complete, this study involved contacting the program managers of key Federal social welfare programs, including: Food Stamps, Supplemental Security Income (SSI), Medicaid, Medicare Savings Program, State Children's Health Insurance Program (SCHIP), Women, Infant, and Children Nutrition Program (WIC), Nutrition Programs for the Elderly, Maternal and Child Health Programs, Head Start Program, and Special Education Programs to identify additional statistics and/or outreach initiatives that are not yet documented.
State LIHEAP Programs
LIHEAP statistics demonstrate that individual State LIHEAP programs vary substantially in targeting rates.3 The elderly targeting rates using State LIHEAP maximum income standards varied from a low of 31 to a high of 221 in FY 2006. (For FY 2006, the national recipiency targeting index for elderly households was 74.) The young child targeting rates for FY 2006 varied from a low of 33 to a high of 234. (For FY 2006, the national recipiency targeting index for young child households was 115.) Since States have considerable flexibility in the design of their LIHEAP programs as LIHEAP is a block grant program, it is reasonable to consider that the higher targeting rates in some States may be associated with certain unique program design characteristics.
This study reviewed the FY 2006 targeting statistics to identify nine States that were high, moderate, and low on their elderly targeting rates and nine States with that were high, moderate, and low on their young child targeting rates. For each group of States, researchers contacted the State LIHEAP Directors and asked questions about the design of outreach, intake, and benefit determination procedures. The study then included analysis to assess what program designs appeared to be associated with high targeting outcomes for elderly households and what program designs appeared to be associated with high targeting outcomes for young child households.