Providing National Statistics on Health and Social Welfare Programs in an Era of Change: Summary of a Workshop (1998)
Chapter: MEDICAID PROGRAM AND HEALTH CARE
which allows for a single set of rules for the food stamp and TANF programs. While generally restricted to TANF recipients, states may apply for a waiver to expand this simplified program to include non-TANF households.
The new law also grants states expanded authority to apply for waivers from the federal food stamp regulations. The U.S. Department of Agriculture will now consider a broad range of waivers, including those that reduce benefits, require work, and institute consistent multiprogram rules. A number of changes will not be considered, including new projects to cash out food stamps and experiments with eligibility requirements that target behavior, such as a family cap that limits benefits for newborn children or time limits on benefit receipt. While new cash-out waivers will be denied, PRWORA allows certain states to cash out food stamp benefits for TANF recipients who are working in unsubsidized employment. This cash-out program is restricted to states in which at least 50 percent of the food stamp recipients received AFDC in 1993.
Benefits for Immigrants
PRWORA limits assistance to legal immigrants: legal immigrants are barred from receiving SSI and food stamps, while states have the option to determine the eligibility of current legal immigrants for assistance under TANF and Medicaid.4 Newly arriving legal immigrants are barred from all means-tested, federally funded public benefits for the first 5 years they are in the United States, after which states may provide services. Exceptions to these restrictions are made for refugees and asylees, who are eligible for their first 5 years in the United States; veterans; lawful permanent residents with 40 qualifying quarters of work; and Cuban-Haitian entrants.
Medicaid Program and Health Care
While comprehensive changes to the Medicaid program were not included in PRWORA, important modifications were made to the Medicaid eligibility requirements for welfare recipients and, as described above, immigrants. Under the previous law, people who were eligible for AFDC were automatically entitled to receive Medicaid. The TANF grant severs this automatic link, instead tying eligibility to the state's AFDC plan as it existed on July 16, 1996.5
Other recent changes to the Medicaid program and the broader U.S. health care system affect the ability of existing national surveys to measure costs, access, and quality of health care. The Medicaid program, for instance, continues to encourage state experimentation through the waiver process. Some key changes due to waivers include changes in the eligible population, in the copayments required of beneficiaries, and in the types of health care plans that are available.6
Overall, there has been an increase in the number of Medicaid beneficiaries in managed care programs, reflecting the changes in the broader health care industry that are transforming relation-
ships between patients, health plans, and providers. Because of these changes, such classifications as Health Maintenance Organization, Independent Practice Association, Preferred Provider Organization, and fee-for-service no longer adequately distinguish among types of health care plans.
Finally, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates several changes in the private health insurance market that may affect participation and costs for Medicaid and other social welfare programs. For example, HIPAA extends the portability of health insurance coverage for workers who change jobs, and it limits restrictions on pre-existing conditions for new coverage. (For a more detailed description of the changing public and private sector health care systems and the implications for the adequacy of existing data, see Harvey, 1996.)
