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TANF and Disability-Importance of Supports for
Families with Disabilities in Welfare Reform
Position Paper
National Council on Disability
1331 F Street, NW, Suite 850
Washington, DC 20004
202-272-2004 Voice
202-272-2074 TTY
202-2720-2022 Fax
Lex Frieden, Chairperson
March 14, 2003
Introduction
The Temporary Assistance for Needy Families (TANF)
block grant, first created in 1996 to replace Aid to Families with
Dependent Children (AFDC), was slated for reauthorization in 2002.
Rather than undertaking the full reauthorization, Congress passed
a short extension, which has since been extended to the end of June
2003. It is likely to be reauthorized by Congress in the next few
months. As part of the reauthorization process, there have been
many proposals to strengthen protections for parents and children
with disabilities participating in TANF-funded programs. It is important
that the law establish policies that reflect both the intention
and desire of people with disabilities to work, and the reality
that certain individuals may still have severe work limitations
requiring long-term assistance.
While the TANF program is not specifically directed
towards individuals with disabilities, research data indicate far-reaching
effects of this program on people with disabilities. According to
the General Accounting Office (GAO), a substantially higher proportion
of TANF recipients reported having physical or mental impairments
than did adults in the non-TANF population. In addition, many TANF
families include a child with a disability. The work requirements
and lifetime limits to benefits, which are key elements of welfare
reform, pose special challenges for state and local TANF agencies
in addressing the unique needs of families with a disability who
are TANF beneficiaries.
People with disabilities often face multiple barriers
to work. In addition to the barriers faced by most low income Americans
as they attempt to work, such as inadequate transportation and limited
opportunities to improve education and skills, people with disabilities
must meet the specific challenges of their physical or mental impairment
or health condition – often requiring assistive technology,
access to accessible transportation, sign language interpreters,
or personal care assistance, work place supports etc. in order to
participate in programs designed to assist them in finding work.
When appropriate assessments of individual needs for reasonable
accommodations are provided, people with disabilities are afforded
equal opportunity for full participation, independent living, and
economic stability.
Also facing extraordinary challenges are parents of
children with disabilities, who are frequently unable to find or
to afford a child care setting able or willing to handle the special
needs of their children. . These parents are often called upon to
miss work to provide for these special needs, putting them at risk
of incurring TANF sanctions. They are more likely than others to
experience significant hardships when forced to leave the TANF program
due to time limits.
While these additional challenges faced by people
with disabilities may seem to paint a bleak picture, in fact, TANF
creates a great opportunity to creatively design programs that can
give parents with disabilities, and parents of children with disabilities,
the training and support they need to secure and maintain employment.
Some states and communities are already collaboratively working
to help people with disabilities prepare for and sustain employment.
Greater national emphasis on systemic collaboration and review of
policies and legislation among federal, state, and local entities
that bring consumers with disabilities to the table and begin dialogue
and actions would serve to remove barriers and create real opportunities
for people with disabilities to transition from welfare to work.
There have been many proposals to address the unique
circumstances facing families on TANF who experience a disability
(of the parent or the child or another family member). The most
common of these proposals would require states to provide more comprehensive
assessments of barriers to employment, including disabilities; provide
states with greater flexibility in determining what counts as a
work activity; bar states from sanctioning a family for non-compliance
with a program rule if the TANF recipient or a family member has
a barrier which prevents compliance and has not been provided with
help in addressing that barrier; and provide funds for state-level
advisory panels to consider ways in which a state can improve its
TANF policies and procedures to better assist families who have
barriers, including disabilities.
“Every American should have the opportunity
to participate fully in society and engage in productive work. Unfortunately,
millions of Americans with disabilities are locked out of the workplace
because they are denied the tools and access necessary for success.”
President George W. Bush, New Freedom Initiative at p. 18, (Feb.
2001), www.whitehouse.gov/news/freedominitiative/freedominitiative.html.
For many people with disabilities, TANF, if appropriately designed,
could provide the tools and access needed to unlock doors to opportunity,
productivity, and economic self-sufficiency. This paper summarizes
research about people with disabilities and TANF and some of the
proposals being offered for consideration to improve how TANF-funded
programs address the needs of families with a member with a disability.
This paper concludes with the following recommendations from the
National Council on Disability (NCD) for TANF reauthorization:
- Increase TANF and childcare funding;
- Ensure that parents with disabilities are screened,
in a timely manner, with appropriate diagnostic tools;
- Prohibit states from sanctioning families until
the state has taken steps to identify barriers, provided the family
with assistance in meeting the rules; and modified rules, if necessary
to address the parent’s or child’s disability so that
the family can comply with TANF requirements;
- Provide states with flexibility in how they define
countable work activities, including rehabilitation and participation
in other activities that will help the parent to become work-ready,
and how they determine the length of time a particular individual
or family will need the specific services or treatment;
- Provide states with additional resources to train
case workers and other staff who serve TANF recipients about issues
unique to disabilities, including how to provide timely and effective
screening, and how to identify programs, resources, and opportunities
for collaborative community initiatives to achieve systemic improvements
in services for people with disabilities;
- Create advisory panels at the state level to assist
states in addressing the needs and barriers of people with disabilities;
- Facilitate access to continued Medicaid or other
health coverage when recipients move from welfare to work;
- Assist states to better coordinate and provide
services needed by children with disabilities and their families
to address the multiple challenges facing parents and children
with disabilities;
- Ensure that TANF programs and services comply with
the Americans with Disabilities Act and Section 504 of the Rehabilitation
Act.
Family Members with Disabilities and TANF –
What We Know From the Research
Parents with disabilities.
Case #1
“DD is a 42 year-old woman with two children who has been
trying to find appropriate work for the past five years. She has
been receiving TANF … She suffers from phlebitis, which causes
severe pain without warning; her leg will become swelled and force
her to rest, and on some days she cannot get out of bed at all.
Extensive standing, walking, or other physical activity exacerbates
the problem. She worked as a clerk for the Liquor Control Board
for six months …, but she was forced to quit because the job
involved lifting boxes, and she was physically unable to perform
the job’s requirements. … In 2001 she took the civil
service exam as a clerk/typist, and she passed, but most recently
she was #577 on the waiting list. Should her name come up, she will
likely be further hindered by her lack of a General Equivalency
Degree. DD is not considered exempt from TANF work requirements
by DPW, and so she has had to look for work, and attend job readiness
programs, rather than focus on a program which would enable her
to earn her G.E.D. and improve her chances … If she does find
an appropriate job, she will need a boss who will grant her accommodations
on days when she is unable to come to work. DD emphasizes that she
is ready and willing to support her children, but after five years
on TANF, despite her steady efforts to find work, she still does
not have an education, the networking skills, or the medical support
that would enable her to leave the welfare rolls. …DPW referred
her to a program in which she could obtain job training while also
obtaining her GED, but on the second day of the program, her phlebitis
acted up and she could not get out of bed. … she cannot re-enroll
until she provides satisfactory proof … but she cannot see
a doctor [in time to keep the slot.] Eventually she may be able
to re-enroll, but her sixty months on TANF will have long since
run out. It is possible, though far from certain, that she could
have obtained a full-time job by now, with the potential for raises
and promotions, if she had been placed in a high-quality GED program
at the outset of her time on TANF, if she had regular medical coverage
and a steady relationship with a doctor who could provide ongoing
treatment for phlebitis … and if she had been placed in a
good job training and placement program which helped line up interviews
for appropriate clerical positions. Instead, DD encountered frustration,
denials and inappropriate job offers.” Community Legal Services,
Philadelphia, PA, Case Histories of Disabilities in TANF Families
in Pennsylvania.
Case #2
“I am 28 years old and I have two children, ages five and
seven. I have suffered from epilepsy ever since I was five, and
I have unpredictable seizures that make it difficult to work. Although
I can usually control the epilepsy with medication, when I am under
a lot of stress I am more likely to experience seizures …
The father of my children was abusive to me, but in the summer of
1999 I escaped from the situation with the help of … a domestic
violence program. After leaving, I had a difficult time finding
employment that would allow me to support my family … I received
TANF for a few months, but then my income from working in a laundromat
was high enough that I was no longer eligible. Unfortunately, the
laundromat manager had to let me go because I was having a lot of
seizures, some of them at work …that caused me to miss work.
I turned to the state for help again … I reapplied and thought
I had completed the process. Around that time, I was also in intensive
care for six days due to severe seizures. For that reason I missed
an … appointment. When I got home from the hospital, I was
greeted with a letter saying that since I hadn’t shown up
at the meeting I was not eligible for that month because I had not
completed the application process. … no TANF, no food stamps,
and no help with childcare or other support services. I called my
caseworker to explain that I had been hospitalized. … For
some reason, she questioned whether I had an appropriate referral
to be hospitalized … Even though my caseworker knew about
my history of domestic violence and health problems, I was never
told about good cause for exemptions.” Statement of a Maine
mother from collection of Maine Equal Justice Partners.
There is now a substantial body of research that documents
the nature and extent of physical and mental impairments of parents
participating in TANF programs.1 In a national study of TANF recipients,
the General Accounting Office (GAO) found that 44 percent of TANF
recipients had at least one physical or mental health impairment,
three times higher than the rate of such impairments among adults
not receiving TANF benefits.2 In 1999, 38 percent of TANF recipients
reported an impairment severe enough that the individual was unable
or needed help to perform one or more activities, such as walking
up a flight of stairs or keeping track of money and bills.3 In a
second report, in July 2002, GAO found that recipients with impairments
are half as likely to exit TANF as recipients without impairments.
And, people with impairments are less likely than people without
impairments to be employed after leaving TANF. Some who no longer
receive TANF receive Supplemental Security Income benefits (SSI)
while others do not.4 In 2002, the U.S. Department of Health and
Human Services (HHS) Office of the Inspector General confirmed that
high numbers of people with disabilities receive TANF.5
The Manpower Demonstration Research Corporation (MDRC),
in another study measuring barriers among recipients in four large
urban counties, found that nearly one-third of the non-working recipients
studied reported having fair or poor health. Companion ethnographic
interviews conducted by MDRC indicated that health problems were
likely to be under-reported and under-rated in the survey and that
the survey data did not accurately reflect the depth of severity
of the problems that the mothers and children faced.6
There is a high incidence of mental impairments among
parents who receive TANF. Based on its National Survey of American
Families, the Urban Institute has reported that almost half of parents
receiving TANF either said that they were in poor general health
or scored low on a standard mental health scale. One-third either
said that their health limits their ability to work or scored as
having very poor mental health.7 Approximately one-quarter of those
who have left welfare and are not working also have mental health
impairments.8 Two studies, in Michigan and Utah, did in-depth diagnostic
questioning of TANF recipients. The Michigan study focused on a
sample of all TANF recipients in one urban county while the Utah
study looked at those who had received welfare for at least three
years. In Michigan, one-quarter experienced major or clinical depression,
one-seventh had post-traumatic stress disorder, and about seven
percent had general anxiety disorder. The results in Utah were similar:
two-fifths had major or clinical depression, about one-seventh had
post-traumatic stress disorder, and about seven percent had general
anxiety disorder.9
Three states — Kansas, Washington, and Utah
— undertook significant efforts to determine the extent of
learning disabilities among current TANF recipients. The three studies
found that somewhere between one-fifth and one-third of recipients
have learning disabilities. The Washington study suggested that
up to one-half may have learning disabilities.10 There also are
significant numbers of parents who have physical disabilities. While
less has been written about the nature and extent of recipients’
physical impairments, it appears that about one-fifth of current
TANF recipients have physical impairments that limit their ability
to work. According to a 1999 report by the University of Utah Social
Research Institute, among recipients who were not working, about
one-third had physical problems. The Utah study suggests that the
figure may be even higher among longer-term recipients.11
Children with disabilities.
Case #3
“I have four children, three of whom have special needs …
my son, who is eight, has attention deficit hyperactivity disorder
and has been diagnosed with oppositional defiant disorder …
my son, who is nine, is being studied for depression. My daughter,
who is now six, has spina bifida, which is a serious problem that
has required her to be catheterized several times a day ever since
she was six months old. … The worst part of my story is that
when my daughter was from about six months until three, I put her
in day care so I could work. The day care would not perform the
catheterization because of legal concerns. I was scared that if
I did not work that I would be sanctioned and our family would go
without needed food or some other necessity. So I worked and my
daughter did not get catheterized that day. Her health was put at
risk so I could meet unreasonable obligations in order to get my
TANF check to take care of my family … .” Statement
of a Maine mother from collection of Maine Equal Justice Partners.
Research shows significant numbers of children with
disabilities live in poverty and many are in TANF families. The
number of poor children with disabilities has increased dramatically
over the past two decades — from 3.94 million in 1983 to 4.99
million in 1996.12 Using data from the National Survey of America’s
Families, Child Trends reports that children in families receiving
welfare are more likely to have a physical, learning or mental health
condition that limits their activity (20 percent of the children)
than children whose families have left welfare (14 percent of the
children). Additionally, children of current and former recipients
are more likely than other poor children to have such conditions.13
In July 2002, the General Accounting Office reported that 15 percent
of TANF families include a child with an impairment.14 The MDRC
study found that one-fourth of non-employed mothers receiving TANF
had a child with an illness or disability that limited the mothers’
ability to work or attend school.15 The Michigan study of TANF recipients
in one urban county found that 22 percent of respondents had a child
with a health, learning or emotional problem.16 In a study of California
families receiving welfare, a 1996 study found that “the presence
of chronically ill and disabled children has a significant negative
impact on mothers’ labor force participation, even after controlling
for differences in women’s human capital characteristics,
household configuration, and other income.” The presence of
a child with a disability or chronic health problem was associated
with a 36 to 90 percent reduction in the odds that the mother worked,
depending on the number of children with disabilities in the family.17
Families with a member with a disability - multiple
barriers.
Case #4
“I suffer from anxiety, panic and social phobia disorder.
I have four children and the youngest two need to use a respiratory
machine every four to eight hours. This makes child care very hard
to find and also very expensive. In the past, I tried to attend
a Job Club … but I was too sick and overwhelmed to go and
I couldn’t do it. … About six months ago, I got a doctor’s
note that said that I couldn’t work at that time due to my
problems. My caseworker told me that “the sate is not going
to go for this,” and that I would have to work.” Statement
of a Maine mother from collection of Maine Equal Justice Partners.
Case #5
“My name is Sandra. I am a 27 year old mother of three boys
ages 12, 8 and 1. My children and I live with my mother, two of
my mother’s grandchildren, and my adult brother, Billy, who
is severely mentally retarded. I went to live with my mother when
I left an abusive situation a year and a half ago. I have had many
problems that keep me from working full-time, especially taking
care of my disabled family members. Two of my children have medical
problems that I must deal with. Shawn, my eight year old, has Attention
Deficit and Hyperactivity Disorder. I must make sure that he takes
his medication. I take him to therapy each week. Mark, my baby,
was hospitalized for several weeks when he was born with a severe
respiratory infection and seizures. He is still sickly and has many
doctors appointments. My brother cannot take care of himself. My
mother is in poor health herself, suffering from high blood pressure,
anxiety and other health problems. She needs my help to take care
of Billy. I cook food for him, help feed him, change his clothes,
and help him with bathing and other personal care. My mother is
often too tired and sick to do these things and Billy cannot do
them for himself. … I have worked for most of my adult life
at various jobs … I have had learning disabilities throughout
my life, which have made it hard to keep a job. Also, I miss so
much work to take care of my family that I get into trouble for
attendance. I have participated in job training programs offered
by the Welfare Department, which have been useful for me. But I
could not go to school regularly because of my family responsibilities.
I wish I could work steady and support my family. But these problems
often cause me to miss work, and I don’t see that changing
in the future.” 18
It is common for families with a parent with a disability
or a child with a disability to have other barriers as well.19 These
barriers include having more than one health condition, more than
one person with disabilities in the family, and the range of barriers
faced by other low-income parents as they attempt to work, such
as lack of child care, inadequate or non-existent transportation,
and limited education and skills. In its July 2002 report, the General
Accounting Office found that eight percent of TANF families include
both a parent with impairments and a child with impairments.20
A study prepared by the University of Kentucky Institute
on Women and Substance Abuse for the Kentucky Cabinet for Families
and Children found that the majority of TANF clients have at least
one significant barrier to becoming self-sufficient.21 Two-thirds
(67 percent) of the Targeted Assessment Project clients had significant
mental health problems alone or in combination with domestic violence,
substance abuse, and/or learning problems. Mental health problems
were a factor in all cases assessed with three problems. Of those
assessed with only one issue, most had a serious mental health problem,
such as major depression, agoraphobia, bipolar disorder, anxiety
disorder, post-traumatic stress disorder, or psychotic disorders.
Of those assessed with a mental health problem, 73 percent said
that they were not receiving services to address the problem, and
44 percent said they had never received services.
As the number of barriers a parent faces increases,
the chances that the parent will be working decrease. It also is
very likely that the existence of some impairments, such as clinical
depression, low intelligence, and learning disabilities, exacerbate
a parent’s inability to address other barriers and to comply
with program rules. In its Temporary Assistance for Needy Families
(TANF) Program: Second Annual Report to Congress, the Department
of Health and Human Services stated that, “[a]lthough there
have been dramatic gains in work for many TANF families, too many
families with multiple barriers to success are at risk of being
left behind.”22 The Urban Institute has found that “[p]erhaps
the strongest predictor of not participating in work activity is
the presence of multiple obstacles.”23 A Michigan study similarly
found that the more barriers a woman has, the less likely it is
that she is working. The authors predicted that women with four
to six barriers had only a 41.4 percent probability of working at
least 20 hours per week and women with seven or more barriers had
only a 5.6 percent probability of working at least 20 hours per
week.24 As a result, it is important not only to have identified
the barriers a parent or family faces but then to work to reduce
the number of barriers to increase the likelihood that the parent
can both secure and retain employment.
Consequences for Families with Disabilities in TANF
Some of the studies also have looked at the outcomes
for TANF families in which there is a member with a disability.
They found the following:
Families are often inappropriately sanctioned.
Case #6
“I brought my son to Children’s Hospital and Dr. Rudd
discovered my son has CP [cerebral palsy]. While my son was in the
hospital, I got sanctioned because I wasn’t going to school
for the mandatory 20 hours a week. They told me to get a doctor’s
note and I did, but they haven’t taken my sanctions off. They
need to have a different program for parents whose children are
disabled.” 25 Minnesota parent
Case #7
“I suffer from multiple mental illnesses. I have two children
who live at home with me, my son, who is 17, and my daughter who
is 10. I am getting treatment and eventually hope to get to the
point where I can work, but my doctor believes it will take a while.
In the summer 1998, ASPIRE verified that I could not work because
of my disabilities. In October, 1998, even though nothing had changed,
ASPIRE had me sign a family contract that required me to work 25
hours per week through “Build, Develop and Learn” (BDL)
. I signed it because I thought I had to and I was told that my
family would be sanctioned if I didn’t sign it. Apparently
the goal of this contract was to move me into a “full time
job”. In the spring of 1999, I was sanctioned for not going
to a meeting with my BDL worker. I appealed and had a hearing over
the phone. My counselor wrote a letter … she explained how
my disabilities affect me,… and that I needed more help with
my disabilities before I could think about getting a job. The doctor
said that making me participate would be counter-productive to my
treatment. I’m not sure how, but we lost the hearing. Luckily,
I found help at Maine Equal Justice Partners. We appealed …
and DHS’s attorney agreed with us that I could not work and
DHS dropped the sanction. … I hope no one with mental illness
has to go through what I did.” Statement of Maine mother,
collection of Maine Equal Justice Partners.
Most states impose severe sanctions on families receiving
welfare when a parent fails to comply with TANF work requirements.
More than two-thirds of the states impose full-family sanctions,
stopping aid to children as well as parents when a parent fails
to meet a program requirement. Nearly half of these states impose
the full-family sanction the first time a parent fails to meet the
requirement. Various research studies have analyzed the extent to
which parents who have been sanctioned were unable to understand
what was required of them to comply with state rules and did not
understand the consequences for failing to comply — in other
words, rather than willfully ignoring program rules, the parent’s
barriers impeded her ability to comply with the rules.26 This may
have happened because the requirements or activities were inappropriate
for the parent, the parent never understood the program rules, the
parent failed to receive the information in essential accessible
format and other alternative means of communication, or the parent
did not receive other support she needed to be able to comply. In
many cases, the states do not identify the barriers or develop appropriate
activities and services for people with barriers. Then, when the
family fails to meet program requirements, a sanction is imposed.
Studies suggest that high numbers of families with
a member with a disability are being sanctioned. For example:
- MDRC found that, “[w]elfare recipients with
multiple health problems and with certain health problems (notably,
physical abuse, risk of depression, having a chronically ill or
disabled child) were more likely than other recipients to have
been sanctioned in the prior year.” And, among those who
had left welfare, “[w]elfare leavers with multiple health
problems were more likely than other women who had left welfare
to say that they had been terminated by the welfare agency rather
than that they left of their own accord.”27
- Studies in Utah and Delaware suggest that parents
who have learning disabilities or who have low intelligence find
it difficult to understand and comply with the program’s
rules.28
- One-third of the families who were sanctioned in
Utah, thereby losing their family’s entire cash benefit,
cited an individual health condition as the reason for their failure
to participate; one-fifth cited mental problems.29
- In Iowa, one-fifth of parents who were placed in
the state’s limited benefit plan a second time – the
plan in which families that have not complied with program rules
receive a reduced benefit (akin to a sanction) – said that
their disability/health contributed to their being returned to
the sanction status, while almost three out of ten cited their
lack of understanding of program rules.30
Families who leave TANF due to sanctions are less
likely than others who leave TANF to be working, and if they are working,
they are likely to be earning less than others who have left TANF.31
A recent study in three cities — Boston, Chicago, and San Antonio
— also found that children in sanctioned families are more likely
to have behavior problems and emotional problems than children in
other families on welfare or who never received welfare.32
A medical study issued in 2002 provides additional
information about young children in sanctioned families. The study
looked at the impact of sanctions on the health of infants and toddlers.
It was conducted in six cities from August 1998 through December
2000: Baltimore, Boston, Little Rock, Los Angeles, Minneapolis,
and Washington, DC. The researchers found that households with children
aged 36 months or younger whose welfare benefits had been terminated
or reduced by sanctions had odds of being food insecure 1.5 times
as great as comparable households whose benefits were not decreased.
In addition, young children in families whose welfare benefits had
been terminated or reduced by sanctions had 1.3 times the odds of
having been hospitalized since birth.33
Families with a family member with disabilities often
are not working after leaving TANF.
Case #8
“My name is Eve. I live in Philadelphia. I have received welfare
since about 1997. I have three children, my son Woodley, who is
now grown up and away in Job Corps; my 28-year-old son, Naquaine;
and my son, Andrew, who died as an infant. I am the sole caregiver
for Naquaine, who suffers from autism. Naquaine needs 24 hour a
day care. I have been the only one to provide it since my husband
left a long time ago. Because I need to take care of Naquaine, I
simply cannot work 40 hours a week, every week. … Things are
always coming up with Naquaine that make me drop everything to take
care of him. If his bus is late, I need to wait with him. If he
acts up in school, the teachers call me and expect me to come immediately.
The after-school program has been a great help. But the welfare
office cut off my childcare subsidy, and the program is getting
ready to put him out, because I cannot pay. I am so worried about
losing my care for him. When you are a single parent, it is very
hard to both work and take care of your children. When I came on
welfare, I tried to do it by working the 11:00 pm to 7:00 am shift,
when my children were sleeping, so I could take care of them during
the day. I left Naquaine and my baby Andrew with my older son when
I went to work, because I didn’t have anyone else to care
for them. My baby died one night while I was at work; he just stopped
breathing. They say it was Sudden Infant Death. I feel like if I
had been there Andrew would not have died. People on welfare have
no problem working if their children are safe. I want to work. I’ve
worked all my life. But it always ends up that I get fired because
of missing work. Everything may be going well on the job, then something
comes up, and I lose it.” 34
Many parents with disabilities who have left TANF
do not work; some have lost jobs they held when they left TANF.
For example:
- In a Colorado study, 35 percent of the former TANF
recipients surveyed were not working at the time of the survey.
Almost one-third said that personal health problems or other personal
problems prevented them from working.35 That study concluded:
“We need to attend much more carefully to the plight of
families experiencing welfare sanctions. Sanctioned families have
a number of characteristics that serve as markers of concern for
the healthy development of children and youth. As such, state
and federal governments should explore options for identifying
and reaching out to the most disadvantaged and high-risk families
involved in the welfare system. Possible policy options include
assistance to bring families into compliance with rules before
they are sanctioned, closer monitoring of sanctioned families,
and the provision of additional supports, such as mental health
services, academic enrichment, after-school programs, and other
family support services.”
- In a Mississippi survey of people who left TANF
early in 1998, three to eight months later 53 percent had not
worked since leaving TANF and 65 percent were not working at the
time of the survey. Of the latter group, 27 percent reported they
were physically or mentally ill.36 In the article about this study,
the authors conclude that, “Child health professionals should
be concerned that increasingly stringent requirements proposed
for the 2002 welfare reform law reauthorization may further jeopardize
the health of some of America’s most vulnerable children
as the economic cycle, sanctions, and time limits simultaneously
decrease families’ resources.”
- A study by the Hudson Institute and Mathematica
Policy Research of Milwaukee families who were involved in the
conversion of the Wisconsin welfare plan from AFDC to Wisconsin
Works (W-2), found that among those who reported a personal disability
or health problem or the disability or health problem of a family
member, 23 percent were not employed, were not in a W-2 work training
placement and did not receive either SSI or a kinship care payment.37
Anecdotal evidence suggests that, to avoid the
ultimate loss of benefits, some TANF recipients with disabilities
were shifted off TANF and onto the SSI roles before they could take
advantage of the TANF supports and services that might have led to
employment. Parents with a child with disabilities
face more barriers to work.
Case #9
“My name is Theresa. I am a 33 year old …mother of three
children ages 13, 10 and 8. I currently receive TANF for myself
and my three children, and I am likely to reach my five-year lifetime
limit for TANF in March, 2003. My 10-year-old Chae suffers from
Attention Deficit Hyperactivity Disorder and major depression. His
needs prevent me from working in a full-time job. I participated
in several job training programs offered by my welfare caseworker
… I did not have a good experience at these programs, but
I really wanted to find a way to get the education and training
that I needed to find a job that would support my family. In June,
2000, I decided to close my TANF case and join the Army. I thought
the Army would provide me with training and job advancement that
I did not get through the welfare department. While I was in the
Army my children were cared for by my relatives. But several months
after I enlisted, Chae was diagnosed with ADHD and major depression.
He was even hospitalized for some time due to his depression. Because
of his illness and hospitalization, I was forced to get a leave
of absence and later an Honorable Discharge from the Army in order
to take care of him. I returned to Philadelphia and re-opened my
TANF case. I currently meet my work requirements … by doing
20 hours per week of community service, as well as an independent
job search. I am afraid of working too much. Because of what happened
when I was in the Army and not around for Chae. I am very scared
that he can be hospitalized again if I don’t spend enough
time taking care of him. I very much want to find a job that will
enable me to get off welfare and support my family. But I am also
very concerned about my children’s health and well being.
I feel that I am in a “lose-lose” situation.”38
In addition, research indicates that parents with
children with disabilities are less likely to leave TANF, and when
they do leave welfare for work, they are less likely to have the
flexibility on their jobs to meet their children’s needs.
For example:
- The presence of a child with disabilities in a
family has been found to dramatically reduce the chances that
the parent will be working. A 1996 Syracuse University study of
California families receiving welfare found that “the presence
of chronically ill and disabled children has a significant negative
impact on mothers’ labor force participation, even after
controlling for differences in women’s human capital characteristics,
household configuration, and other income.” The presence
of a child with a disability or chronic health problem was associated
with a 36 to 90 percent reduction in the odds that the mother
worked, depending on the number of children with disabilities
in the family.39
- In a study of women in urban and rural Michigan
who receive TANF cash assistance and who have children with disabilities,
families identified three systemic barriers to self-sufficiency
for their families: poorly trained welfare caseworkers who do
not understand the complexities of raising a child with disabilities,
limited public transportation (nonexistent in rural areas and
unreliable, inaccessible, or limited in range in urban areas)
and inadequate child care.40
State Responses to the Research The
results of these studies suggest that states need to design their
programs better to identify and assist parents with disabilities
and parents of children with disabilities. Two key features of the
1996 law make these improvements possible: the flexibility states
have to design their programs to assist families to move to self
sufficiency and the availability of federal TANF funds. The decline
in cash assistance caseloads — freeing up TANF funds to provide
work supports and to assist families with barriers — provided
some states with the opportunity to look more closely at how best
to meet the needs of this population.41
Some states have been moving in this direction. Some
of the steps states have taken include:
- Reducing inappropriate sanctions. Tennessee has
established a sanction review procedure that determines whether
the state followed its policies and also provides the family with
a second chance to come into compliance. In 2001, Maine adopted
a pre-sanction review procedure as well. Vermont, Iowa, and Utah
have procedures that help to better identify families with disabilities
who need greater supports or modifications of rules in order to
come into compliance with program rules.
- Tailoring services to the individual needs of families
with a member with disabilities so that the parent can move towards
employment.42 Tennessee has established the “Family Services
Counseling” (FSC) program designed to help parents address
barriers. The 100-plus masters-level social workers across the
state who staff the FSC program have the authority to modify program
rules so that a family can comply; secure treatment, education
and training; and otherwise take steps to help parents and children
with barriers such as mental health, learning disabilities, domestic
violence and substance abuse. Pennsylvania has created the “Maximizing
Participation Project” (MPP) for people with barriers who
cannot meet the current work requirement and are approaching their
five year time limit. MPP provides comprehensive assessments and
intensive case management to help parents address barriers. There
is no minimum work requirement in MPP. Currently, 1700 parents
with disabilities voluntarily participate in MPP.43 Vermont has
designed a collaborative effort between its TANF agency and the
vocational rehabilitation agency, creating 11 new counselor positions
in the VR agency, to work with TANF families with disabilities.44
Kentucky’s 32 Targeted Assessment Specialists, employed
by the University of Kentucky under a contract with the state’s
TANF agency, are on-site at public assistance and child protective
services offices in 18 communities to conduct assessments, pre-treatment,
and follow-up services focused on mental health, domestic violence,
substance abuse and learning problems.45
- Adjusting requirements when a parent’s full
attention needs to be devoted to the health and welfare of a child
with a disability. Illinois recently modified its rules to provide
for a “family care” barrier, stopping the TANF time
clock for a parent who provides full-time care required by a child
under age 18 or a spouse due to their medical condition. California
has a rule similar to the Illinois rule, providing that if a person’s
care-taking responsibilities for a child or other family member
who is ill or incapacitated significantly impairs the ability
of the person to be regularly employed or to participate in welfare-to-work
activities, the person will be exempt from the work rules and
the months will not count toward the person’s time clock.
Helpful guides for state and county administrators
on how to identify and serve families with a member with a disability
have been published, often with funding from HHS.46 In addition, in
2001, the Office for Civil Rights at HHS issued guidance to states
and counties on the applicability of Section 504 of the Rehabilitation
Act of 1973 and the Americans with Disabilities Act in TANF-funded
programs.47 This technical assistance has helped state administrators
to focus on ways to assist parents with disabilities as well as parents
with a child with a disability. The HHS Inspector
General’s report provides some information about the types
of actions states are taking to identify families with barriers
to work and then concludes that “states are still facing challenges”:
“States report facing several challenges in addressing recipients
with barriers to employment. At least 13 states report they do not
have the capacity to serve all recipients with some of the barriers
we addressed. Forty-one states do not have any specific strategies
to help recipients who face multiple barriers. Only nine states
report using pilot programs to implement new approaches for any
of these populations. Additionally, few states have information
about the barriers faced by recipients who have been sanctioned
or have strong evidence about the effectiveness of their strategies
to help recipients with the barriers we addressed in this inspection.”48
Solid TANF methods of administration can make all
the difference for people with disabilities as they struggle to
support and nurture their families and live independently. However,
experience to date suggests that while TANF’s potential is
being realized for some families with a disability, the state’s
TANF rules can also unravel a family if the parent’s disability
is not identified and services and supports are not provided. The
following examples from Colorado set out starkly the differing consequences.
These examples are taken from a report by the Governor of Colorado’s
Task Force on TANF implementation that focused on several barriers,
including mental health issues, chronic health problems, physical
disabilities, learning disabilities, language barriers, and multiple
barriers.49 The examples were included in testimony before the House
Human Resources Subcommittee of the Ways and Means Committee on
April 11, 2002.50
Case #10
“Client A was tested and had an IQ of 67. She was sent to
Vocational Rehab and then instructed to seek work. She received
childcare for two occasions and then was sanctioned in Colorado
Works. Her family became homeless in November 1998 and the children
were placed in foster care in December 1998.”
Case #11
“Client B has an IQ of 67 and is a victim of domestic violence.
There is suspicion of brain damage as a result of abuse. She cannot
communicate well, she is conscientious but has few skills. She has
an anxiety disorder which cannot be treated because of her heart
problem. She sees a physician weekly to manage blood thinning medications.
She had surgery for a valve replacement one year ago. She was assigned
to a community college program which reported that she would be
doing fine but then the next day she couldn’t remember what
she had learned. It takes the parent approximately one month to
learn a bus route. The county required that she find a job in six
months. Later that expectation was lowered to ten hours of time
within her supported living program._
“The description of the steps the state took
to help Client B provides a sense of the types of steps that states
will need to take in order to help some parents with disabilities
to maximize their potential. Unfortunately, no steps — not
even ongoing child care for her children — were taken to assist
Client A, with the tragic consequence that she was sanctioned, lost
her home, and then lost custody of her children.”
Proposals to Improve Outcomes for Families with Disabilities
in TANF
It is clear that disability is a significant issue
within the TANF program and that the unique needs of individuals
with disabilities must be addressed if the system is to achieve
the goal of securing employment and economic independence for TANF
recipients who live with a disability. A number of improvements
needed in the TANF law have been proposed by organizations representing
people with disabilities to assist states to best meet the needs
of families with disabilities. 51 The National Council on Disability
makes the following recommendations to strengthen the ability of
the states to support families with disabilities in their welfare
system.
1. Increased TANF and Child Care
Funding. Last year, the Congressional Budget Office estimated
that the costs to states of meeting new work requirements and increased
participation rate targets would be up to $11 billion over five
years (roughly $6 billion in work program costs and $5 billion in
increased child care costs for work program participants). The Center
for Law and Social Policy estimates that the five-year costs of
implementing proposed increased work and participation rate requirements
are in the range of $15.1 billion above what states would otherwise
spend under current law.52 Without the funding needed to meet the
new requirements, states will have to cut effective programs now
funded with TANF in order to comply. In other words, there already
is significant evidence that states need more than they currently
receive annually in order to simply maintain the programs they currently
have in place.
The Congressional Budget Office estimated that :an
additional $4.55 billion in child care funding over the next five
years is needed to ensure that the mandatory federal child care
funding stream, state funds used to match these federal funds, and
the TANF funds devoted to child care keep pace with inflation. CBO’s
$4.55 billion figure may understate the cost of maintaining current
services because the estimate assumes that states will be able to
maintain their current levels of using TANF for childcare. This
is unlikely to occur. In 2002, states spent $1.6 billion more than
their annual TANF allotments, by drawing on unspent TANF funds carried
over from prior years.53 These “carry-over” funds have
been exhausted or nearly exhausted in most states. To bring spending
in line with their annual TANF block grant allotment, many states
will have to cut TANF funding for various programs, including child
care programs, in the next few years. The funding shortage will
hit hardest families who have children with disabilities who may
require more expensive specialized care.54
Not surprisingly, the types of services and supports
that families with a member with a disability need in order to succeed
are often intensive, individualized, long-term, and more costly
than the services that families without barriers need. If no additional
funds are added to the basic TANF block grant, as inflation further
erodes the value of the TANF block grant, it will become increasingly
difficult for states to pay for the services and supports that people
with disabilities need in order to be able to move successfully
from welfare to work. Additional funding for both the TANF block
grant and the child care program will be necessary to enable these
programs to meet federal requirements and programmatic needs for
families with disabilities.
2. Screening and Assessment.
The reauthorization must include provisions to ensure that parents
with barriers, including disabilities and other health conditions,
are screened in a timely manner with appropriate diagnostic tools
to determine if a more comprehensive assessment is needed. Comprehensive
assessments must be provided by qualified professionals to identify
barriers to employment and to suggest to state or county staff the
steps needed to assist the family. As part of the screening and
assessment process, states should also consider documentation from
other systems of the existence of a disability in a family. The
changes to TANF must also ensure that screening and assessments
are voluntary on the part of TANF beneficiaries and that TANF beneficiaries
with disabilities are not subjected to a sanction or closure for
failing to participate in a screening or assessment. Screening and
assessment results must be maintained in accordance with professional
standards of confidentiality.
3. Sanctions. The federal
legislation should prohibit a state from sanctioning a family until
the state has: 1) taken steps to identify barriers, including disabilities;
2) provided the family with assistance in meeting the rules; and,
3) modified rules, if necessary to address the parent’s or
child’s disability, so that the family can comply. The federal
legislation should require states to have pre-sanction review procedures
to reduce the chance of arbitrary and inappropriate sanctions being
applied against a family with a family member with a disability.
Based on the research on people with barriers and sanctions, it
is reasonable to expect that greater numbers of parents with disabilities
and other barriers will be sanctioned rather than helped under proposals
for the new TANF program if they are not provided these protections.
4. State Flexibility. As
pointed out in an earlier section of this paper, a key feature of
the 1996 law that has made it possible for states to improve the
way they support individuals with disabilities has been the flexibility
states have to design their programs. The federal legislation should
build on the 1996 statute by providing states with flexibility in
how they define countable work activities, including rehabilitation
and participation in other activities that will help the parent
to become work-ready and how they determine the length of time that
a particular individual or family will need the specific services
or treatment. States must be given greater flexibility in how they
will determine who will be exempt from the time limit and for how
long.
TANF Families with disabilities must be provided with
the services and supports needed to assist them to be able to successfully
move into an independent work setting. States need the flexibility
to design the individualized plans that parents with disabilities
and children with disabilities need. For example,
- While 30 hours of activity each week is required
by current law for families with children age six or older, states
currently have the flexibility to require 40 hours of participation
from families, but most have not chosen to do so universally.
Instead of focusing on keeping participants busy for precisely
40 hours per week while they are on welfare, states have been
able to place a greater emphasis on structuring work programs
that provide the types of activities needed to move participants
with and without disabilities into paid employment and off of
welfare (regardless of the precise number of hours these activities
add up to each week).
- Some parents with young children with disabilities
are helped by the provision in the current statute that allows
states to get full credit when a parent with a child under the
age of six (regardless of disability) is working for 20 hours
because they are able to meet their child’s needs while
being involved in a countable work activity part-time, for 20
hours. The flexibility states have to provide this modest protection
must be retained. 55
- Important information is available on the issue
of state flexibility from the Vermont experience, which has created
“hybrid” TANF/VR counselors in the VR agency. The
agency’s experience with non-TANF closures may be instructive.
Forty-eight percent of VR’s non-TANF successful closures
to employment were people whose primary disability was mental
illness, mental retardation, learning disability, or substance
abuse. “The average length of time from applying for services
to becoming employed for these individuals has been: mental illness,
15 months; mental retardation, 14 months; learning disability,
17 months; and substance abuse, 10 months.”56 Without the
flexibility to adapt work requirements and participation rates
to the needs of the individuals, states would be forced to provide
services to recipients which are less individualized and less
appropriate to their needs, forcing recipients into a “one
size fits all” approach that will be harmful to parents
with disabilities and children with disabilities in TANF families.
The federal legislation should also allow states
with waivers to continue under their waiver rules after reauthorization.
A number of states were granted waivers to the welfare requirements
under the old AFDC rules and were allowed to continue to operate under
the same waiver, even when the rule differed from the new TANF rules.
Often these rules allow states to provide more appropriate activities
for parents than are permitted under standard federal TANF rules and,
in some cases, to extend time limits for some parents with disabilities
based on individual circumstances. It is important to note that NCD
does not endorse a practice that exempts an individual from work requirements
in lieu of providing the appropriate accommodations for the disability.
However, extensions may be justified and especially important for
families with care giving requirements that make it impossible for
them to participate in required activities.57 5.
Training. The federal legislation should provide states with
additional resources to train caseworkers and other staff who serve
TANF recipients about issues unique to disabilities, including timely
and effective screening, and the design of programs responsive to
the needs of people with barriers of disability, identification
and utilization of resources available in the community, and opportunities
to develop collaborative relationships with other state and local
public and private agencies, including grants to states and counties
interested in supporting initiatives to achieve systemic improvements
in addressing the needs of persons with diagnosed and undiagnosed
disabilities. Caseworkers and other staff should also receive training
in the unique needs of, and issues that have implications for, people
with disabilities from diverse cultures. According to Fujiura, “If
you have a disability in America, and you are from a diverse racial/ethnic
group, odds are that you and your family live in poverty and that
you will be poorer than others of your class and color.” http://www.mswitzer.org/sem99/papers/fujiura.html.
6. Advisory Panels. The federal
legislation should create advisory panels at the state level to
assist the state in determining steps it should take to improve
how it addresses the needs of people with barriers, including people
with disabilities, in their TANF programs.
7. Health Care. The federal
legislation should facilitate access to continued Medicaid or other
health insurance coverage when recipients move from welfare to work.
For any family, health coverage is essential. For a parent with
a disability, continuing health care coverage when working may be
the key support that allows the parent to work while addressing
her medical needs. Transitional Medicaid Assistance (TMA) has helped
to meet this need. For a parent with a disability, because TMA is
time-limited, it will not fill the gap over time if the parent’s
job does not provide insurance — which is often the case for
many low-wage jobs. However, it does help to ease the transition
and, in states that have expanded Medicaid coverage to more parents
at incomes higher than the very low TANF levels, the parent may
be able to move into the expanded Medicaid coverage program after
TMA. Because the Medicaid eligibility rules for children are more
generous and the children can also enroll in the State Children’s
Health Insurance Program if they are over-income for Medicaid, TMA
is most important for parents who typically have to meet more stringent
income eligibility rules than children.58 Studies in other income
programs, such as SSI, have shown that fear of loss of health coverage
is one reason that recipients with disabilities may be reluctant
to work.59 While there are no parallel studies in TANF, it would
seem likely that similar concerns exist for parents with disabilities
in TANF. The Transitional Medicaid Assistance program reauthorization
period must parallel the reauthorization period for the rest of
TANF.
8. Service Coordination. Because
multiple services are available at the state and local level for
adults and children with disabilities, the federal legislation should
assist states to better coordinate and provide services needed by
children with disabilities and their families, including coordination
among state agencies to address the multiple challenges facing parents
and their children with disabilities.60
9. ADA and Section 504 Compliance.
The federal legislation should be consistent with federal
civil rights protections for individuals with disabilities under
the Americans with Disabilities Act (ADA) and Section 504 of the
Rehabilitation Act, enabling states to easily comply with all three
Acts. These recommendations would help states and counties meet
their legal obligations to implement the long-standing national
policy set forth in Section 504 of the Rehabilitation Act and the
ADA to ensure that people with disabilities have equal and meaningful
access to their TANF-funded programs, including the ability to benefit
from state programs that assist families in transitioning from welfare
to self-sufficiency.
Conclusion
There is now a very strong record that indicates that
significant numbers of parents with disabilities and parents with
children with disabilities are in the TANF program. The record also
indicates that many of these families have been sanctioned and have
not received the services and supports they need to succeed. Some
of the states, using the flexibility that Congress gave them in
1996 and the TANF funds freed up due to falling cash assistance
caseloads, have taken very practical steps to assist these families.
The federal legislation should include provisions to ensure that
people with disabilities receive the appropriate supports and services
to enable them to transition to work successfully.
The National Council on Disability wishes to acknowledge
the contributions of Eileen Sweeney, Cary LaCheen, and Celane McWhorter
to this paper.
Endnotes
1 For a more detailed discussion, see Eileen P. Sweeney,
Recent Studies Indicate that Many Parents Who are Current or Former
Welfare Recipients Have Disabilities or Other Medical Conditions,
Center on Budget and Policy Priorities, February 2000, http://www.cbpp.org/2-29-00wel.htm.
For a discussion of the most recent studies as well as the prevalence
of other barriers to work in the TANF population, see Heidi Goldberg,
Improving TANF Program Outcomes for Families with Barriers to Employment,
Center on Budget and Policy Priorities, January 2002, http://www.cbpp.org/1-22-02tanf3.htm.
2 U. S. General Accounting Office, Welfare Reform:
More Coordinated Federal Effort Could Help States and Localities
Move TANF Recipients with Impairments Toward Employment, GAO-02-37,
October 2001, available at www.gao.gov.
3 Id.
4 U.S. General Accounting Office, Welfare Reform:
Outcomes for TANF Recipients with Impairments, GAO-02-884, July
2002, available at http://www.gao.gov.
5 HHS Office of the Inspector General, State Strategies
for Working with Hard-to-Employ Recipients, OEI-02-00-00630, July
2002, http://oig.hhs.gov/oei/reports/oei-02-00-00630.pdf .
6 Denise Polit, Andrew London, and John Martinez,
The Health of Poor Urban Women: Findings from the Project on Devolution
and Urban Change, Manpower Demonstration Research Corporation, May
2001, http://www.mdrc.org/Reports2001/UC-HealthReport/UC-HealthRpt-Overview-2001.htm.
The study was conducted in four large urban counties: Cuyahoga County,
Ohio; Los Angeles, California; Miami-Dade, Florida; and Philadelphia,
Pennsylvania.
7 Sheila Zedlewski, Work Activity and Obstacles to
Work Among TANF Recipients, Urban Institute, Series B, No. B-2,
September 1999, http://www.urban.org.
8 Pamela J. Loprest, Sheila R. Zedlewski, Current
and Former Welfare Recipients: How Do They Differ? Urban Institute,
Discussion Paper 99-02, 1999, http://www.urban.org.
9 Sandra Danziger, Mary Corcoran, Sheldon Danziger,
et al., Barriers to the Employment of Welfare Recipients, University
of Michigan Poverty Research and Training Center, February 2000,
http://www.fordschool.umich.edu/poverty/wesappam.pdf; Amanda Smith
Barusch, Mary Jane Taylor, et al., Understanding Families with Multiple
Barriers to Self Sufficiency: Final Report, University of Utah Social
Research Institute, February 1999, http://www.socwk.utah.edu/pdf/sri-final1.pdf.
See also, Why Some Women Fail to Achieve Economic Security: Low
Job Skills and Mental Health Problems are Key Barriers, Research
Forum on Children, Families and the New Federalism, August 2001,
http://www.researchforum.org, summarizing the findings of Danziger,
et al.; Surjeet K. Ahluwalia, Sharon M. McGroder, Martha Zaslow,
Elizabeth Hair, Symptoms of Depression Among Welfare Recipients:
A Concern for Two Generations, Child Trends, December 2001, a discussion
of the problems facing both adults and children with mental impairments
in TANF, see Elisa Rosman, Jan McCarthy, and Maria Woolverton, Focusing
on Families in Welfare Reform Reauthorization: Adults with Mental
Health Needs and Children with Special Needs, National Technical
Assistance Center for Children’s Mental Health, Georgetown
University Child Development Center, October 2001. This series of
nine short issue briefs is available at http://gucdc.georgetown.edu.
10 Martin Gerry, Candace Shively, The Kansas Learning
Disabilities Initiative, National Technical Assistance Center for
Welfare Reform, University of Kansas, and Kansas Department of Social
and Rehabilitative Services, January 1999; Learning Disabilities:
A Report by the State of Washington Department of Social and Health
Services, Economic Services Administration, Work First Division,
September 1998; Barusch, Taylor, et al., Understanding Families
with Multiple Barriers to Self Sufficiency: Final Report.
11 Barusch, Taylor, et al., at 44-45, Table 14. “When
asked if their health interfered with specific activities, 38.4
percent answered that their health interfered a lot with vigorous
activities, 12.0 percent reported that their health interfered a
lot with moderate activities, 27.5 percent reported a lot of difficulty
climbing several flights of stairs, and 26.9 percent reported a
lot of difficulty walking more than one mile.”
12 Glenn T. Fujiura, Kiyoshi Yamaki, Trends in Demography
of Childhood Poverty and Disability, published in Exceptional Children,
Vol. 66, No.2, 187, 190-192, Winter 2000. This study looked at annual
data sets – 1983 through 1994 – from the National Health
Interview Survey, for children ages three to 21.
13 Kathryn Tout, Juliet Scarpa, Martha J. Zaslow,
Children of Current and Former Welfare Recipients: Similarly at
Risk, Child Trends, March 2002, http://www.childtrends.org/PDF/leaversRB302.pdf.
14 U.S. General Accounting Office, Welfare Reform:
Outcomes for TANF Recipients with Impairments, GAO-02-884, July
2002, available at http://www.gao.gov.
15 Polit, London, and Martinez, May 2001.
16 Sandra Danziger, et al., February 2000.
17 Meyers, Lukemeyer, Smeeding, Work, Welfare, and
the Burden of Disability: Caring for Special Needs of Children in
Poor Families, Center for Policy Research, Syracuse University,
April 1996, http://www-cpr.maxwell.syr.edu/incomsec/incomlst.htm.
18 Sharon Dietrich, Community Legal Services, Philadelphia,
PA, Many Welfare Recipients Could Not Meet TANF Proposals for 40
Hours of Work, page 15.
19 For a more detailed discussion, see Heidi Goldberg,
Improving TANF Outcomes for Families with Barriers to Employment,
page 7; and Eileen Sweeney, Recent Studies Indicate that Many Parents
Who are Current or Former Welfare Recipients Have Disabilities or
Other Medical Conditions, pages 18-21.
20 U.S. General Accounting Office, cited above.
21 The Targeted Assessment Project and TANF Reauthorization:
Preliminary Client Data, July 1, 2000 – December 31, 2001,
prepared by University of Kentucky Institute on Women and Substance
Abuse and Center on Drug and Alcohol Research for the Kentucky Cabinet
for Families and Children, May 23, 2002
22 Temporary Assistance for Needy Families (TANF)
Program: Second Annual Report to Congress, U.S. Department of Health
and Human Services, August 1999, at 140.
23 Pamela J. Loprest, Sheila R. Zedlewski, Current
and Former Welfare Recipients: How Do They Differ? Urban Institute,
Discussion Paper 99-17, November 1999, http://www.urban.org/
24 Danziger, Corcoran, et al., at 23.
25 Faces of Change, Alliance for Children and Families,
http://www.alliance1.org/Home/Home.asp.
26 See, for example, studies in Delaware and Iowa:
David J. Fein, Wang S. Lee, Carrying and Using the Stick: Financial
Sanctions in Delaware: a Better Chance Program, Abt Associates,
Inc., May 1999, http://www.abtassoc.com/reports/ES-Sanfin3.pdf;
and Lucia Nixon, Jacqueline Kauff, Jan L. Losby, Second Assignments
to Iowa’s Limited Benefit Plan, Mathematica Policy Research,
August 1999, at 19, 23, http://www.mathematica-mpr.com/PDFs/secondlbp.pdf.
27 Polit, London and Martinez, 2001.
28 Barusch, Taylor, et al., at 51; Fein, Lee, at 13,
22.
29 Michelle K. Derr, The Impact of Grant Sanctioning
on Utah’s Families, University of Utah, October 1998.
30 Nixon, Kauff, and Losby, August 1999, cited in
footnote 26. Chronic health conditions identified as contributing
to being placed in the program included drug addiction, manic depression,
and chronic asthma.
31 Heidi Goldberg, A Compliance-Oriented Approach
to Sanctions in State and County TANF Programs, Center on Budget
and Policy Priorities, March 2001, http://www.cbpp.org/3-28-01tanf.pdf.
32 P. Lindsay Chase-Lansdale, Rebekah Levine Coley,
Brenda J. Lohman, Laura D. Pittman, Welfare Reform: What About the
Children? Welfare, Children and Families: A Three-City Study, Policy
Brief 02-1, Johns Hopkins University, 2002, http://www.jhu.edu/~welfare/19382_Welfare_jan02.pdf.
“We need to attend much more carefully to the plight of families
experiencing welfare sanctions. Sanctioned families have a number
of characteristics that serve as markers of concern for the healthy
development of children and youth. As such, state and federal governments
should explore options for identifying and reaching out to the most
disadvantaged and high-risk families involved in the welfare system.
Possible policy options include assistance to bring families into
compliance with rules before they are sanctioned, closer monitoring
of sanctioned families, and the provision of additional supports,
such as mental health services, academic enrichment, after-school
programs, and other family support services.” Id.
33 Children’s Sentinel Nutrition Assessment
Program, The Impact of Welfare Sanctions on the Health of Infants
and Toddlers, July 2002, Arch Pediatr Adolesc Med, Vol. 156, 678-683,
http://dcc2.bumc.bu.edu/csnappublic/welfaresanctions.htm. In the
article, the authors conclude that, “Child health professionals
should be concerned that increasingly stringent requirements proposed
for the 2002 welfare reform law reauthorization may further jeopardize
the health of some of America’s most vulnerable children as
the economic cycle, sanctions, and time limits simultaneously decrease
families’ resources.”
34 Sharon Dietrich, Community Legal Services, Philadelphia,
PA, Many Welfare Recipients Could Not Meet TANF Proposals for 40
Hours of Work.
35 Evaluation of the Colorado Works Program: First
Annual Report, Berkeley Planning Associates, November 1999, at 29,
Figure 2-4.
36 Jesse D. Beeler, Bill M. Brister, Sharon Chambry,
et al., Tracking of TANF Clients, First Report of a Longitudinal
Study: Mississippi’s Temporary Assistance for Needy Families
Program, Center for Applied Research, Millsaps College, revised
January 1999, at 12, Table 8.
37 Rebecca Swartz, Jacqueline Kauff, Lucia Nixon,
Tom Fraker, Jay Hein, Susan Mitchell, W-2: Converting to Wisconsin
Works: Where Did Families Go When AFDC Ended in Milwaukee? Hudson
Institute and Mathematica Policy Research, 1999, at 37-38, Table
6-4, http://www.mathematica-mpr.com/PDFs/w2report.pdf.
38 Sharon Dietrich, Community Legal Services, Philadelphia,
PA, Many Welfare Recipients Could Not Meet TANF Proposals for 40
Hours of Work, p.21.
39 Marcia K. Meyers, Anna Lukemeyer, Timothy Smeeding,
Work, Welfare, and the Burden of Disability, Caring for Special
needs of Children in Poor Families, Center for Policy Research,
Syracuse University, April 1996, http://aspe.hhs.gov/daltcp/reports/wrkwlfes.htm.
40 Barbara W. LeRoy, Donna M. Johnson, Sharonlyn Harrison,
Open Road or Blind Alley? Welfare Reform, Mothers and Children with
Disabilities, Skillman Center for Children, Wayne State University,
Occasional Paper Series 2000, No. 4, November 2000, http://www.skillmancenter.culma.wayne.edu
41 For information on TANF spending, see U.S. Department
of Health and Human Services, Temporary Assistance for Needy Families
(TANF) Fifth Annual Report to Congress, February 2003, Tables 2:8
through 2:15, http:www.acf.hhs.gov/programs/ofa/indexar.htm, and
Zoe Neuberger, TANF Spending in Federal Fiscal Year 2001, Center
on Budget and Policy Priorities, March 2002, http://www.cbpp.org/3-21-02tanf.htm.
42 For greater detail about these and other state
programs, see Heidi Goldberg, Recent TANF Proposals Would Hinder
Successful State Efforts to Help Families Overcome Barriers to Employment
and Find Better Paying Jobs, Center on Budget and Policy Priorities,
April 2002, http://www.cbpp.org/5-9-02tanf.pdf .
43 Jonathan M. Stein, Brendan Lynch, The Administration’s
Proposed Increases in TANF Work Requirements are Unfair to Pennsylvania
TANF Recipients with Disabilities, Community Legal Services, April
2002.
44 Johnette T. Hartnett, Vermont’s Response
to Welfare Reform for People with Disabilities: An Evaluation of
Vermont’s Vocational Rehabilitation (VR) and PATH Partnership,
University of Vermont, Fall 2002.
45 See study referred to in footnote 22.
46 See Gretchen Kirby, Jacquelyn Anderson, Addressing
Substance Abuse Problems Among TANF Recipients: A Guide for Program
Administrators, Mathematica Policy Research, July 2000, http://www.mathematica-mpr.com/PDFs/addresssubstance.pdf;
Michelle Derr, Heather Hill, LaDonna Pavetti, Addressing Mental
Health Problems Among TANF Recipients: A Guide for Program Administrators,
Mathematica Policy Research, July 2000, http://www.mathematica-mpr.com/PDFs/addressmental.pdf.
See also, Rebecca Brown, Evelyn Ganzglass, Serving Welfare Recipients
with Learning Disabilities in a Work First Environment, National
Governors Association Center for Best Practices, 1999, http://www.nga.org;
Amy Brown, Beyond Work First: How to Help Hard-to-Employ Individuals
Get Jobs and Succeed in the Workforce, Manpower Demonstration Research
Corporation, 2001, http://www.mdrc.org/Reports2001/HardtoServe/MDRCHow-ToHardtoEmploy.pdf;
M.Robin Dion, Michelle K. Derr, Jacquelyn Anderson, LaDonna Pavetti,
Reaching All Job Seekers: Employment Programs for Hard-to-Employ
Populations, Mathematica Policy Research, October 1999, http://www.mathematica-mpr.com/PDFs/hdemploy.pdf.
47 Office for Civil Rights, U.S. Department of Health
and Human Services, Prohibition Against Discrimination on the Basis
of Disability in the Administration of TANF (Temporary Assistance
for Needy Families), January 2001, http://www.hhs.gov/ocr/prohibition.html;
see also Eileen P. Sweeney, HHS Guidance Explains How Federal Laws
Barring Discrimination Against People with Disabilities Apply in
State and County TANF Programs, Center on Budget and Policy Priorities,
February 2001, http://www.cbpp.org/2-26-01wel.htm. In his reply
to the HHS Inspector General’s report, cited at footnotes
5 and 45, at page 23, HHS Assistant Secretary for Children and Families
Wade Horn indicated that there has been broad dissemination of the
OCR guidance on TANF and disabilities.
48 HHS Office of the Inspector General, cited at footnote
5, above, page iii. The report focused on eight barriers: substance
abuse, domestic violence, mental health issues, chronic health problems,
physical disabilities, learning disabilities, language barriers,
and multiple barriers.
49 Both clients_ stories are printed in Moving Forward
with Welfare Reform, The Governor_s Task Force on Welfare Reform
Report, Colorado, September 12, 2000.
50 Paul Marchand, Co-chair of Consortium for Citizens
with Disabilities TANF Task Force, testimony before Human Resources
Subcommittee, Ways and Means Committee, April 11, 2002. http://www.aucd.org/legislative_affairs/testimony_tanf.htm.
In the testimony, Mr. Marchand stated: “It should not be acceptable
to the Congress that even one parent with disabilities or one parent
caring for a child with disabilities faces these types of consequences
in TANF. Unfortunately, the research suggests that problems like
this are all to frequently occurring across the country, at great
personal expense to parents and children.”
51 For a more detailed discussion, see two documents
prepared by the TANF Task Force of the Consortium for Citizens with
Disabilities, Principles Guiding the Reauthorization of TANF, and
TANF Reauthorization Policy Priorities, both of which are included
in the testimony of Paul Marchand, The Arc, on behalf of the Consortium
before the Human Resources Subcommittee of the Ways and Means Committee,
April 11, 2002. The Policy Priorities also are available on the
CCD website, http://www.c-c-d.org/tanfreautho.htm.
52 Steve Savner, Julie Strawn, Mark Greenberg, TANF
Reauthorization: Opportunities to Reduce Poverty by Improving Employment
Outcomes, April 2002, http://www.clasp.org.
53 Zoe Neuberger, Annual TANF Expenditures Remain
$2 Billion Above Block Grant, Center on Budget Policy and Priority,
October 30, 2002
54 CBO’s $4.55 billion figure may understate
the cost of maintaining current services because the estimate assumes
that states will be able to maintain their current levels of using
TANF for childcare. This is unlikely to occur. In 2002, states spent
$1.6 billion more than their annual TANF allotments, by drawing
on unspent TANF funds carried over from prior years. These “carry-over”
funds have been exhausted or nearly exhausted in most states. To
bring spending in line with their annual TANF block grant allotment,
many states will have to cut TANF funding for various programs,
including childcare programs, in the next few years.
55 For a detailed discussion of why the 40 hour proposal
is not feasible and will be impossible for many parents to meet,
see Sharon Dietrich, Many Welfare Recipients Could Not Meet TANF
Proposals for 40 Hours of Work, Community Legal Services, April
2002, http://www.clsphila.org/Tanf_reauthorization.htm. The appendix
to the paper provides examples of families in Pennsylvania who are
working or trying to work and whose family circumstances would make
it impossible to meet 40 hours as they cannot meet the current 30
hour requirement. In the majority of the examples, the parent is
caring for children with disabilities or other family members with
disabilities.
56 Johnette T. Hartnett, cited above at footnote,
page 7.
57 Ruth Bourquin, Persons with Disabilities and TANF:
A Promising Massachusetts Model, Massachusetts Law Reform Institute,
March 2002.
58 For information on state actions to expand Medicaid
for parents, see Matthew Broaddus, Shannon Blaney, Annie Dude, Jocelyn
Guyer, Leighton Ku, Jaia Peterson, Expanding Family Coverage: States’
Medicaid Eligibility Policies for Working Families in the Year 2000,
Center on Budget and Policy Priorities, February 2002, http://www.cbpp.org/1-2-02health.pdf.
59 See, for example, The Environment of Disability
Policy Income: Programs, People, History and Context, National Academy
of Social Insurance, 1996, page 104.
60 See Rosman et al, Issue Brief 3, page 4.
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