Evaluating Eligibility Rules

Evaluating Eligibility Rules
Anna Andreula
HSM 240
Dawn Collins
May 31, 2015

Human service organizations vary from time to time. All have a set of goals and objectives, social problems, and rules that need to be addressed on a regular basis. These rules are mainly used to determine what families or individuals are eligible for specific benefits. The objective for eligibility rules is to determine who needs the benefits the most and if in fact, those who have applied for benefits are truly utilizing these benefits and allocating them appropriately. “The decentralized disarray of the U.S. welfare system creates literally hundreds of public and private programs that offer welfare services and benefits. Each has a somewhat
different set of rules for determining who gets what, how much, and under which conditions” (Chambers and Wedel, 2005). Eligibility rules are mostly important for rationing benefits and services. If in fact these benefits are off-targeted to clients who do not necessarily need them as much as other, at any given point, those individuals who do need them may go without. First hand, identifying eligibility rules is an essential part to determining who can receive benefits. Rules vary from state to state but primarily all have the same function which to make sure the benefits are given to the right people who need them. “ So, as long as there are insufficient resources for every conceivable social need, every time a benefit or service is given to one client/consumer, it takes away the opportunity to give it to another one in need” (Chambers and Wedel, 2005). The eligibility rules that are present are based on prior contributions, administrative rule, private contracts, professional discretion, administrative discretion, judicial decision, means testing (needs minus assets and/or income), and attachment to the workforce. The Department of Human Services offers a variety of these benefits. Starting with food stamps which are newly known as SNAP. “Food Stamps - now called SNAP, for Supplemental Nutrition Assistance Program - help eligible New Jerseyans – including senior citizens on small fixed incomes - receive benefits that help them afford a nutritionally balanced diet. Local County Welfare Agencies/Boards of Social Services determine who is eligible for food stamps” (The Department of Human Services, 1996). The best rule to determine the eligibility for a patient for this service would be the administrative rule. “There are some eligibility rules that are almost fully spelled out in the law, and the food stamp program is probably the best example. Almost all of the details necessary to determine whether a citizen is entitled to food stamps are built into the law. The exact amount of assets, as well as income, is specified by family size in the text of the act, along with definitions of what constitutes a household” (Chambers and Wedel, 2005).
Consequently, The Department of Human Services offers this service along with an eligibility rule that determines whether certain individuals need the extra assistance for nutritional valued foods or not. The County Welfare Agencies/Boards of Social Services, which would be considered the administrative rule, is who determines who is eligible for these benefits. Eligibility by professional discretion is an eligibility rule that determines several issues for families and children.
“ A common and concrete example is eligibility for medical benefits, which is always contingent on the discretion of the physician (or physician surrogate)” (Chambers and Wedel, 2005). Evidently, this rule allows for social workers and case workers to make decisions which may or may not be challenged through a judicial hearing. The Department of Human Services offers a benefit known as Temporary Assistance for Needy Families (TANF), which helps aids families receive medical care. “DFD offers a variety of support services and financial aid to kinship caregivers, who may be eligible for monthly payments through the federal Temporary Assistance for Needy Families (TANF) program. The children under their care may be eligible for Medicaid health insurance” (The Department of Human Services, 1996). With this stated, it is apparent that some of these rules are utilized by the Department of Human Services and promoted a structured settlement when applying these benefits to those who really need
it. Adjacent to social analysis, there must be an evaluation that merits these rules to be applied and helps agencies better determine who is receiving certain benefits and services. Unfortunately, like most organizations usually deal with, there can sometimes be a set back with eligibility rules and evaluations. In some cases, certain information is overlooked and can lead to another person in need of the benefits, not receiving them at all. “For a program or policy to be a coherent solution to a social problem, those who receive the program’s benefits and/or services must be included within the group whom the social problem analysis identifies as having the problem” (Chambers and Wedel, 2005). Considering the possible stigmatization for those who do not really need benefits is a question that raises eyebrows with time. Eligibility rules like the administrative rule or private contracts, usually determine if a person or family is able to receive the benefits and services requested.
“WorkFirst New Jersey (WFNJ) is the state’s public assistance program, designed to help families move to self-sufficiency by offering them a full array of supports, from child care, health insurance and transportation, to substance abuse treatment and emergency funds. Recipients face a five-year lifetime limit on cash assistance, and must become employed or take part in work activities” (The Department of Human Services, 1996). The stigmatization occurs solely if a social worker or human service agency feels they are contributing to households with their funds, who do not really need the extra funding and the allocation of funds then tends to become misused and over utilized. “ To be stigmatized means to be marked as having lesser value, to bear the burden of public disapproval” (Chambers and Wedel, 2005). This may cause an issue for those who believe certain individuals should not be receiving welfare or food stamps. A perfect example of stigmatization would be a family of five or more that only has one income but continues to produce offspring and receive benefits. When applying for food or housing benefits, the families must reveal very detailed information about their income and household. Considering they will be exposing all details it allows for the people to accept being apart of the stigma and can
create negative side effects that will cause the public to disapprove of these benefits being allocated.
The Department of Human Services does not stigmatize those whom they help. Based on their goals and objectives, the agency does not encourage for families and individuals to see this as a career opportunity but more so, to encourage them to do better where they eventually long term will no longer need these benefits and services in the future. “Let us use the concept of trade-off to characterize what we will be considering here. It is not an exotic idea; rather it is one we all use in working out our everyday lives” (Chambers and Wedel, 2005). As far as trade-offs existing in the organization, it is apparent that the most over utilized eligibility rule is the one that determines who receives what and how much.
Rules such as private contracts and judicial decisions always tend to play a huge role in the stigma of those who abuse their benefits and services given. Budget costs have been cut because of the epidemic of those having the benefits and services allocated and not being used appropriately by the clients. “Bad eligibility rules can create severe overutilization and, thus, serious cost overruns” (Chambers and Wedel, 2005). The only weak eligibility rules that seem to be unfair or insufficient are professional discretion, administrative rule, and prior contributions. The agency will eventually find themselves being over utilized with these rules because of the lack of information that a client may or may not present. It is apparent that one of benefits that may be over utilized are Medicare benefits. So many Americans that are unemployed still need health care benefits. The more people that have applied the more money is being funded and requested to be allocated appropriately. However, the agency does not always have the best end of the stick when it comes to this eligibility rule. Evidently, the eligibility rules play a tremendous role in human service agencies like The Department of Human Service. Considering the success rates shown based on the agencies’ aid and guidance for individuals and their families, it is safe to say that eligibility rules have a positive impact in the organization. The ability to segregate different services and benefits, the determination of who will receive what and the conclusion of how much exactly goes into these services is what shapes the organization into what it is and their goals and objectives.

References
Chambers, Donald E., Wedel, Kenneth R. (2005). Social Policy and Social Programs: A Method for the Practical Public Policy Analyst, Fourth Edition. Published by Allyn and Bacon.
The Department of Human Services. (1996). Family Programs. Retrieved from: http://www.state.nj.us/humanservices/clients/family/