EXHIBIT A.-ILLUSTRATIONS OF NEGOTIATIONS BETWEEN CHILDREN'S BUREAU AND STATE AGENCIES IN RELATION TO SERVICES FOR NONRESIDENTS UNDER TITLE V, PARTS 1 AND 2 OF THE SOCIAL SECURITY ACT [Copy] UNITED STATES DEPARTMENT OF LABOR, R. L. CLEERE, M. D., CHILDREN'S BUREAU, Washington, May 10, 1940. Secretary and Executive Officer, Division of Public Health, Denver, Colo. DEAR DR. CLEERE: This is to inform you that I have approved your supplemental maternal and child health budget No. 7 for the fiscal year 1940, authorizing the expenditure of $10,000, fund B. The effective date of approval is January 1, 1940. Approval has been given with the understanding that all medically needy patients in these counties will be eligible for service irrespective of their residence status, and that no medical or hospital services will be provided from maternal and child health funds that are now being paid for from State, local, or private funds. Sincerely yours, MARTHA M. ELIOT, M. D. RESPONSIBILITY FOR THE NONRESIDENT CRIPPLED CHILD (Article in The Child, issued by Children's Bureau, U. S. Department of Labor, September 1937) Reciprocal agreements between States in regard to services for individual crippled children whose parents have not yet acquired residence in a State to which they have moved or who are living temporarily in a State in which they are not legal residents are being developed under the social-security program. If a child eligible for medical care is a bona fide resident of a State administering a program of services for crippled children under the Social Security Act, it has appeared to be a desirable policy for the official agency in that State to assume responsibility for meeting the cost of medical care until the family has established residence in the State to which it has moved or until the child has returned to his home State. Federal funds brought into the State program on a matching basis under the Social Security Act can be expended for this purpose. In such instances, the quality of services can be safeguarded by the official agency in the State where the child is receiving medical care. The development of such policies means that crippled children will not be denied the necessary medical care because of residence restrictions. This is undoubtedly the intent of the social-security legislation. One such reciprocal agreement is that concerning Lucy May. Lucy May was first examined at a North Carolina clinic for crippled children when she was only a year old. Her right knee was stiff and swollen. The orthopedic surgeon diagnosed the case and advised hospitalization. It was several months before facilities for hospitalization through the services for crippled children established by the State agency under the Social Security Act became available. When at length a bed was available, Lucy May and her family could not be found. It was finally discovered that they had moved to Colorado, hoping to benefit Lucy May. But in Colorado she was not eligible for assistance until her family had established a year's residence. Fortunately, it was possible to work out a reciprocal agreement between the two States concerned, through the patience and cooperation of the State agencies and of the county in Colorado to which the family moved. The medical social worker attached to the Colorado agency arranged for Lucy May's care in the county hospital, since the State law did not permit it to assume the responsibility until residence was established. The county was reimbursed for this first hospitalization by the North Carolina agency at a per diem rate agreed upon, which did not exceed the North Carolina rate. North Carolina agreed to finance further needed care until a year's residence was established in Colorado or until the family returned to North Carolina, on condition that the North Carolina agency be given advance notice of indicated needs with the privilege of approving or disapproving the expenditures involved. In acknowledging this agreement, the Colorado agency pointed out: "The acceptance by your State of this first responsibility will materially aid other States in formulating a similar policy with the hope that care for all crippled children will be assured wherever they are in the United States." * The Nebraska State plan for services for crippled children under the Social Security Act now includes a provision that the State agency will assume financial responsibility for needed medical care for children whose families are legal residents of Nebraska but who are temporarily living in another State. It is hoped that other States will adopt similar provisions in their State plans in order to facilitate the handling of cases of this nature. CHILDREN'S BUREAU NEWS RELEASE, NOVEMBER 22, 1937 Crippled children whose parents move from one State to another will not be deprived of the services provided for them under the Social Security Act because of residence requirements of the State to which they move if reciprocal agreements now being worked out by some States become general, the Children's Bureau of the United States Department of Labor said today. A reciprocal agreement between North Carolina and Colorado has already been worked out, and the Nebraska State plan for services for crippled children under the Social Security Act now includes a provision that the State agency will assume financial responsibility for needed medical care for children whose families are legal residents of Nebraska but who are temporarily living in another State. The development of such policies means that crippled children will not be denied the necessary medical care because of residence requirements. If a child eligible for medical care is a bona fide resident of a State administering a program of services for crippled children under the Social Security Act, it has appeared to be a desirable policy for the official agency in that State to assume responsibility for meeting the cost of medical care until the family has established residence in the State to which it has moved or until the child has returned to his home State. Federal funds brought into the State program on a matching basis under the Social Security Act can be expended for this purpose. In such instances, the quality of services can be safeguarded by the official agency in the State where the child is receiving medical care. An actual example of the way such an agreement works out in practice, the Children's Bureau reports, is the case of a child whose parents moved from North Carolina to Colorado. Lucy May was first examined at a North Carolina clinic for crippled children when she was only a year old. Her right knee was stiff and swollen. The orthopedic surgeon diagnosed the case and advised hospitalization. It was several months before facilities for hospitalization through the services for crippled children, established by the State agency under the Social Security Act, became available. When at length a bed was available, Lucy May and her family could not be found. It was finally discovered that they had moved to Colorado, hoping to benefit Lucy May. But in Colorado she was not eligible for assistance until her family had established a year's residence. Fortunately, it was possible to work out a reciprocal agreement between the two States concerned, through the patience and cooperation of the State agencies and of the county in Colorado to which the family moved. The medical social worker attached to the Colorado agency arranged for Lucy May's care in the county hospital, since the State law did not permit it to assume the responsibility until residence was established. The county was reimbursed for this first hospitalization by the North Carolina agency at a per diem rate agreed upon, which did not exceed the North Carolina rate. North Carolina agreed to finance further needed care until a year's residence was established in Colorado or until the family returned to North Carolina, on condition that the North Carolina agency be given advance notice of indicated needs with the privilege of approving or disapproving the expenditures involved. In acknowledging this agreement, the Colorado agency pointed out: "The acceptance by your State of this first responsibility will materially aid other States in formulating a similar policy with the hope that care for all crippled children will be assured wherever they are in the United States. * * * DEAR DR. BROWN: Miss Ball, our regional medical social consultant, has recently called to our attention the case of a Mexican child who received treatment in Imperial County in your State for a crippling condition and subsequently returned to Mexico. Since that time, it is our understanding that the parents of this child have lost their residence in California and have appeared at one of the diagnostic clinics held for crippled children in Arizona. A question has arisen as to whether or not it would be possible to provide further services for the care and treatment of this child through the use of funds made available under an approved State plan of services for crippled children. Inasmuch as no limitation has been made in the provisions of the Social Security Act relating to residence requirements for children who may receive services for the care and treatment of crippling conditions, it will be possible to provide such services for this child through the use of Federal funds. The only question which would appear to arise in connection with the services which might be provided for this child by either the State agency in California or Arizona is the authority given to the State agency to provide services for children who have not attained a legal residence within the State. If this matter can be satisfactorily settled between the two State agencies we hope that it will be possible to make arrangements for the care and treatment of this child. Sincerely yours, A. L. VAN HORN, M. D. Acting Director, Crippled Children's Division. EXHIBIT B.-ILLUSTRATIONS OF NEGOTIATIONS BETWEEN STATE CRIPPLED CHILDREN'S AGENCIES IN REGARD TO RECIPROCAL AGREEMENTS FOR SERVICE FOR NONRESIDENT CRIPPLED CHILDREN [Copy] DR. W. J. BREEDING, STATE OF ALABAMA, DEPARTMENT OF EDUCATION, Montgomery, Ala., January 20, 1938. Director, Services for Crippled Children, State Department of Public Health, Nashville, Tenn. DEAR DR. BREEDING: Since there is a possibility of a number of crippled children moving into Tennessee from Alabama and the same possibility of Tennessee crippled children moving into Alabama, our service would like to enter into a reciprocal agreement with the service for crippled children, of which you are director. It would be a very fine thing if children, moving from your State into ours and from our State into yours, would not be deprived of the services provided for them under the Social Security Act because of residence requirements in the States. We feel that a great deal may be lost to crippled children coming within this group who cannot meet residence requirements. We shall be glad to have you report any crippled child to us who moves into Alabama from your State and I assure you that he will receive the same type of service as a child who has had a lifetime residence in the State. If your service can enter into such an agreement as is suggested above, we should like to refer a crippled child to your service. Looking forward to hearing from you and assuring you that our first interest is in the crippled child, I am, Sincerely yours, THELMA MCGINTY, Supervisor, State Crippled Children's Service. EXCERPT, PROGRESS REPORTS ON CRIPPLED CHILDREN PROGRAM TO CHILDREN'S BUREAU, UNITED STATES DEPARTMENT OF LABOR, FROM A. H. COLLINS, SUPERINTENDENT OF EDUCATION, ALABAMA Question and answer: VI. b. Describe progress made in planning with other States for care of individual children where questions of residence are involved. Have reciprocal agreements been made with other States for the care of such children? Reciprocal agreements have been made with the four States bordering Alabama; namely, Florida, Mississippi, Tennessee, and Georgia. Several referrals have been made to Alabama by these States. In every instance, there has been demonstrated a desire to cooperate fully on the part of both the State making the referral and the State receiving it. Frequently reports on the progress of a particular case is requested and given. Many referrals have been made in keeping with these reciprocal agreements. [Copy] UNIVERSITY OF MISSOURI, University Hospital's State Service for Crippled Children Dr. FRANCES C. ROTHERT, Regional Medical Consultant, 1048 Canal Bank Bldg., New Orleans, La. DEAR DR. ROTHERT: We have not made any particular issue of reciprocity agreements between our service and other State crippled children's agencies. This is not necessary in Missouri since there are no minimal residence requirements for admission to this service. Any child may be admitted to this service a soon as he has established a residence of any sort in the State. So far we have had no inquiries about transfer of children from other States, although we have referred some of our own children who have moved to other States to the appropriate agencies. You may be assured if we are informed of any children moving to Missouri who have been under care by other agencies, that they will be admitted for care to our service as soon as it is possible. Very sincerely, WILLIAM J. STEWART, M. D., Director, State Crippled Children's Service. [Copy] THE KENTUCKY CRIPPLED CHILDREN COMMISSION, Dr. FRANCES C. ROTHERT, 1048 Canal Bank Bldg., New Orleans, La. DEAR DR. ROTHERT: Acknowledging your letter under date of January 3, with enclosed mimeographed news letter, also the State agencies administering services for crippled children, I am delighted to have this information. Just as soon as our biennial report is off the press I will send a copy to each State division. In reference to reciprocal agreements between States, this matter will have to be presented at the next commission meeting. I hardly believe that Ken tucky would be allowed to pay bills outside the State. However, any child moving here from another State we are more than willing to accept as a patient and carry on the treatment. It seems to me that some arrangement could be made to modify the laws in the various States and allow them to take care of the children when they move into the State; this seems a much more simple arrangement than paying bills outside of the State. However, the matter will be discussed at the next meeting of the commission which will be January 25 and I will write you accordingly. With cordial good wishes for a happy new year, I am, Sincerely yours, MARIAN WILLIAMSON, Director. TESTIMONY OF EDITH ROCKWOOD AND LAURA ELMORE WARREN Mr. THOMAS. Miss Rockwood, in connection with the programs which your office operates under the Social Security Act, you say there are no residence requirements in Title V of the Social Security Act. Miss ROCKWOOD. Yes; that's so. Mr. THOMAS. And your program contemplates that State plans be submitted in connection with these programs? Miss ROCKWOOD. Yes; it is a requirement of the act. Mr. THOMAS. Do you construe the fact that there are no residence requirements in the national act to mean that you could automatically reject a State plan which did contain a residence requirement? Miss ROCKWOOD. That issue hasn't arisen, but we in the Children's Bureau have regarded it as an obligation to see to it that provision is made for service to all children within the areas where services are set up, regardless of residence. In consultation service with the States we have worked out arrangements excluding residence as a factor. INCLUSION OF NONRESIDENTS IN MATERNAL AND CHILD-WELFARE PROGRAMS Mr. THOMAS. Do you require that provision to be in a State plan? Miss ROCKWOOD. If a State plan should contain a residence requirement provision, which ordinarily would not occur in either the maternal and child health or child-welfare programs, before the plan is approved we would discuss with the State the means of taking care of nonresident children. Mг. THOMAS. By that you mean that a State plan might contain a resident requirement but that you would have a discussion with them on how to avoid it. Miss ROCKWOOD. The issue might arise under the program for services for crippled children, where medical and hospital care are provided and where, in some of the States, there are restrictions in State laws. In the instructions for the State plans we ask them to report any restrictions, residence or otherwise, on the children who can be served under their State law; and then, because of the entrance of the Federal funds into the picture, we can encourage them in making arrangements through reciprocity agreements with other States to provide service regardless of the particular State restrictions. |