Eligibility for the Medicare buy-in programs, based on a survey of income and program participation simulation.

Medicare buy-in programs are designed to reduce out-of-pocket expenses of beneficiaries with modest income and assets. This article provides estimates of the size of the Medicare beneficiary population eligible for the Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, and the Qualified Individual-1 (QI-1) program. The buy-in programs use the same resource limits (twice those used in the Supplemental Security Income (SSI) program) but different thresholds for determining income eligibility. The QMB program uses 100 percent of the poverty line as the cutoff, QI-1 covers persons above 120 percent but at or below 135 percent of the poverty line, and the SLMB program is in between. Making informed judgments about the rate of participation in the buy-in programs and the need for outreach requires an accurate estimate of the size of the eligible population. If that population is underestimated, policymakers might come to unduly optimistic conclusions about current buy-in participation. In contrast, an overestimate may make current participation seem too low. If policymakers react to an upwardly biased estimate of the eligible population by increasing outreach, they are bound to be disappointed by the results of that effort. Estimates of the eligible population from past studies of the QMB and SLMB programs range from 5.1 million to 9.1 million. In the absence of new information, it is difficult to judge the accuracy of those estimates because the methodologies had substantial shortcomings that might bias the results. The most common shortcomings include the lack of high-quality, monthly income data and the lack of information on assets from the same data file that was used to estimate participation and income eligibility for Medicare. The current study uses the most recently available (as of August 2000) Survey of Income and Program Participation (SIPP) file that is matched to the Social Security Administration's (SSA's) administrative records. The data file covers 1995 information. Estimates were also obtained using 1991 data to assess the sensitivity of eligibility estimates to the year chosen. The SIPP has several major advantages over other data sources because it contains relevant, high-quality information on both income and assets for establishing financial eligibility for the buy-in programs. First, the SIPP collects detailed and conceptually appropriate information on monthly, rather than annual, income and therefore has more complete information about income than do other surveys. As a result, SIPP-based estimates of poverty are substantially lower than estimates based on the Current Population Survey. Second, the SIPP also collects information on assets at the individual level. Thus, the survey provides enough detail to measure the major income and asset exclusions directly. Finally, the SIPP data are matched to SSA administrative records: Medicare eligibility can therefore be accurately measured, and self-reported data on Social Security and SSI benefits can be replaced with more accurate monthly information. Our 1995 simulation estimates that approximately 4.8 million persons in the U.S. noninstitutionalized population were eligible for the QMB program and an additional 1.6 million for the SLMB program. The total--roughly 6.5 million--is within the range of estimates from past studies but is closer to the lower end, suggesting that the eligible population is smaller than was previously believed. When the estimated QI-1 eligible population of 0.9 million is added, the total for the three buy-in programs is 7.4 million. Because the QI-1 program did not exist in 1995, only the estimated 6.5 million QMBs and SLMBs would actually have been eligible to receive benefits. The 7.4 million figure represents the 1995 Medicare beneficiaries who would be eligible for buy-in under program rules for 2000. Adjusting that number to account for increases in the Medicare population between 1995 and 1999 yields an estimated eligible population of 7.8 million in 1999. Compared with other elderly Medicare recipients, eligible elderly QMBs and SLMBs have poorer health, more functional limitations, and higher rates of health care use. Thus, not only are their income resources relatively limited, but their need for potentially expensive medical care is also greater. Similar differences were not found in health, functional limitations, and health care use among disabled participants in the QMB and SLMB programs. Our estimates imply that about 2.5 million noninstitutionalized individuals were eligible for but not enrolled in the QMB and SLMB programs in 1999. That finding suggests that fewer eligibles may be available for targeting by outreach efforts than was previously believed. Outreach may be more difficult than it would be with a larger eligible population. (ABSTRACT TRUNCATED)     

The net effects of the Project NetWork return-to-work case management experiment on participant earnings, benefit receipt, and other outcomes

The Social Security Administration (SSA) initiated Project NetWork in 1991 to test case management as a means of promoting employment among persons with disabilities. The demonstration, which targeted Social Security Disability Insurance (DI) beneficiaries and Supplemental Security Income (SSI) applicants and recipients, offered intensive outreach, work-incentive waivers, and case management/referral services. Participation in Project NetWork was voluntary. Volunteers were randomly assigned to the "treatment" group or the "control" group. Those assigned to the treatment group met individually with a case or referral manager who arranged for rehabilitation and employment services, helped clients develop an individual employment plan, and provided direct employment counseling services. Volunteers assigned to the control group could not receive services from Project NetWork but remained eligible for any employment assistance already available in their communities. For both treatment and control groups, the demonstration waived specific DI and SSI program rules considered to be work disincentives. The experimental impact study thus measures the incremental effects of case and referral management services. The eight demonstration sites were successful in implementing the experimental design roughly as planned. Project NetWork staff were able to recruit large numbers of participants and to provide rehabilitation and employment services on a substantial scale. Most of the sites easily reached their enrollment targets and were able to attract volunteers with demographic characteristics similar to those of the entire SSI and DI caseload and a broad range of moderate and severe disabilities. However, by many measures, volunteers were generally more "work-ready" than project eligible in the demonstration areas who did not volunteer to receive NetWork services. Project NetWork case management increased average annual earnings by $220 per year over the first 2 years following random assignment. This statistically significant impact, an approximate 11-percent increase in earnings, is based on administrative data on earnings. For about 70 percent of sample members, a third year of followup data was available. For this limited sample, the estimated effect of Project NetWork on annual earnings declined to roughly zero in the third followup year. The findings suggest that the increase in earnings may have been short-lived and may have disappeared by the time Project NetWork services ended. Project NetWork did not reduce reliance on SSI or DI benefits by statistically significant amounts over the 30-42 month followup period. The services provided by Project NetWork thus did not reduce overall SSI and DI caseloads or benefits by substantial amounts, especially given that only about 5 percent of the eligible caseload volunteered to participate in Project NetWork. Project NetWork produced modest net benefits to persons with disabilities and net costs to taxpayers. Persons with disabilities gained mainly because the increases in their earnings easily outweighed the small (if any) reduction in average SSI and DI benefits. For SSA and the federal government as a whole, the costs of Project NetWork were not sufficiently offset by increases in tax receipts resulting from increased earnings or reductions in average SSI and DI benefits. The modest net benefits of Project NetWork to persons with disabilities are encouraging. How such benefits of an experimental intervention should be weighed against costs of taxpayers depends on value judgments of policymakers. Because different case management projects involve different kinds of services, these results cannot be directly generalized to other case management interventions. They are nevertheless instructive for planning new initiatives. Combining case and referral management services with various other interventions, such as longer term financial support for work or altered provider incentives, could produc     

Modeling SSI financial eligibility and simulating the effect of policy options

This article simulates eligibility for Supplemental Security Income (SSI) among the elderly, analyzes factors affecting participation, and looks at the potential effects of various options to modify financial eligibility standards for the federal SSI program. We find that in the estimated noninstitutional elderly population of 30.2 million in the United States in 1991, approximately 2 million individuals aged 65 or older were eligible for SSI (a 6.6 percent rate of eligibility). Our overall estimate of the rate of participation among eligible elderly is approximately 63 percent, suggesting that more than a third of those who are eligible do not participate in the program. The results of our analysis of factors affecting participation among the eligible elderly show that expected SSI benefits and a number of demographic and socioeconomic variables are associated with the probability of participation. We also simulate the effects of various policy options on the poverty rate, poverty gap, annual program cost, the number of participants, and the average estimated benefits among participants. The simulations consider the potential effects of five policy alternatives: Increase the general income exclusion (GIE) from $20 to $80. Increase the earned income exclusion (EIE) from $65 to $260. Increase the federal benefit rate (FBR) by $50 for individuals and $75 for couples and eliminate the GIE. Increase the asset threshold to $3,000 for individuals and $4,500 for couples. Increase the asset threshold to $6,000 for individuals and $9,000 for couples. Using 1991 microdata from the Survey of Income and Program Participation (SIPP) matched to Social Security Administration administrative records and making adjustments reflecting aggregate program statistics, we present the results of our simulations for December 1999. The results show substantial variation in the simulated effects of the five policy alternatives along the various outcome dimensions considered. The simulated effects on the poverty gap of the elderly population range from a 7.9 percent reduction ("Increase the GIE from $20 to $80") to a 0.1 percent reduction ("Increase the EIE from $65 to $260"). All simulated interventions are expected to increase the rate of SSI participation among the elderly from a high of 20.3 percent ("Increase the GIE from $20 to $80") to a low of 0.5 percent ("Increase the EIE from $65 to $260"). We also find that the interventions that have greater estimated effects in terms of increased participation and reduced poverty tend to cost more. At the high end, we estimate that increasing the GIE from $20 to $80 could raise annual federal SSI cash benefit outlays by about 46 percent, compared with only 0.9 percent for increasing the EIE from $65 to $260. Similar to the EIE intervention, raising the resource thresholds by 50 percent would reduce the overall poverty gap of the elderly by only 0.2 percent, would increase SSI participation only modestly (by 1.3 percent), but would entail slightly higher program costs (by 1.4 percent). Increasing the asset threshold by 200 percent would have higher estimated effects on all three outcomes, but it would still be associated with relatively low increases in both costs and benefits. Finally, the simulated effects on the three key outcomes of increasing the FBR by $50 for individuals and $75 for couples, combined with eliminating the GIE, are relatively large but are clearly less substantial than increasing the GIE from $20 to $80. This work relies on data from the SIPP matched to administrative data on federal SSI benefits that provide a more accurate picture of SSI participation than has been feasible for previous studies. We simulate eligibility for federal SSI benefits by applying the program rules to detailed information on the characteristics of individuals and couples based on the rich array of demographic and socioeconomic data in the SIPP, particularly the comprehensive information SIPP provides on assets and monthly income. A probit model is estimated to analyze factors affecting participation among the eligible elderly. Finally, we conduct the policy simulations using altered program rules represented by the policy alternatives and predicted participation probabilities to estimate outcomes under simulated program rules. We compare those simulated outcomes to observed outcomes under current program rules. The results of our simulations are conditional on the characteristics of participants and eligibles in 1991, but they also reflect aggregate adjustments capturing substantial changes in overall participation and program benefit levels between 1991 and 1999.     

Medicaid matters: children's health and Medicaid eligibility expansions.

In the late 1980s, a series of federal laws were enacted which expanded Medicaid eligibility to more of the nation's children. States had a great amount of discretion in how fast and how far these expansions were implemented. As a result, there was great variation among the states in defining who was eligible for the program. This variation provides a rare opportunity to disentangle the effect of Medicaid from a child's socioeconomic status. Using data from the National Health Interview Survey, we address whether the Medicaid expansions improved the health and functional status of children. Econometric models were developed using fixed-effects regressions, and were estimated separately for white, black, and Hispanic children. White children experienced statistically significant reductions in acute health conditions and functional limitations. Black and Hispanic children showed some evidence of improved health conditions and functional status, but this evidence is inconclusive in the study sample. This may be due to differences in their access to appropriate health services or to the smaller sample size of minorities in each geographic area. The findings are also relevant to the implementation of the Children' Health Insurance Program (CHIP), the latest federal effort to expand access to health care to poor and near poor children. In many states, CHIP is being implemented in whole or in part through further Medicaid expansions.     

The devil may be in the details: how the characteristics of SCHIP programs affect take-up.

In this paper, we explore whether the specific design of a state's program has contributed to its success in meeting two objectives of the Children's Health Insurance Program (SCHIP): increasing the health insurance coverage of children in lower income families and doing so with a minimum reduction in their private health insurance coverage (crowd-out). In our analysis, we use two years of Current Population Survey data, 2000 and 2001, matched with detailed data on state programs. We focus on two populations: the eligible population of children, broadly defined--those living in families with incomes below 300 percent of the federal poverty line (FPL)--and a narrower group of children, those who we estimate are eligible for Medicaid or SCHIP. Unique state program characteristics in the analysis include whether the state plan covers families; whether the state uses presumptive eligibility; the number of months without private coverage that are required for eligibility; whether there is an asset test; whether a face-to-face interview is required; and specific outreach activities. Our results provide evidence that state program characteristics are significant determinants of program success.     

Medicare premium buy-in programs: results of SSA demonstration projects.

Three programs known collectively as the Medicare buy-in programs are available to pay Medicare Part B premiums and, in some cases, other medical expenses for certain low-income individuals. The Health Care Financing Administration administers those programs, with most functions performed by the states. The Social Security Administration (SSA) plays an indirect role in the buy-in programs: with certain exceptions, people who qualify for Medicare and hence for buy-in are beneficiaries of Social Security retirement or disability programs. SSA is often cited as an agency that might be able to increase enrollment in the buy-in programs through outreach to its beneficiaries and by acting as an intermediary in the enrollment process. The three buy-in programs have different requirements for eligibility. The Qualified Medicare Beneficiary (QMB) program includes individuals who have Part A Medicare benefits and whose income does not exceed 100 percent of federal poverty guidelines. People in the Specified Low-Income Medicare Beneficiary (SLMB) program are individuals who would otherwise be QMBs but whose income is more than 100 percent but less than 120 percent of poverty guidelines. People in the Qualified Individual (QI) program are those who meet the other criteria but whose income is less than 175 percent of poverty guidelines. Various reports and studies by government agencies and advocacy organizations conclude that the buy-in programs are not reaching many of the people who are eligible. Low enrollment appears to be a particular issue for the SLMB and QI programs. States have tried various outreach efforts, but the effectiveness of those efforts has not been adequately assessed. In 1998, Congress mandated that SSA conduct a demonstration project to determine how to increase participation in the buy-in programs. The project tested six different administrative models in which outreach letters were sent to potential beneficiaries asking them to contact SSA and then be screened for eligibility and referred for enrollment. SSA was able to screen about 7.1 percent of letter recipients for buy-in eligibility: 4.2 percent were potentially eligible for the programs based on income and resources, and 3.7 percent enrolled in a buy-in program. An evaluation of the probability that letter recipients would contact SSA to be screened found that: Among the elderly, older individuals were less likely to be screened but more likely to enroll. Among the disabled, older individuals were more likely to be screened but less likely to enroll. The disabled were less likely to be screened but more likely to enroll. Individuals with higher Social Security benefits were more likely to be screened but less likely to enroll. Women were more likely to be screened and to enroll. Being married did not appear to affect screening but negatively affected enrollment. Individuals with a preference for materials in Spanish were much more likely to be screened and enrolled. In some of the demonstration sites, enrollment in a Medicare+Choice plan increased the probability of being both screened and enrolled. SSA conducted a survey of some people who did not respond to the outreach letter. Most of those from whom explanations of the nonresponse were obtained had not responded because they were not eligible on the basis of their income or resources. If SSA were to reproduce the demonstrations in a nationwide outreach effort, a national mailing would include nearly 20 million individuals. If response rates were similar to those seen in the 1999 demonstrations, outreach would produce over 740,000 new buy-in enrollees. That number might be increased modestly by conducting additional outreach efforts in conjunction with the mailing.     

SSI eligibility and participation among the oldest old: evidence from the AHEAD

The proportion of elderly SSI recipients aged 70 or older has been growing in recent years, perhaps because of rising life expectancies overall and a higher incidence of poverty among the oldest old. In 1999, 84 percent of all elderly SSI recipients were 70 or older. This article examines Supplemental Security Income (SSI) eligibility and participation among the oldest old. The analysis was based on 1993 data from the Study of Assets and Health Dynamics Among the Oldest Old that were used to build a detailed SSI eligibility model to identify individuals who meet the federal criteria for SSI income and resource eligibility. The participation rate among those eligible for federal SSI benefits is 53.9 percent, which is generally consistent with the findings of other studies. Furthermore, eligible participants would receive a significantly higher federal SSI benefit than eligible nonparticipants. Correspondingly, eligible participants have significantly lower incomes and assets than eligible nonparticipants. An econometric model is used to estimate the influence of various demographic, financial, and health care use characteristics on the probability of SSI participation among eligible individuals and couples. The model corrects for measurement error in calculated benefits and for misclassifying someone as ineligible. The empirical results show that the effect of higher SSI benefits on the probability of participation is substantial--a $100 increase in benefits would increase the probability of participating for an average eligible unit by 15 percentage points. Many of the demographic, financial, and health care use variables also are important predictors of SSI participation among the oldest old. The eligibility and participation models are also used to simulate the effect of increasing the SSI unearned income disregard from $20 to $125. Those made eligible by this policy change would receive a very low federal SSI benefit on average, suggesting that they are on the margin of eligibility under the original program rules. The simulated participation rate is 48.8 percent--5 percentage points lower than under the original program rules--reflecting the low benefit that new eligibles would receive. Only 36 percent of those made eligible by the new program rules are predicted to participate. These SSI eligibility and participation models are potentially useful tools for policy analysis. It is fairly straightforward to use these models to change a feature of SSI eligibility, reestimate the group of eligible individuals and couples, and predict participation among those who are eligible under the simulated program rules. New eligibles can be compared with those eligible under original program rules. New participants can be compared with old participants. Although these models focus only on individuals aged 70 or older, this type of analysis can be helpful in estimating the potential distributional effects of proposed SSI policy changes.     

General Motor Holden's closure in Playford,South Australia: Analysis of the policy response and its implications for health

Deindustrialisation and the closure of automotive manufacturing can differentially affect the socioeconomic prospects of workers and their communities, and contribute to social and health inequity. We used Bacchi's problematisation approach to examine the South Australian (SA) Labor government's policy responses to the General Motors Holden (GMH) Elizabeth plant closure announcement. We focused on the way that these policy responses framed the ‘problem’ of this major economic shock, particularly the extent to which potential social and health equity consequences were addressed. We found a narrow focus on economic strategies, neglecting the compounding impact of poverty in Playford, which may exacerbate health inequity. The community effects from the GMH closure remain uncertain and may be delayed for several years. SA requires better integrated social and economic policies to minimise social and health inequalities, as the consequences of the car manufacturing loss are realised.     

Normative perspectives on financial inclusion: Facts beyond statistics

The paper is an attempt to understand and differentiate the significance of financial inclusion in the context of India wherein a large population is deprived of financial services, which are very much essential for an overall economic and inclusive growth. The paper discusses the problem of financial exclusion and the socioeconomic impact of financial inclusion on the underprivileged. We go a step further through a normative discussion of India's journey so far in this respect and highlight the impediments to financial inclusion. The paper also suggests a few critical dimensions that are to be taken care of so as to accelerate deep-rooted penetration of financial services.     

Covid-19 communication in emerging markets—Not viral enough?

Public health communication acts as a social vaccine in case of pandemics. Prior research has identified that such initiatives often fail to reach vulnerable sections of society. In India, while the first wave of infections mainly hit the urban areas, rural areas witnessed a surge in the second wave. Using the World Bank data, we attempt to understand the effectiveness of public awareness campaigns in rural areas. We use the Ecological Model for public health and find how the various factors relate to public health outcomes. The ecological factors are found to be related to awareness of Covid-19. We find inadequate awareness about the symptoms and preventive measures associated with Covid-19 among the rural population. We also find significant differences in communication and awareness along dimensions such as education and access to media. The role played by SHGs and hospitals in dealing with pandemics is also evident in this study. We conclude that the disparity in public health communication needs to be bridged to ensure equitable access to health information in society during public health crises.     

Comparing beneficiaries of the Medicare savings programs with eligible nonparticipants

This note focuses on participation in two entitlement programs that help reduce out-of-pocket expenses for low-income Medicare beneficiaries: the Qualified Medicare Beneficiary (QMB) program and the Specified Low-Income Medicare Beneficiary (SLMB) program. As of 1999, about 2.75 million eligible, noninstitutionalized individuals were not enrolled in these Medicare savings programs. The eligible nonparticipants differed substantially from the QMB and SLMB participants in that they were less likely to be Supplemental Security Income beneficiaries and more likely to be elderly, nonblack, and in relatively good health. These findings, which could help target future outreach efforts, are based on Survey of Income and Program Participation data matched with administrative records from the Social Security Administration.     

Are Reemployment Services Effective? Experimental Evidence from the Great Recession

We examine an experimental‐design reemployment program implemented in Nevada during the Great Recession that required Unemployment Insurance (UI) recipients to: (1) undergo an eligibility review to confirm they were qualified for benefits and actively searching for work and, if deemed eligible, (2) receive job‐counseling services. Our results show that the program expedited participant exit from UI, produced UI savings that exceeded program costs, and improved participant employment outcomes. Analyses of program effects on the UI exit likelihood show that the program's effects are partly associated with increased participant exit up through the time when program activities were scheduled, reflecting voluntary exit of participants from UI to avoid program activities and disqualifications of participants who failed to meet eligibility requirements. In addition, the program induced substantial participant exit from UI in the period after participants fulfilled requirements and their interactions with the program had ended, suggesting that the job‐counseling services offered by the program may have helped participants to conduct more effective job searches. Our findings provide evidence that reemployment programs that combine an eligibility review with mandatory participation in job‐search services can be effective during recessions.     

Coproduction and Equity in Public Service Delivery

Public managers and researchers devote much attention to the benefits of coproduction, or the mixing of the productive efforts of public employees and citizens in public service design and delivery. One concern, however, is the distributional consequences of coproduction. This article proposes that disadvantaged citizens may be constrained by a lack of knowledge or other resources necessary to contribute to and benefit from the coproduction process. From this assumption, the authors develop the theoretical argument that if coproduction programs were designed to lift constraints on disadvantaged citizens, they might increase both efficiency and equity. This claim is tested using a field experiment on educational services. A coproduction program providing immigrant parents with knowledge and materials useful to their children's early educational development had a substantial positive impact on the educational outcomes of disadvantaged children, thereby diminishing inequity. Economically, the program was more efficient than later compensation of low‐performing children.     

Health information systems,decentralisation and democratic accountability

While decentralisation is a much‐used term in development discourse, there is lack of clarity about how much autonomy should be granted to local agencies in programme implementation. This is particularly the case in the health sector in developing countries where decentralisation has resulted in the primary health centre (PHC) being identified as the focal point for the delivery of basic health services to rural citizens. An important element of primary healthcare reform has been the implementation of health information systems (HIS). These systems primarily account for monies spent to higher levels of administration and funding bodies rather than account for primary healthcare provision to citizens. In this article, we focus on various emergent processes of change that are occurring under the auspices of the National Rural Health Mission (NRHM) in India to strengthen the interface between the PHC and the community. We present a case study of Gumballi PHC in Karnataka, South India. Our findings reveal ways in which these new processes can be supported by conceptualising the HIS as more than a mere reporting tool. Copyright © 2010 John Wiley & Sons, Ltd.     

Information Shocks and the Take‐Up of Social Programs

The causes of participation in social programs have been studied extensively, with prominent roles found for program rules and benefits. A lack of information about these programs has been suggested as a cause of low participation rates among certain groups, but it is often difficult to distinguish between the role of information sharing and other features of a neighborhood, such as factors that are common to people of the same ethnicities or socioeconomic opportunities, or uniquely local methods of program implementation. We seek to gain new insight into the potential role of information flows by investigating what happens when information is disrupted. We exploit rich microdata from Florida vital records and program participation files to explore declines in Women, Infants, and Children (WIC) participation during pregnancy among foreign‐born Hispanics in the “information shock” period surrounding welfare reform. We identify how the size of these reductions is affected by having a high density of neighbors from the same place of origin. Specifically, we compare changes in WIC participation among Hispanic immigrants living in neighborhoods with a larger concentration of own‐origin immigrants to those with a smaller concentration of own‐origin immigrants, holding constant the size of the immigrant population and the share of immigrants in the neighborhood who are Hispanic. We find strong evidence that having a denser network of own‐origin immigrants mediated the information shock faced by immigrant women in the wake of welfare reform.     

The national evaluation of the food stamp employment and training program

This article reports the results of the national evaluation of the Food Stamp Employment and Training (E&T) Program, based on an experimental study involving over 13,000 program participants in 53 separate local food stamp agencies. The story told by these findings begins with the types of individuals who participated in the E&T Program in FY 1988. Nearly 70 percent did not have children (removing this barrier to finding employment), and about half were single, highly mobile adults living alone. Most received no public assistance other than food stamps. For the most part, then, these were individuals who needed to work—food stamp benefits are not intended to meet total subsistence needs. It would, therefore, be expected that most of the E&T participants would be looking for work (whether or not they were successful) in the absence of E&T requirements. Next, it is apparent that large numbers of E&T participants did not engage in employment or training services in FY 1988. As currently structured, beyond imposing the obligation to meet the requirements of E&T, the program failed to provide any actual services to about half of those deemed eligible to participate. For the most part, the services received by E&T participants consisted primarily of referral to individual job search. In the absence of E&T, many of the individuals currently targeted by the program were able to obtain similar referrals on their own. Consequently, it is not surprising, that E&T was found to have no effect on participants' employment and earnings, and only a relatively small effect on average food stamp benefits.     

The control of urban growth in Mexico City. Suppositions regarding poor planning

It is argued that mechanisms for planning land use and controlling urban expansion in Mexico City have failed to achieve their aims. Although in theory Mexico's urban planning process has recently attempted to go beyond purely physical aspects to include socioeconomic dimensions, it has in fact been inflexible and oriented to exclusively to technical and administrative aspects, to the detriment of social distribution goals. Planning instruments have not included important aspects such as specific mechanisms for altering employment structures or income levels or mechanisms for providing access to land or housing to the most disadvantaged groups. The urban planning process in Mexico City, instead of assuming a socially compensatory role in favor of disadvantaged groups, has maintained the status quo or discriminated in favor of the already advantaged. The spatial and technical orientation or urban planning in Mexico City does not leave room for a well-defined social policy. The population of the Mexico City metropolitan Zone increased from 3 million in 1950 to 18 million in 1985, while its total area increased from 11,750 hectares in 1940 to 125,000 in 1985. Transfer of population from the Federal District to the conurban municipios of the state of Mexico has been very significant since the 1970s. Around 20% of the total area of metropolitan Mexico City has been settled through illegal means, with communal and ejido lands accounting for a large share. Settlements on some 60% of lands in metroplitan Mexico City were illegal or irregular at some time. Low income housing is the cheapest form for the government because the frequently illegal status of settlers prevents them from making any demands for services or equipment for the 1st several years. Construction is undertaken and financed almost entirely by the settlers themselves, freeing the government of responsibility in regard to the constitutionally mandated right of all Mexicans to housing. The Urban Development Plan of the state of Mexico published in 1986 proposed 2 important programs for controlling urban growth. The territorial reserves program aimed to anticipate the need and make available through purchase, expropriation, or other means sufficient lands for housing to which the lowest income groups would share access. The "Paint Your Line" program establiished physical limits for urban expansion in each of the 17 conurban municipios in the State of Mexico. To date, however, few lands have been set aside for legal acquisition and the Paint Your Line program has been slow in delimiting the areas to be settled. Data from a 1989 study in the municipios of Chalco and Ixtapaluca demonstrate the shortcomings of the programs, which do not address the true processes and agents that control new settlements and especially illegal occupations and which fail to satisfy the needs of low-income population sectors.     

The Food Stamp Program and Supplemental Security Income

The Food Stamp Program (FSP) and Supplemental Security Income (SSI) are important parts of national public assistance policy, and there is considerable overlap in the populations that the programs serve. About half of all SSI recipients reside in FSP recipient households. This article uses Social Security administrative data and the Food Stamp Quality Control samples for federal fiscal years 2001-2006 to study the prevalence of food stamp receipt among households with SSI recipients, the contribution of FSP to household income, and the importance of various FSP features in contributing to the well-being of recipient households. The prevalence of FSP participation among households that include SSI recipients is estimated to have grown steadily over the entire 2001-2006 period, rising from 47.4 percent in 2001 to 55.6 percent in 2006. This growth has occurred across all age groups of SSI recipients. The FSP contribution to household income has grown as well. In 2001, FSP increased the income of the households of SSI/FSP recipients by 13 percent; by 2006 the increase was 16.8 percent. Almost 80 percent of the food stamp recipient households that include SSI recipients receive increased benefits because of excess housing costs. In 2006, 44 percent of SSI recipients lived in households that did not receive food stamps. Given available information, it is difficult to gauge the FSP eligibility of nonparticipating households and, therefore, to assess the potential benefit of outreach efforts. Currently available measures of FSP take-up probably overstate participation among eligible households that include SSI recipients, and there is some evidence that enhanced state promotion of the FSP raises participation among households with SSI recipients. We conclude with recommendation for review and renewal of collaboration between the Food and Nutrition Service of the U.S. Department of Agriculture (the agency responsible for administering the FSP) and the Social Security Administration in ensuring that eligible SSI recipients utilize FSP benefits.     

THE IMPACT MAXIMUM BENEFIT AMOUNTS HAVE ON THE LENGTH OF TIME FAMILIES RECEIVE AFDC-BASIC BENEFITS

Analysts and program evaluators have rightly focused on the impact policies have on participants achieving programs’ goals and objectives. Yet a potentially neglected aspect of these analyses is the impact policies themselves have on who is initially eligible to participate in the programs and the impact policy parameters have on the length of time people participate in the program. This article reports the findings of a study on the length of time families receive AFDC (now TANF) benefits in two counties in a high benefit state, Wisconsin, between 1987 and 1989 and a low benefit state, Texas, from mid‐1989 through 1992 and the influence the states’ maximum benefits have on who is eligible to receive benefits and how families lose eligibility. Results of a life table analysis indicate that families in Texas receive benefits over significantly less time. However, results of a multivariate analysis indicate that when selected personal and familial attributes are held constant, the difference disappears.     

Health awareness of rural households towards COVID-19 pandemic in India: Evidence from Rural Impact Survey of the World Bank

This paper aims at analysing the level of awareness of the symptoms and the methods of protection from COVID-19 based on the Rural Impact Survey of the World Bank, collected from 5200 households belonging to six states in India that is, Andhra Pradesh, Bihar, Jharkhand, Madhya Pradesh, Rajasthan, and Uttar Pradesh. Data has been analysed using chi-square test and regression analysis. Results of the analysis indicate that about 70.8% rural households are aware of the symptom of coronavirus, and 81.9% are aware of the preventive measures for controlling the spread of COVID-19. Analysis indicates a significant association between awareness level on symptoms and prevention of COVID-19 and socio-demographics and location. The study further analyses the key determinants of awareness of COVID-19 symptoms and preventive measures using the logistics regression model, indicating that age, gender, education, income, poverty status, access to information, cash relief and medical services are the determining factors of health awareness on COVID-19 pandemic among rural households in India. Considering the importance of self-protecting measures in fighting the pandemic, this paper highlights the importance of strengthening public awareness for containing the spread of the COVID-19 pandemic.