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Full text of "Massachusetts Department of Public Welfare Statistical Supplement to the Annual Report 1972-1974"

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in 2014 



https://archive.org/details/massachusettsdep00mass_4 



State Library of Masse 
State House, Boston 



Massachusetts Department of 

Public Welfare 

Steven A. Minter, Commissioner 



Statistical Supplement 

to the 
Annual Report 



Fiscal Year 1973 

Office of Research and Planning • Division of Analysis 



Public 
Alfred 



Document No 
C. Holland, 
Apr i 1 1 , 



8016. Approved 
State Purchasing 
1974 



by 

Agent 




STEVEN A. MSNTER 

COMMISSIONER 



COMHOHHEALTH OF MASSACHUSETTS 
D«p*rt»«nt of Public tfelfar* 



TOi Steven A. Minter, Commissioner OATll March 15, 1974 

FRQMi Sumner J. Hoisington, Assistant Commissioner tor Research & Planning 
RE I 



I am pleased to transmit to you the Fiscal Year 1973 Statistical 
Supplement to the Annual Report. This supplement was prepared 
by my staff, principally under the direction of Herold Doherty, 
Director of Research. It includes statistical information in 
tabular form, charts and graphs and an analysis of these data 
in narrative form. 

I believe that this report represents a significant step in 
our continuing efforts to present reliable information in a 
readable and usuable format. 

Acknowledgement is gratefully given to Mr. Kenneth Buck, 
Office of Planning and Management, Executive Office for 
Administration and H nance, for designing the cover for this 
report. 



SJH/icf 



CONTENTS 



Foreword i. 
Data Sources ii. 

Part I 
Public Assistance 

Page 

Expenditures 1969-1973 1 

Caseload A 

Expenditures 1973 compared to 1972 5 

Regional Differences in Caseload and Payments 6 

Total Expenditures By Program 7 

Medical Assistance 

Total Medical Expenditure 8 

Chart: Medical Vendor Payments, 1969-1973 9 

Average Monthly Caseload Eligible for Medical Care 10 

Eligible recipients and medical payments by type of case 11 

Average Monthly Payments per recipient by category of assistance 12 
Medical Assistance (Title XIX) 

Comparison of caseloads and payments, 1972-1973 13 

Distribution of Expenditures by type of medical service 13 

Recipients, Expenditures and Average payments, 1968-1973 14 

General Relief - Distribution of Medical Expenditures by type 15 

Old Age Assistance 

Caseload and Payments 16 

Social Services 17 

Comparison with Other States 18 

Aid To Families With Dependent Children 

Caseload and Payments '9 

Social Services 20 

Work Incentive Program 21 

Selected Characteristics 22 

Comparison with Other States 23 

Disability Assistance 

Caseload and Payments 24 

Social Services 25 

Comparison with Other States 26 

General Relief 

Caseload and Payments 27 

Comparison with Other States 0A 



Part II 
Child Welfare Services 



Caseload and Expenditures 
Applications and Referrals 
Age and Length of Stay 
Children Taken into Care 
Location of Children 
Reasons for Discharge 
Services to Unwed Mothers 
Abused Children 



FOREWORD 



This supplement to the Annual Report of the Department of Public Welfare, 
for the first time, incorporates data from a computer orientated data collection 
system. 

Since the last supplement, for the Fiscal Year 1971, significant changes 
have taken place both in the manner in which the data is collected and in the 
definition of the terms used to describe this data. Because of these changes, 
comparison with past data requires adjustments and trend analysis is most 
difficult. 

In this report we have endeavored to develop many series of comparable data, 
both for caseloads and expenditures, so that the reader will have an idea of the 
changes over time, at least in general terms, experienced by the Welfare Department. 

To further aid the reader we have included in the next section a detailed 
explanation of the sources of data and each table in the report will have the 
source designated. 

The preparation of this document was the joint effort of many people in the 
Research and Planning Office of the Department of Public Welfare. Special credit 
however for the final product should go to Diane Ericksen, Marlene Knoll and John 
Keohane who rewrote and edited the final draft and to the typists, Gail Hescock 
and Joanne Tidd who prepared the final copy. 

Hopefully, this report is both readable and informative to the citizens 
interested in the operations of the Massachusetts Department of Public Welfare and 
they will have a better appreciation of the complexity of the Welfare System and 
the overall magnitude of the assistance supplied to the citizens of the Commonwealth. 

Herold Doherty 
Director of Research 



ii 

Sources of Data 



RSI Series - A series of forms submitted by each Welfare Service Office giving 
caseload and expenditure data. Manually produced and processed. 

Monthly Summary Expenditure Report - A computer printout giving the expenditures 
by program for direct payments, including the flat grant. In existance since 
April, 1973 for all cash assistance programs except General Relief. 

RS 2079 - A report, processed manually, from a ten percent sample of all caseworke 
having responsibility for a caseload, both Child Welfare and Public Assistance. 
Approximately half of the sample responded. 

Public Assistance Statistics - June 1973 - A report numbered A-2 published by the 
Department of Health, Education and Welfare, National Center for Social Statistics. 

Raymond Trial Balance Records -Account of Expenditures, adjusted for Accounts 
Payable and encumbered funds. 

Participant Characteristics : Form MA5-99 Division of Employment Security 
Program Activity * Form MA5-98 Division of Employment Security 

Status of Appropriations Account ; Department record showing expenditures^ encumbrance 
and balances in Appropriation accounts for each fiscal year. 

Recap of Recipient Payroll - Number of cases receiving a direct payment for each 
payroll period. A caseload was determined by averaging the two counts. 



Part I 
Public Assistance 

Expenditures 1969 - 1973 

In Fiscal Year 1973, total expenditures by the Department of Public Welfare 

reached $996,192,669. After adjustments were made for encumbrances (1973 appropriated 

funds not spent until the 1974- fiscal year) and accounts payable (1972 appropriated 

funds spent in the 1973 fiscal year) the total expenditure reached over $900 

million, broken down as follows for the major segments: 

Social Services (Services and Administration) 30 4-10 4-54 
Administration 4-6 325 356 

Medical Assistance 386 370 557 

Income Maintenance U+\ 139 516 

Total* 904 2l£ 883 

In the table above the administration for Child Welfare Services has been 
added to Social Services. Medical Assistance includes all payments for medical 
care including payments for children under Child Welfare Services, mental hospital 
patients, and General Relief recipients. The income maintenance segment includes 
WIN payments along with Cuban Relief in addition to the four major categories of 
direct assistance. 

Compared to past years, expenditures in 1973 reached a new high. When we 
remove the Cuban Relief Programs which is 100% paid by the federal government, the 
Social Services programs and Administration, expenditures are almost double those 
of just five years ago. As seen in the table below } all the programs except Old Age 
Assistance and General Relief have shared in this overall increase. Old Age 
Assistance payments declined because of a shift of intermediate care facility 



*Source: Status of Appropriation Accounts 



patients to the Medical Assistance Program in July 197? thereby reducing payments 
by over $30,000,000 under OAA and General Relief declined because of an overall 
decrease in the size of the caseload. It is interesting to note that even though 
the ICF cases on the Disability Assistance Program shifted to Medical Assistance 
the caseload and expenditures both continued to rise. 

When we compare 1973 expenditures for Medical Assistance with the expenditure 
in past years we must take into consideration the 36 million dollar addition for 
Intermediate Care Facility costs previously paid for from the OAA and DA appropriatio: 



Total Payments in Millions 
1969 1970 1971 1972 1973 



All Programs 


$452.5 


$564.0 


$724.2 


$772.0 


$825.6 


Old Age Assistance 


56.4 


77.0 


85.3 


91.3 


71.5 


Medical Assistance 


226.9 


252.9 


304.8 


348.5 


371.0 


Aid to Families With 


128.1 


172.8 


245.1 


239.8 


286.2 


Dependent Children 












Disability Assistance 


19.7 


25.2 


32.4 


37.1 


45.0 


General Relief 


21.4 


36.1 


56.6 


55.3 


51.9 



Source: 1969 - 72, RSI Series; 1973, Status of Appropriation Accounts, Adjusted. 

The largest portion of total expenditures has been paid for medical care under 
the Medical Assistance Program. This has been true since the inception of the 
program in Fiscal Year 1967. Medical Assistance Payments have continued to rise 
since 1967 and reached a new high in 1973 of $371 million. Without the added 
expenditure for ICF's a decrease over 1972 would have been experienced. 

The second largest portion of total expenditures was for the AFDC Program. 
AFDC expenditures continued to rise each year until 1972 when they fell about i z 
million. In 1973 they again increased to reach a new high of $286.2 million. 

Although Old Age Assistance expenditures declined in 1973 due to the transfer 
of ICF cases to Medical Assistance along with the decline in caseload, expenditure 
for Disability Assistance continued to increase despite the transfer of ICF cases 
to Medical Assistance. 

The following chart illustrates the charges in expenditures over the years 
since 1967. 

-2- 



Millions 
of Dollars 



Total Expenditures for Public Assistance Programs, Fiscal Years 1 967-1 973 



Total 




1967 1968 1969 1970 1971 1972 1973 

Source: RS 1 Data - 1967-72,' Status of Appropriations-1973, Adjusted. 

-3- 



Caseload 



Average Monthly Caseload * 



FY 1972 FY 1973 Difference % of Change 



All Direct Payment Programs 


196 


529 


192 


015 


- 4 


514 


- 2.3% 


Old Age Assistance 


62 


737 


57 


148 


- 5 


589 


- 8.9% 


Aid to Families with 
Dependent Children 


79 


618 


83 


952 


+ 4 


334 


+ 5.4% 


Disability Assistance 


22 


168 


25 


252 


+ 3 


084 


+13.9% 


General Relief 


32 


006 


25 


663** 


- 6 


343 


-19.8% 


Medical Assistance 


240 


355 


254 


788*** 


+14 


433 


+ 6.0% 



The average monthly caseload for all direct payment programs (Old Age Assistance 
Aid to Families with Dependent Children, Disability Assistance, General Relief) 
decreased by 2.3% and by approximately 4500 cases, from FY 1972 to FY 1973. The 
largest decrease occurred in the General Relief program where the average monthly 
caseload was down 19.8%. 

In contrast to the decrease in direct payment caseloads, the average monthly 
Medical Assistance caseload increased 6.0% from FY 1972 to FY 1973. 

The decline in the General Relief caseload is somewhat overstated as there is 
no comparable data for Fiscal Year 1973 when compared to earlier years. In addition 
to the 22681 cases who on each payroll received a money payment we may perhaps have 
another 4 or 5 thousand who have a vendor medical payment made for them or who 
receive assistance in the form of a vendor maintenance payment. At the present 
time there is no way to determine exactly how many cases receive assistance through 
the vendor payment system or assistance for part of one month. 



* Source: RS 1 data: All of 1972 and July 1973 for 0AA, DA, AFDC, GR 

Payroll Recap Sheets: August 1972 - April 1973 0AA, DA, AFDC, GR 
August - June. 

Summary of Expenditures: May - June 1973 0AA, DA, AFDC. 

Medical Assistance: Recap Sheets, RS 1, Summary of Expenditures Report. 

** Estimate included for vendor payment only cases. 

*** Estimate includes GR Families and Foster Care Children but not GR Adult cases. 



Expenditures. 1973 compared to 1972 

Compared to 1972, Expenditures in 1973, after being adjusted for accounts 
payable and unexpended funds from the 1973 appropriation, were in total about 
53.6 million dollars higher. The table below shows that the largest increase in 
dollar terms was for the Aid to Families with Dependent Childrens Program closely- 
followed by the Medical Assistance Program. In percentage terms the program having 
the largest percentage increase, year-to-year, was Disability Assistance, closely 
followed by the AFDC program. 

Payments 
Millions of Dollars 





1972 


1973 


Difference 


Percentage Change 


All Programs 


$772.0 


$825.6 


+^3.6 


+ 6.9 


Old Age Assistance 


91.3 


71.5 


- 19.8 


-21.7 


Medical Assistance 


348.5 


371.0 


+ 22.5 


+10.6 


Aid to Families with 










Dependent Children 


239.8 


286.2 


+ 46.4 


+19.4 


Disability Assistance 


37.1 


45.0 


+ 7.9 


+21.3 


General Relief 


55.3 


51.9 


- 3.4 


- 6.1 


Source: 1972 - RS 1 


Series 1973 - Status of Appropriation Accounts. 



In 1973 lower expenditures were made both on Old Age Assistance Program and 
the General Relief Program due to the transfer of ICF cases to Medical Assistance 
in the case of OAA along with a decline in caseload and for General Relief a 



decline in caseload. 



-5- 



Regional Differences in Caseload and Payments, June 1973 



Region 


Total U 


Percent 

i/lSX/JTlD. 


Net Direct 2J 
Payments 


Percent 

T~i-" e*4- -r* V 

U2.S trio. 


Average 

I dyiucll L 


ix)3xon 


45 OUO 




$11 


222 


067 






Greater Boston 






6 


883 


973 


1ft 1<£ 




Springfield 


21 838 


12.5% 


A 


885 


546 


12.8% 


$224 


Lavrence 


21 090 


12.1% 


4 


278 


609 


11.2% 


$203 


New Bedford 


19 684 


11.356 


3 


883 


705 


10.2% 


$197 


Worcester 


17 198 


9.9% 


3 


513 


492 


9.2% 


$204 


Brockton 


16 284 


9.3% 


3 


453 


905 


9.1% 


$212 


Total - All Regions 174 405 


100.0% 


$38 


121 


297 


100.0% 


$219 


Source: Monthly Summary 


of Expend! 


tures , 


July, 1973. 







_l/ Number of cases all programs, receiving a cash grant. 
_2_/ Payments not adjusted for refunds. 



The above table shows the relative size of the department's regions in terms of 
the total caseload and net direct payments, based on the June 1973 data. The 
rankings by caseload and total payment are identical. 

The Boston Region, the largest, accounts for 26.1% of the caseload ** *> f 
of the total direct payment. Therefore, the average payment per case in th_s region 
is higher than the state average. 

The Springfield Region has the third largest caseload and the average 
payment per case in this region is also higher than the state average be cause the 
region's proportion of total expenditure is greater than its proportion of total 
caseload. 

In the five remaining regions their proportions of total expenditures are 
less than their proportions of total caseload, and therefore their average payment 
per case is less than the state average. 

The average payment per case also depends on the region's total caseload 
compoSti"! Rfgionf with P a large proportion of AFDC cases would tend to have a 
higher average payment since the average payment per AFDC case is higher than that 
fol Other programs because an AFDC case usually comprises two or more recipients. 



-6- 



Distribution of Public Assistance Expenditures by Program, pisoal Year 1973 
Total Expenditures: $825 607 741 




This chart illustrates the relative size of the various programs which together 

account for the total expenditures for Public Assistance, By far the largest 

portion of total expenditures is for payments to medical vendors for various 

types of medical care. Over 44.9 percent of the total expenditures is acoounted 

for in this way. Another 34«7 percent is for expenditures under the Aid to 

Families With Dependent Children Program. The Old Age Assistance portion accounts 

for 8.7 percent, the General Relief portion } which includes over $15 000 000 in 

medical vendor payments, 6.3 percent, and the Disability Assistance portion, 

5.4 percent. The Cuban Relief Program, 100 percent matched, is omitted from this 
chart . "7 - 



Medical Assistance 



Total Medical Expenditures 

In describing the medical expenditures for fiscal year 1973 the following 
table will perhaps be of assistance. Because of the delay in processing claims 
and the transition from a manual to a computer payment system for vendor medical 
bills, the amount of money actually paid to vendors is less than the total claims 
made by the vindors for payment. As the appropriation was based on the claims 
rather than actual payments a difference between expenditures in fiscal terms and 
statistical terms is evident. In the long run these differences will disappear 
and in fact in the present fiscal year 1974, actual payments will out run medical 
care appropriations by an estimated 80 million dollars as the encumbrances from 
fiscal year 1973 are expended. 

Medical Payments Fiscal Year 1973 
(In thousand dollars) 



Exp. of funds Less Plus Acct. 

Appropriated Encumbrances Payable FY 1972 Payments 1 



Direct Medical Assistance 


$421 


086 


$67 216 


$ 826 


$354 


697 


Tewksbury Hospital 




130 


10 


12 




131 


Mental Health 


13 


349 


2 200 


2 282 


13 


431 


City & Towns Reimb. 




75 








75 


General Relief* 


30 


246 


14 875 




15 


371 


Child Welfare* 


1 


808 


426 


1 283 


2 


666 


Total 


&66 


694 


$84 727 


$4 403 


$386 


371 



* Estimated 



Source: Status of Appropriation Accounts, June 1973. 



As seen on the chart on the next page, two types of medical services, 
Nursing Home Care and Hospital Care, account for approximately two thirds of the 
total medical care budget each year. The proportion of total medical costs 
accounted for by these services and the relationship to one another have remained 
relatively constant over the five year span. 

Under the individual sections for program data we show the breakdown of 
expenditures for both Medical Assistance under Title XIX and General Relief by 
type of service. (See Contents). For both programs together we find that Title 
XIX expenditures account for 96 percent of the total or $370,999,337 and General 
Relief about 4 percent or $15,371,220. When we combine General Relief and Title 
XIX expenditures ($386,370,557) we find that In-patient Hospital Care accounts for 
34.5 percent of the total. Acute Hospitalization alone accounts for 21.8 percent 
with chronic hospitalization accounting for the remainder or 12.7 percent of total 
medical costs. 



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Expenditures for Nursing Home Care account for 29.5 percent of total medical 
costs or just under $114. million. A very small part of this expenditure was for 
General Relief Adults. 



Intermediate Care Facility Payments accounted for 9.4 percent of the total, 
Drug Suppliers 6.3 percent, and Out-patient Departments of hospitals 4.7 percent. 

Using the medical identification card count, an estimate of the number of 
cases by type of case can be made for the fiscal year. Just over 280 thousand cases 
and 530,000 persons were eligible to receive medical assistance each month. About 
88,500 of these cases were eligible to receive mec'.ical care only. 



Average Monthly Caseload Eligible for Medical Care 

Category of Assistance Direct Payment Cases Medical Only Cases ** Total 

Old Age Assistance 57 148 47 493 104 641 

Disability Assistance 25 252 4 788 30 040 

Aid to Families with 83 952 7 576 91 528 

Dependent Children 



General Relief 

Other Needy Children 
Under 21 



25 663* 



28 578** 



25 663 
28 578 



All Programs 



192 015 



88 435 



280 450 



* Includes estimate for Vendor Only Cases 
** Breakdown estimated - Other Needy Children includes estimate for General Relief 
Families and Foster Care Children. 



As can be seen in the table above, the aged cases account for the largest 
percentage of eligible cases or over one third. The Families with Children account 
for almost one half or about 120,000 cases. Of the total eligible persons or 530 
thousandi about 280 thousand are children and 105 thousand over 65 years of age. 

Based on Medical Vendor data for November 1973 and reports from earlier years 
we find that even though aged persons account for less than one fifth of the total 
eligible persons they account for over half the total payments. The less than one 
tenth of total persons who are aged and receiving medical care only,in fact, account 
for about forty percent of the total medical payments. Conversely Family cases 
which include 370,000 persons or about 70 percent of the persons > account for only 
about one fourth of the payments. 



-10- 



Eligible Recipients and Medical Payments by Type of Case 



Average Monthly Number of Medical Payments 

Type of Case Eligible Recipients (aillion dollars) 

Persons 65 and over 

Direct Payment 57 U8 

Medical Only 4-7 493 166.1 
Disabled Persons 

Direct Payment 25 252 38.6 

Medical Only A 788 27.0 

Persons in Families 

Direct Payment 293 832 73. A 

Medical Only 26 516 7.7 

Other Needy Children 47 156 11.6 

General Relief 

Adults 29 000 (est) 15.4 

Total 531 185 386.3 

The table above shows a breakdown of the total payments and recipients by the 
type of case. Although by far the majority of cases are children and adults in 
families receiving a direct payment (about 300,000) only one fifth of total 
medical payments are made for this type of case. 

Now we have seen the total payments, the type of services paid for and the 
eligible cases receiving these services each month. The table above combines the 
recipient counts rather than cases with expenditures by type of case and category 
of assistance to show exactly for what types of case the most funds are expended. 
The table on the next page goes deeper and shows the wide variation in average 
payments and some explanation for these wide differences. Even though the medical 
only cases have larger resources the average per case eligible for medical 
assistance is greater because of the differences in services received and amount 
of services received per recipient. 



-11- 



Average Monthly Payment by Category of Assistance 



The average payment per case and per person varies from program to program 
and illustrates this point very well. In the table below we show the average 
payment per person by category of assistance for each of the eligible persons in 
that category. 



Category of Assistance 

Old Age Assistance 

Disability Assistance 

Aid to Families with 
Dependent Children 

General Relief 

Other Needy Children 

All Categories 



Average Monthly Payment for Medical Care 
Direct Payment Recipient Medical Only Recipient 



$ 67.61 
127.50 
20.82 

44.17 
$ 35.73 



$291.51 

470.70 
24,30 



20.48 
$140.60 



The overall average payment per person for all the eligible persons was 
$60. 60 in Fiscal Year 1973. With the Related Cases (Medical Only Gases) a much 
higher percentage of the eligible persons are apt to have a payment made for them 
than the cases receiving a direct payment. This accounts in large part for the 
difference in the average payment between direct and related cases. The difference 
between programs for related cases and direct payment cases can be explained by 
the higher use of institutional facilities (long term case) by the adults and the 
influence of Medicare payments for the aged when compared to Disability Assistance. 



-12- 



Medical Assistance 
(Title XIX) 

Comparison of Average Monthly Recipients of MA and Payments, FY 1972 and FY 1973 

FY 1972 FY 1973 Percent Increase 

Average Monthly No. Recipients* 226 352 226 713 + 0.2 

Total Payments (in Millions) $348.5 $371.0 +10.6 

Ave. Monthly Payment/Recipient $128.30 $136.37 +10.6 

* Estimated from RS 1D data 

The Medical Assistance program showed a substantial increase in average 
payment and expenditure. For the Fiscal Year 1973, 371 million dollars, of which 
over $36 million was for Intermediate Care Facilities, was paid to vendors for 
Medical Care. This is an increase of 10.6 percent over 1972, but without the 
addition of ICF's as a type of medical care L$ decrease would have been experienced, 



The Medical Assistance Program covers the medical needs of clients who are 
aided financially in the direct payment programs (0AA, AFDC, DA and GR children), 
as well as those low income families and individuals who cannot afford medical 
care. The types of medical care needed and provided can be seen in the following 
table . 

Distribution of Expenditures in Medical Assistance Program 
by Type of Medical Service. Fiscal Year 1973 



Type of Service Expenditures Percentage Distribution 

Total - All Services $370 999 337 100.0$ 

Total Inpatient Hospitals 123 178 726 33.2 

Acute Hospitals 77 253 627 20.8 

Chronic Hospitals 45 925 099 12.4 

Licensed Nursing Homes 113 844 '»37 30.7 

Intermediate Care Facilities 36 242 699 9.8 

Drug Suppliers 23 462 967 6.3 

Physicians 19 459 254 5.2 

Outpatient Departments 16 660 470 4.5 

Dentists 16 348 959 4.4 

Other Licensed Medical Practitioners 6 186 143 1.7 

Public Medical Institutions 6 174 660 1.7 

Laboratories and Radiological Services 1 502 365 0.4 

Other Medical Services* 7 938 957 2.1 



* Includes other medically-related needs such as transportation, personal care 
needs, Medical Advisory Board, and third party payments (for example, Health 
Maintenance Organizations). 



-13- 



Medical Assistance* 
ReclpientSj Expenditure and Average Payments 

Monthly Average Payment 



Fiscal Year 


Total Expenditure 


Average Monthly Recipients 


per recipient 


1968 


$189 918 779 


203 954 


77.60 


1969 


226 921 568 


237 263 


79.70 


1970 


252 931 893 


229 526 


91.83 


1971 


304 840 298 


233 208 


108.93 


1972 


348 491 998 


226 352 


128.30 


1973 


370 999 337 


226 713 


136.37 



* Estimate based on RS 45; RS 1D and Status of Appropriations data - does not 
include GR Expenditures for Adult Recipients. 

The table above shows the average number of recipients (people for vhom a 
medical payment was made) for each year since 1968 and the total fiscal year 
expenditure. The average monthly payment per recipient has increased steadily. 
Administrative changes and inflation has limited the increase in recipient count. 
The rising average payment reflects the increased cost of particular medical 
services and the increase in cases having large medical bills and care relative 
to the number of persons having only incidental payments made for them. 




Distribution of Medical Expenditures for General Relief Recipients 
by Type of Service, FY 1973* 



Type of Service Expenditures Percentage Distribution 



Total - All Services 


$15 371 


220 


100.0* 


Total Inpatient Hospital Care 


10 045 


753 


65.3 


Acute Hospitals 


7 0^3 


047 


45.8 


Chronic Hospitals 


3 002 


706 


19.5 


Licensed Nursing Homes 


100 


927 


0.7 


Intermediate Care Facilities 


32 


003 


0.2 


Drug Suppliers 


938 


782 


6.1 


Physicians 


1 065 


840 


6.9 


Outpatient Departments 


1 586 


879 


10.3 


Dentists 


1 073 


357 


7.0 


Other Licensed Medical Practitioners 


214- 


797 


1.4 


Public Medical Institutions 


5 


472 


0.1 


Laboratories and Radiological Services 


59 


825 


0.4 


Other Medical Services 


247 


585 


1.6 



For General Relief Medical Expenditures, Hospitalization accounted for 65.3* 
of the total, and Acute Hospitalization alone accounted for 45.8*. This proportion 
is almost double that for MA expenditures vhere Hospitalization accounts for 33.2* 
of total expenditures • Again 3 the allocation of expenditures for Outpatient Departments 
under GR (10 o 3*) was over twice the amount under the MA program (4.5*). While GR 
medical expanses for Licensed Nursing Homes and Intermediate Care Facilities were 
relatively small., the distribution of other medical expenses was similar to that 
under the MA program 



* Distribution based on previous years percentages. 



-15- 



Old Age Assistance 
Comparison of Average OAA Caseload and Payments FY 1972 and FY 1973 





FY 1972 


FY 1973 


Percent Change 


Ave. Monthly Caseload 


62 737 


57 148 


- 8.956 


Total Payments (in Millions) 


$ 91.3 


$ 71.5 


- 21.7* 


Ave. Annual Payment/Case 


$ 1 455 


$ 1 251 


- 14.0* 


Ave. Monthly Payment/Case 


$121.23 


$104.23 


- 14.0* 



The average monthly OAA caseload decreased by 8.9* from FY 1972 to FY 1973. 
Most of this decrease (7.9*) was due to the transfer of ICF cases into the Medical 
Assistance program as mentioned previously. Another factor causing a decrease in 
the average monthly OAA caseload was the increase in OASDI payments during FY 1973 
which raised the income of many recipients above the maximum income allowed under 
the OAA program. These changes also effected a decrease in the OAA total expendi- 
tures, average annual payment per case, and average monthly payment per case. 

Average Monthly OAA Caseload. Fiscal Years 1970 - 1973 
Fiscal Year Average Monthly Caseload Change from Previous Y« 

1970 55 347 + 9.6% 

1971 58 994 + 6.6* 

1972 62 737 + 6.3* 

1973 57 148 - 8.9* 

The average monthly Old Age Assistance caseload increased from 1970 through 
1972 and then decreased in FY 1973. However, the rate of increase was decelerating 
in the period of 1970 - 1972. 



-16- 



Old Age Assistance 
Sooial Services Provided in Pisoal Year 1973 



Average Monthly Number of Cases 

Receiving at Least One Service* 6 114 

Percent of OAA Caseload 10*7 

Average Monthly Number Receiving 
Each Type of Service** 

To Meet Health Needs 1 943 

Homemaker or Aide 1 108 

Adult Protective Service 926 

Counselling Services 892 

Housing Services 451 

Chore Services 280 

Legal Services 149 

Community Adjustment 91 

Educational -Training 40 

Other Unspecified Casework Services 1 543 



Source: RS 2079 for Fiscal Year 1973 
* Based on a five percent sample for one month of each quarter. 
** Some cases receive more than one service each month. 

The above table shows that almost 11^ of the Old Age Assistance cases receive 
some form of sooial service in the average month. The two most common services 
required were primarily to meet health needs for 32^ of the service oases, and 
secondly to provide Homemaker or Home Aide services for another I856 of the OAA 
oases requiring sooial service. 



-17- 



Old Age Assistance 
Hational and State Average Payments in June 1973 



State 


Rank 


Average Payment 


New Hampshire* 


1 


$170.79* 


Wisconsin 


2 


$158.01 


Alaska 


3 


$118.42 


California 


4 


$112.21 


IlcLWcLXX 


R 

J 


41 C\(\ Q7 


West Virginia 


6 


$104.71 


New York 


7 


$102.90 


Massachusetts 


8 


$102.64 


North Dakota 


9 


$ 95.14 


District of Columbia 


10 


$ 94.62 


National 




$ 78.78 


Source: Public Assistance 


Statistics, 


June, 1973, NCSS, DHEW. * 



* Nursing Home Care was included in average payment. 



In June 1973 » Massachusetts granted an Old Age Assistance average payment of 
$102,64 which was exceeded by seven other states. However, in one of these 
states, New Hampshire, the cost of nursing home care was included in the 
average payment. The Massachusetts average 0AA payment was $23.86 higher 
than the national average. 



18- 



Aid to Families With Dependent Children 
Comparison of Average AFDC Caseload and Payments FY 1972 and FY 1973 





FY 1972 


FY 1973 


Percent Increase 


Average Monthly Caseload 


79 618 


83 952 


+ 


5.4* 


Total Payments (in millions)* 


$239.8 


$286.2 


+ 


19.4* 


Average Annual Payment/Case* 


$3 011 


$3 409 


+ 




Average Monthly Payment/Case* 


$250.95 


$284.11 


+ 


13.2* 



The average monthly AFDC caseload increased 5.4* from FY 1972 to FY 1973, 
while the total payments or expenditures increased 19.4* during the same period. 
The average annual payment per case increased from $3 011 to $3 409 or 13.2*. 
Similarly, the average monthly payment per case increased 13.2* from $250.95 
in FY 1972 to $284.11 in FY 1973. 



Average Monthly AFDC Caseload. Fiscal Years 1970-1973 
Fiscal Year Average Monthly Caseload Increase over Previous Year 



1970 56 392 24.2* 

1971 71 016 25.9* 

1972 79 618 12.1* 

1973 83 952 5.4* 



The above table demonstrates a downward trend in the rate of increase in the 
average monthly AFDC caseload for the Fiscal Years 1971 through 1973. 



* Includes Work Incentive Program expenses. 



-19- 



Aid to Families With Dependent Children 



Social Services Provided in Fiscal Year 1975 



Average Monthly Number of Cases 

Receiving at Least One Service* 27 788 

Percent of Caseload 33.1 

Average Monthly Number of Children 

Receiving at Least One Servioe 47 013 

Percent of Children in Caseload 22.4 

Average Monthly Number of Cases 
Receiving Each Type of Service** 

Counselling Services 10 234 

To Meet Health Needs 7 556 

Educational -Training 6 842 

Housing Services 5 381 

Legal Services 4 038 

Child Care Services 3 249 

Children's Protective Services 1 612 

Family Planning 1 527 

Work Incentive Program 1 234 

Homemaker or Aide 907 

Foster Care 235 

Adoptive Services 101 

Other Unspecified Casework Services 4 550 



* Based on a five percent sample for one month of each quarter. 

** Some cases receive more than one service. 

Source: RS 2079 Social Services 

Almost one-third of the AFDC cases receive some form of social service in 
an average month. The most frequent type of service given each month was that of 
counselling for over 10 000 families (or 12$ of caseload). The second most common 
service for AFDC families was provided for health needs. An average 7 500 cases 
or 9$ of the caseload, received this service each month. Another 6 800 cases, or 
8$ of the average monthly caseload, received supportive help in regard to Training 
and Education each month. Almost 5 400 oases, or 6.4$ of the AFDC cases required 
Housing Services and over 4 000, or approximately 5$ of the caseload, received 
Legal Services in an average month. 



-20- 



Aid to Families With Dependent Children 
Work Incentive Program Activity Summary for Fiscal Year 1973 * 



Number of Registrants 

Number Interviewed and Appraised 

Total Participants 

Number Attaining Employment 



30 960 

17 384 
11 176 
3 274 



Estimated Savings in Welfare Payments f 5 322 000 
Characteristics of WIN Participants t * 

Total Participants 

Sex 



Number 
11 176 



Percent 
100.0 



Male 


4 134 


37.0 


Female 


7 042 


63.0 


Education 






7th Grade or less 


1 085 


9.7 


8th - 11th Grade 


5 248 


47.0 


High School Graduate 


3 872 


34.6 


More than High School 


971 


8.7 


Age 






21 years or under 


2 005 


17.9 


22 - 44 years 


7 953 


71.2 


45 - 54 years 


1 087 


9.7 


55 years and over 


131 


1.2 



Work Incentive Program Activity 

Almost 31 thousand people in the AFDC program registered with the Division 
of Employment Security for the Work Incentive Program. Of that number, 17 384 were 
screened and interviewed to see under what conditions the goal of self-support 
could best be obtained. The number of those screened that actually participated 
in a work training or placement program exceeded 11 thousand or 64 percent and re- 
sulted in employment for 3 274 persons. 



The difficulty in finding suitable employment for participants can readily be 
discerned when we review the characteristics of the people under the program. Un- 
fortunately, almost 57 percent have failed to finish High School and approximately 
10 percent have not attended a high school at all. As would be expected* the 
average age of a participant is relatively low, as the registrants are taken from 
a population that is relatively young, for the grantee is either a woman in her 
child bearing years, a father of relatively young children or the older children 
in an AFDC assistance group not attending sohool, and disabled persons. A large 
proportion, or 63 percent, of the participants are women, many of them voluntary 
registrants who hope to obtain some measure of self-support. 

* This data was taken from Forms MA-5-99 (Participant Characteristics) and Form 

MA-5-98 (Program Activity) reported by the Division of Employment Security % June 1 1973. 



-21- 



Selected Characteristics of Aid to Families With Dependent Children Caseload 

January 1971 vs July 1973 



Characteristic 


January 1971 


July 1973 


Number of Persons per Case 






Total 


3.8 


3.5 


Adults 


1.1 


1.0 


Children 


2.7 


2.5 


Age of Children in Caseload 






Percent under 7 years 


38.7 


37.7 


Percent 7-12 years 


35.7 


36.5 


Percent 13-20 years 


25.6 


25.8 



It appears that two relatively important changes are taking place in the AFDC 
caseload. The size of the "average family" is decreasing. Both the average number 
of adults and the average number of children decreased from January 1971 to July 
1973. However there was a greater decrease in the average number of children per 
case. In January 1971, every hundred AFDC cases included 380 persons, whereas in 
July 1973 only 350 persons were included in each 100 cases. The number of children 
declined from 270 per 100 cases to 250 per 100 cases. 

Another change in the AFDC caseload occurred in the same period. There was a 
slight decrease in the proportion of children under 7 years old and conversely, an 
increase in the proportion of older children. 



Living Arrangements of People in AFDC Cases 
1967 vs 1973 



Living Arrangements 


1967 


1973 


Own Home 




8.7% 


Renting 


95. 4% 


91.3% 



In a study conducted in 1967 it was found that only A. 6% of the people in 
AFDC cases were living in a home owned or being bought by a member of the assistance 
group. However, a July 1973 AFDC sample indicated that this percentage of people 
living in their own home had increased to 8.7%. 



-22 



Aid to Families With Dependent Children 



National and State Average Payments in June. 1973 



State 


Rank 


Average Payment 


New York 


1 


$279.86 


Massachusetts 


2 


$264.43 


Wisconsin 


3 


$262.87 


Hawaii 


4 


$262.19 


New Jersey 


5 


$253.93 


Connecticut 


6 


$242.72 


Illinois 


7 


$238.^1 


Vermont 


8 


$233.44 


Pennsylvania 


9 


$233.06 


Michigan 


10 


$230.33 



National $188.63 

Source: Public Assistance Statistics . June, 1973, Report A-2, NCSS, DHEW. 

In June 1973, the average grant in Massachusetts for the AFDC program was 
$264.43 which included one-third of the "flat grant", a quarterly payment given 
to all cases for special needs. This average payment was exceeded by only one 
state, New York. The Massachusetts average AFDC grant was $75.80 higher than 
the national average. 



-23- 



Disability Assistance 

Comparison of Average DA Caseload and Payments, FY 1972 and FY 1973 

FY 1972 FY 1975 Percent Increase 

Average Monthly Caseload 22 168 25 252 +13.9% 

Total Payments (in Millions) $ 37.1 I 45.0 +21.2% 

Ave. Annual Payment /Case $ 1 674 I 1 781 +6.4% 

Ave. Monthly Payment/Case $139.50 SUB. 43 ♦ 6.4% 

The Disability Assistance caseload increased 13 .9% from FY 1972 to FY 1973 
even though some 700 ICF cases were transferred to the Medical Assistance program. 
This caseload increase was accompanied by a 21.2% increase in expenditures. The 
average payment per case also increased 6.4%, partly due to increased transporta- 
tion allowances for DA recipients. This increase occurred regardless of the fact 
that OASDI benefits also increased during FY 1973; such adjustments previously caused 
DA payments and caseload to decrease. 

Average Monthly DA Caseload, Fiscal Years 1970 - 1973 

Percent Increase 

Fiscal Year Average Monthly Caseload Over Previous Year 

1970 16 685 + 8.4% 

1971 18 951 + 13.6% 

1972 22 168 + 17.0% 

1973 25 252 + 13.9% 



The Disability Assistance caseload has been generally increasing in recent 
years, although the rate of increase has been fluctuating. 



-24- 



Disability Assistance 
Social Services Provided in Fiscal Year 1973 



Average Monthly Number of Cases 
Receiving at Least One Service* 

Percent of Caseload 



5 328 



21.1 



Average Monthly Number of Cases 
Receiving Each Type of Service** 

To Meet Health Needs 



2 601 



Homemaker or Aide 



Counselling Services 
Housing Services 



Chore Services 



Adult Protective Service 



Educational Training 
Legal Services 

Other Unspecified Casework Services 



1 717 
657 
455 
455 
328 
278 
126 



1 742 



* Based on a fine percent sample for one month of each quarter. 
** Some oases receive more than one service each month. 
Source: RS 2079 

Over 21$ of the total Disability Assistance cases require social services 
each month. Almost half of the social services are provided to meet health 
needs in an average month. The second most frequent type of social service 
for Disability recipients was that of counselling. 



-25- 



Disability Assistance 
National and State Average Payments in June 1973 



State 


Rank 


Average Payment 


Alaska 


1 


$169.99 


California 


2 


$151.70 


Hawaii 


3 


$149.74 


Massachusetts 


k 


$146.92 


New Hampshire 


5 


$U8.19 


Wisconsin 


6 


$142.62 


New York 


7 


$129.11 


Connecticut 


8 


$126.02 


Vermont 


9 


$117.73 


District of Columbia 


10 


$117.28 



National 



$107.85 



Source: Public Assistance Statistics , June, 1973, Report A-2, DHEW, NCSS. 

For the Disability Assistance program, Massachusetts ranked fourth with only- 
Alaska, California, and Hawaii having higher average payments per case in June 1973. 
The average payment in Massachusetts of $14.8.92 was $4.1.07 higher than the national 
average. 



-26- 



General Relief 

Comparison of Average GR Caseload and Payments FY 1972 and FY 1973 



FY 1972 FY 1973 Percent Change 

Average Monthly Caseload* 32 006 25 663* - 19.8* 

Total Payments (in millions) 55.3 51.9 - 6.1% 

Ave. Annual Payment/Case $ 1 729 $ 2 024. + 17.1 % 

Ave. Monthly Payment/Case $144.06 $168.67 + 17.1% 

* Includes GR Vendor Medical Cases Estimate 

The 19.8% decrease in the General Relief Caseload vas due to various factors 
such as a programmatic change requiring General Relief employable recipients to 
register regularly at the State Division of Employment Security where they would 
also receive their semi-monthly public assistance checks. Also, there exists a 
marginal relationship of many General Relief recipients to the work force, and the 
GR caseload, far more than that of the other programs of public assistance, is 
influenced by changes in the economy. Toward the end of FY 1972 and in FY 1973, the 
job market improved slightly and so unemployment decreased slightly. 

Average Monthly General Relief Caseload 
Fiscal Years 1970 - 1973 

Fiscal Year Average Monthly Caseload Change from Previous Year 

1970 19 722 + 48.6% 



1971 29 423 + 49.2% 

1972 32 006 + 8.8% 

1973 25 663 - 19.8% 



The General Relief Caseload had been steadily increasing until 1972 when the 
rate of increase was less than previous years. In FY 1973, the GR Caseload decreased 
substantially. 

The 19.8% decrease in GR caseload was accompanied by a 6.1% decrease in 
expenditures. The average payment or expenditure per case increased by 
17.1%. The $51.9 million in GR expenditures include approximately $36.5 million for 
recipient direct payments and non-medical vendor payments, and approximately $15.4 
million in payments to vendors for medical care for adult recipients who do not meet 
eligibility requirements for the federally reimbursed programs. 



-27- 



General Relief 
National and State Average Payments in June 1973 



State 

Hawaii 

New Jersey 

New York 

Massachusetts 

Michigan 

District of Columbia 

Connecticut 

Illinois 

Washington 

Pennsylvania 



Rank 
1 
2 
3 
4 
5 
6 

7 
8 

10 



Average Payment Per Case 
$180.97 
$160.13 
$150.12 
$134.58 
$132.27 
$129.28 
$121.33 
$120.84 
$120.50 
$119.41 



National $111 97 

Source: Public Assistance Statistics , June, 1973, Report A-2, DHEV, NCSS, 

The Massachusetts' average payment of $134.58 in the General Relief 
program ranked fourth in June 1973- This amount was $22. 6i higher than 
the national average for the same month. These data exclude Medical Payments 
made for GR recipients. 



-28- 



Part II 



CHILD WELFARE SERVICES 
IN 1973 

Caseload and Expenditures 

Both the caseload and expenditures for child welfare services showed a decline 
in Fiscal Year 1973 in Massachusetts when compared to the preceding year. Total 
expenditures under this program, which is administered by the Division of Family 
and Children's Services, fell almost five percent; from $31.9 million in 1972 to 
$30.3 million in 1973. Inspection of the chart on the next page will give an 
indication of how this $30.3 million was divided among the various types of expense. 

Child welfare service expenditure proportions in Fiscal Year 1973 did not 
differ appreciably from expenditure proportions in recent years. Care and main- 
tenance costs accounted for about 78 percent of the total; administrative costs, 
17 percent and tuition and transportation, 6 percent. 

The single largest expenditure category is that of board costs, comprising 
64 percent of the total expenditure in 1973. Of the $19. K million paid for board, 
about one-third went to foster parents with the remainder going to non-medical 
institutions. Approximately 2,200 children were cared for in these institutions 
each month at an average cost of about $5,000 per child. 

Approximately 6.6 percent of the total expenditure was for hospitalization of 
the children under care. About half of this expenditure is reimbursed by the federal 
government under Medicaid, as are the costs of doctors, dentists and medical supplies 
which account for almost two percent of the total expenditure. 

Over 5.6 percent of the total expenditure is given as reimbursement to the 
school districts in payment for the education and school bus transportation provided 
to children under our care. 



-29- 



CHILD WELFARE SERVICES 
PERCENT OF 

TOTAL EXPENDITURES BY TYPE, 1973 FISCAL YEAR 



TOTAL EXPENDITURE $30,322,794 




-30- 



Another one-sixth of the expenditure in 1973 was for the administration of 
the program, mostly for salaries, but also for other items of expense connected 
with the administration of a program involving 13 500 children over the course of 
a year. 

Expenditures for "other" include advertising for additional foster homes, 
transportation for the children out-of-state, general expense and other special 
services. 

Compared to the previous year, expenditures were below those of the year before 
in every category but "other". The Care and Maintenance account fell $1 360 000 or 
5.4 percent; Administrative Costs, $170 000 or 3.2 percent, and Tuition and 
Transportation, $65 000 or 3.7 percent. 

Expenditures 

Type of Expenditure Fiscal Year 1973 Fiscal Year 1972 



All Expenditures 


$30 


322 


794 


$ 31 


907 


912 


Care and Maintenance of Children 


23 


581 


538 


24 


932 


457 


Board 


19 


355 


690 


20 


227 


031 


Clothing 


1 


092 


373 


1 


221 


221 


Hospital Care 


1 


995 


063 


2 


272 


218 


Doctors and Dentists 




574 


878 




613 


471 


Medical Supplies 




95 


704 




176 


737 


Other 




4.67 


830 




421 


779 


Tuition and Transportation 


1 


703 


271 


1 


769 


019 


Administration 


5 


037 


985 


5 


206 


436 



The second chart on the next page shows that over the past five years expenditures 
continued to rise until 1972 when the first decline since 1957 was experienced. At 
that time total expenditures for child welfare were just over $3.5 million. 
Expenditures continued to climb due to a combination of higher caseloads, additional 



-31- 




-32- 



services and increased costs of the services given. In the last two years, the 
caseload and total expenditures have both fallen but the average per case expendi- 
ture has continued to rise. Compared to the caseload a year before, the number of 
children being served at the end of fiscal year 1973 was down 870 or almost eight 
percent. 

The decline in caseload was almost statewide as shown below. Only the 
New Bedford Region had a year to year increase in caseload in 1973. The Boston 
region had the largest decline in caseload in numbers (362) and percent (10.6). 
The Lawrence region had a 14 percent decline in caseload; the Brockton region a 
9.2 percent decline. 



Region or Unit 






Caseload 




June 


30, 1972 


June 30, 1973 


All Regions 


11 


150 


10 280 


Springfield 


1 


112 


1 057 


Worcester 


1 


472 


1 345 


Lawrence 


1 


004 


990 


Boston 


3 


400 


3 038 


Brockton 




904 


821 


New Bedford 




630 


704 


Adoption Placement Unit 


1 


042 


793 


Group Care Unit 


1 


586 


1 532 



-33- 



Applications and Referrals 

In the 1973 fiscal year, 3,393 applications and referrals were received by 
the Department of Public Welfare of which 2,738 or 80.7 percent were applications 
and the remainder referrals for neglected children. 

As seen below, of this number, plus the number on hand, a total of 3,771 appli 
cations and referrals were processed during the year, of which 2,317 resulted in 
the child being accepted for care and service. Of those processed, 82 percent were 
applications and the remainder referrals. 

NUMBER OF CHILDREN 
TOTAL STATUS 

Dependent Neglect 

Applications and Referrals 



on hand July 1 , 1972 


1 166 


1 122 


44 


Added during the year 


3 393 


2 738 


655 


TOTAL AVAILABLE 


4 559 


3 860 


699 


Processed during the year 


3 771 


3 093 


678 


Accepted 


2 317 


1 710 


607 


Not accepted 


1 454 


1 383 


71 


Remaining June 30, 1973 


788 


767 


21 



In 1972, 4,167 applications and referrals were processed with 2,723 or 65.3 
percent being accepted. In 1973, 2,317 out of 3,771 were accepted or 61.4 percent. 
Of the percentage that were accepted, or 2,723 in 1972, 27.8 percent were neglect 
cases and 72.2 percent were dependent cases. Of the 23 17 cases accepted in 1972, 
26.2 percent were neglect and 73.8 percent dependent. Compared to last year, there 
fore, there has been a slight shift from neglect status to dependent status of the 
children coming into care. 



-34- 



Age and length of stfry 

The children's age at intake ranged from under 1 year to almost 21 years, with 
the average age at seven. Almost 300 children were over 15 years and about 650 were 
three years or younger. The average age of a child under care is 10.7 years and the 
child has been under care for 3.4 years. In the previous year, the average child 
was younger (9.4 years old) and had been under care for a shorter period (just over 
2 years). Since 1966, the average age of a child under care had increased until 
1972 when it fell from 9.6 to 9.4 years. In 1973, the increase resumed and it 
reached the 10.7 year mark or a new high. 

In Fiscal Year 1973 the length of stay is longer than it has been in the last 
ten years. The average length of stay has varied from 3.1 years in 1964 and 1965 
to 2.1 years in 1972 over the 10 year span. 



AGE 



TOTAL 



Under 
6 mos. 



YEARS UNDER CARE 

6 mos. to 1 year 

under to 
one year 4 years 



5 years 

to 
9 years 



10 years 
and 
over 



All Ages 



10 280 



768 



901 



4 895 



2 735 



981 



Under 1 year 180 
1 yr. to 

under 5 1 719 

5 yrs. to 

under 9 2 260 

9 yrs. to 

under 13 2 473 

13 yrs. to 

under 17 2 522 

17 yrs. and 

over 1 126 



101 
203 
167 
116 
164 
17 



79 
238 
200 
172 
172 

40 



1 278 
1 139 
1 105 
973 
400 



754 
907 
743 
331 



173 
470 
338 



-35- 



Children Taken into Care 



From the table below we can see that the number of children taken into care 
in 1973 declined below the 1972 level and in fact is the lowest since 1965 when 
2199 children were taken into care. 



STATUS 


1973 




1972 




Number 


Percent 


Number 


Percent 


TOTAL 


2,317 


100.0 


2,723 


100.0 


Neglect 


607 


26.2 


758 


27.8 


TftmtviT*ft tv 


581 


25.1 


691 


25.4 


Permanent 


26 


1.1 


67 


2.4 


Dependent 


1,710 


73.8 


1,965 


72.2 


Intrastate 


1,684 


72.7 


1,903 


69.9 


Out of State 


26 


1.1 


62 


2.3 



A much larger proportion were neglect cases in 1973 however, compared to earlier 
years. Compared to 1972 the percent of cases coming into care with neglect status 
in 1973 is slightly lower than in 1972 but in 1971 only 17.6 percent of the children 
taken into care were neglect cases. 



From another viewpoint the percent of children coming into care under 
dependent status has declined. Although the percent increased from 72.2 in 1972 to 
73.8 in 1973 in 1969 and 1970 the percent dependent was 85.1 and 86.2 respectively. 
In 1971 the percent dependent was 82.4. 



-36- 



Location of Children 

At the end of the 1973 fiscal year, of the 10,280 children under care one 
half were living in a foster home with board and clothing paid for by the 
Department of Public Welfare. As seen from the table below another twenty percent 
were in a non-medical institutional setting having the same needs and other needs 





• 

Boarding Terms 




Location 


All Children 


Board, clothing 
or both 


Free 


Other 


All locations 


10,280 


7,427 


2,693 


160 


Adoption Home 


781 


42 


706 


33 


Foster Home 


5,292 


5,229 


36 


27 


Non-Medical Inst. 


1,908 


1,852 


48 


8 


Medical Institution 


255 


252 


2 


1 


With Parent 


1,492 


8 


1,460 


24 


With Relative 


381 


7 


345 


29 


Elsewhere 


171 


37 


96 


38 



Only 781 children or 7.5 percent of the total were living in an adoption home but 
of thosejover 90 percent were having all their nesds met by the adoptive parents. 

Last year, at the end of June, of the 11150 children in care, 1042 or 9.3 
percent were in adoptive homes under free boarding terms. The percent in non- 
medical institutions and foster homes with board and clothing provided by the 
Department of Public Welfare was about the same as this year, 49.4 percent and 
19.0 percent respectively. 
Reasons for Discharge 

The table on the next page shows the number of children who were discharged 
in the last five years and for what reason they were discharged. 



-37- 



REASONS FOR DISCHARGE OF CHILDREN 
FISCAL YEARS 1969 - 1973 



Reason for Discharge 

All Reasons 

To Parent 
To Court 
Adopted 

Self-supporting 
To Relative 
To Armed Forces 
Married 

To schools for Mentally 
defective 

Out of State 

Became of Age 

Died 

Whereabouts unknown 
To State Hospitals 
Other 



Number of Children 



1973 


1972 


1971 


1970 


1969 


3 187 


3 571 


3 605 


2 741 


2 396 


1 786 


2 115 


2 230 


1 548 


1 331 




113 


93 


87 


41 
** • 


556 


586 


571 


565 


522 


228 


200 


207 


136 


142 


169 


212 


222 


U9 


124 


31 


48 


37 


38 


48 


58 


50 


53 


63 


45 


3 


5 


5 


5 


5 


9 


3 


8 


9 


8 


98 


108 


65 


45 


43 


28 


31 


33 


34 


27 


65 


U 


46 


29 


30 


11 


5 


5 


4 


4 


40 


31 


30 


29 


26 



-38- 



In 1973, 3 187 children were discharged from care with the largest number and 
percent being returned to their parents. Over 55 percent were discharged for this 
reason. In 1972, 59.2 percent of the children were discharged to their parents. 
Over 17 percent of the children were adopted in 1973 or one percent more than in 
1972. 

More children became self-supporting than in 1972 (7.2 percent) and married, 
(1.8 percent), but the number going to a relative declined (to 5.3 percent) and 
to the armed forces (1 percent). About the same percent died, became of age 21 
and were discharged to the court, .9, 3.1 and 3.3 percent respectively. 

The number of children discharged has declined over the past two years and 
so has the number discharged to parents and to relatives. The largest number of 
discharges, over one-thirdj were in the Boston Regional Office. Five hundred and 
ten were discharged from the adoption placement unit in 1973 followed by the 
Worcester Region (495), Springfield (321), New Bedford (268), Lawrence (258) and 
Brockton (224). 
Services to Unwed Mothers 

Both the number of applications received for these specialized services has 
declined and the number of mothers receiving these services has declined. Services 
were completed for 311 cases of the 406 that received some service in the year or 
over three-fourths. 

Of the applications processed a relatively high proportion were not accepted 
for service compared to other years so that fewer cases were eligible for assistance. 

From the table on the next page we can see that less than 100 cases were 
receiving this type of care at the end of the 1973 fiscal year or only one-third 
to one-fourth the average number in recent years. 



-39- 



CHILD WELFARE SERVICES 
APPLICATIONS RECEIVED AND SERVICES GIVEN TO 
UNWED MOTHERS 
FISCAL YEARS 1970 - 1973 



Applications 


1973 


1972 


1971 


1970 


Applications pending at start of year 


78 


105 


. 116 


134 


Applications received 


1^0 


269 


449 


454 


Applications processed 


206 


296 


460 


472 


Accepted for service 


130 


248 


399 


397 


Not accepted 


76 


48 


61 


75 


Applications pending at end of year 


12 


78 


105 


116 


Services 










Receiving services at start of year 


276 


385 


396 


292 


Accepted for service 


130 


248 


399 


397 


Services completed 


311 


357 


410 


293 


Receiving services at end of year 


95 


276 


385 


396 



-40- 



Abused children 

The number of Investigations completed in 1973, (290), was much higher than 
it has been in recent years with the exception of 1972, when 320 investigations 
were completed. In 1971 only 191 were completed, in 1970; 129, in 1969; 87. The 
number of notices received was the greatest in 1973 (295) than in any year. In 
1972 only 212 notices were received, in 1971; 256 and in 1970; 175. 

After the notices were received, processed and the investigations completed 
in 1973, 98 or one-third of the children were in investigations that resulted in 
the finding that no further action was indicated. Ninety children or 31 percent in 
cases being accepted for service and 102 of the children were taken into care. 
(See following tables) 

By far the largest number of investigations were completed in the Boston 
Region which includes the City of Boston and most of Greater Boston. One hundrsd 
and ninety-seven notices were received and 188 investigations were completed in 
the region. The Worcester and Springfield Regions both had 29 notices and 31 
investigations completed. After Boston, the largest number of children that were 
taken into care were from the Worcester Region. 



-4-1- 



CHILD WELFARE SERVICES 
NUMBER OF ABUSED CHILDREN REPORTED TO 
THE DIVISION OF CHILDREN AND FAMILY SERVICES BY REGION 
FISCAL YEAR ENDING JUNE 30, 1973 



Total State 

Springfield 

Worcester 

Lawrence 

Boston 

Brockton 

New Bedford 



Investigations 
Pending June 72 

94 
12 

3 

4 
75 







Notices 
received 
during year 

295 

29 

29 

21 
197 

16 
3 



Investi- 
gations 
completed 

290 

31 

31 

23 
188 

u 

3 



Children 
not taken 
into care or 
supervision 

98 

12 

9 

4 

9 
1 



Total State 

Springfield 

Worcester 

Lawrence 

Boston 

Brockton 

New Bedford 



Taken under 
supervision 

90 

10 

9 

7 
U 







Total Children 



Under 



Under 



taken into care Section 23SA Section 25 



102 
9 
13 
12 
61 
5 
2 



46 
3 
9 
3 

30 
1 




24 
5 

6 
13 



Other 
Sections 

32 

1 

4 

3 

18 
4 

2 



-42- 



State He 



j;on 02133 



MASSACHUSETTS 

DEPARTMENT OF 
PUBLIC WELFARE 



Statistical Supplement 

to the 
Annual Report 



fiscal year 1974 




mi 



OFFICE OF RESEARCH AND PLANNING 



Public Document No. 81 92 Approved by 
Alfred C. Holland, State Purchasing 



1 





<2fy«*t*um* ^uMo Weft** 



600 WaJunpten ff erect. ^eMo* 020/ 



JERALD I. STEVENS 



COMMISSIONER 



TO: 



Jerald L . Stevens, Commissioner 



DATE: April 1, 1975 



FROM: 



Loran R. Bittman, Acting Assistant Commissioner, 
Research and Planning 



RE: 



FY 19 74 Statistical Supplement to the Annual Report 



I am pleased to transmit to you the Fiscal Year 1974 
Statistical Supplement to the Annual Report. This supplement 
was prepared by Herold Doherty, Director of Research, and 
reviewed by various members on my staff. 

The various tables and graphs together with the results of 
various analyses are expected to provide a valuable reference 
source to you, the Department, and other interested individuals 
and agencies. 



LRB : rk 
Attachment 



CONTENTS 



Foreword i 

Data Sources ii 

page 

Caseload and Expenditures «| 

Total Expenditures - Fiscal Year 1974. 2 

Revenue Estimates for Fiscal Year 1974. 3 

Comparison - Total Payments, Consumer Price Index 

and Adjusted Payments 3 

Chart: Comparison, Total Payments, Consumer Pric* Index 

and Adjusted Payments 4 

Total- Payments - Fiscal Years 1969-1974. 5 

Chart: Expenditures for Public Assistance Programs, F.Y. 1967-1974 6 

Expenditures by Program and Percent Change, Fiscal Years 1973-1974 7 

Total Medical and Direct Payments by Region by Program, June 1974 9 

Average Monthly Caseloads, F.Y. 1973-1974, and Percent Change 

(By Program) 10 

Chart: Distribution of Public Welfare Caseload by Program, F.Y. 1974 11 

Distribution of Public Welfare Caseload by Program, F.Y. 1974 12 

Caseload by Program by Region, June 1974 12 

Medical Assistance 14- 

Total and Percent Distribution of Medical Expenditures by Type of 

Vendor Title XIX only (Fiscal Year 1974.) 15 

Total and Percent Distribution of Medical Expenditures by Type of Vendor 

General Relief, Fiscal Year 1974 16 

Medical Payments, Fiscal Year 1974 1 ? 

Medical Vendor Payments, Total and by Percent, Hospital, Nursing Home 

and Other 18 

Chart: Medical Vendor Payments, Total and by Percent, Hospital, Nursing 

Home and Other 19 

Average Monthly Caseload Eligible for Medical Care, by Program, F.Y. 1974 20 



CONTENTS (Cont.) 



Medical Assistance (Cont.) page 

Eligible Recipients and Medical Payments by Type of Case 21 

Average Monthly Payments by Category of Assistance, Medical Care 23 

Top Twenty Drugs Paid for by the Department of Public Welfare by 

the Number of Prescriptions Supplied 25 

Income Maintenance - Public Assistance 27 

Old Age Assistance - Supplementary Security Income Program 

Caseload and Payments 28 

Average Monthly Caseload 1970-1974- and Change From Prior Tear 29 

Disability Assistance - Supplementary Security Income Program 

Caseload and Payments 30 

Average Monthly Caseload, 1970-1 974 and Change Prom Prior Year 31 

Aid to Families with Dependent Children 

Comparison of Average Caseload and Payments F.Y. 1973-1974 32 

Average Monthly AFDC Caseload Fiscal Years 1970-1974 33 

National and Selected States Average Payment by Rank 34 
Work Incentive Program, Activity Summary and Selected 

Characteristics of WIN Participants 35 
General Relief 

Comparison of Average Monthly Caseload Payments F.Y. 1973-1974 36 

Average Monthly Caseload Fiscal Years 1970-1974 37 

National and Selected States Average Payment by Rank 38 



CONTENTS (Cont.) 



Social Services page 

Expenditure by Program, Fiscal Year 1974 39 

Clients Served by Purchase of Service and Donated Funds Unit 4-0 

Child Welfare Services - Caseload and Expenditures 41 

Child Welfare Expenditures by Type, Fiscal Tears 1973-1974. 42 

Chart: Child Welfare Services - Percent of Total Expenditure by Type 43 

Chart: Expenditure for Care and Maintenance and Tuition and 

Transportation of Children Under Care 1969-1974 44 

Caseloads by Region and Unit, Fiscal Years 1973-1974 46 

Child Welfare Applications, Added, Processed and Accepted 1974 

by Status 47 

Location of Children by Terms of Care 48 

Age and Years Under Care by Age, Children Under Care 50 

Discharges of Children by Reason, Fiscal Years 1970-1974 51 

Applications Received and Services to Unwed Mothers 53 

Administration 54 

Adjusted Expenditures 54 

Staff of the Department of Public Welfare, June 1974, by Region 56 

Inquiries Processed by the Inquiry and Referral Unit by Program, 

Methods and Geographical Area 57 

Child Support Enforcement Unit - Activities 58 

Appendix I 1973 Calendar Year Direct Payments by Welfare Service Office 59 

Appendix II June 1974, Caseloads by Program by Welfare Service Office 62 

« 



w 



FOREWORD 



As a supplement to the official Annual Report of the Massachusetts Department 
of Public Welfare, the following report is designed to inform and familiarize the 
reader with the operations of the Department of Public Welfare in statistical terms. 
It is necessary to describe and define the statistical data and tables if they are 
to have any meaning so a somewhat abbreviated narrative for each table has been 
included . 

Compared to the supplement produced last year, many changes have been made; 
some additions, as requested or interesting data becomes available and some 
deletions, as the source data was no longer available, could not be estimated or 
appeared to be superfluous or of less interest. As time passes, an increasing 
amount of the reported statistics are derived from systems utilizing the computer 
and a decreasing amount from manually processed reports. 

The preparation of this report was the joint effort of many people working 
for the Department of Public Welfare. Special credit, however, should go to the 
typist,- Gail Hescock, who prepared the many, many drafts as well as the final 
copy. 

Hopefully this report is both readable and informative. In the effort to make 
this report increasingly valuable as a source document and of greater assistance 
to the user trying to comprehend the complexities of the welfare system, suggestions 
relative to its improvement will be welcomed. 



Herold Doherty 
Director of Research 



ii 



Sources of Data 



Monthly Summary Expenditure Report ; A computer printout giving the expenditures by 
program for direct payments, including the quarterly grant. This report also gives 
the unduplicated count of cases and recipients. All data broken down by region and 
local welfare service office ^ in this summary for 1974. are from this report. 

Status of Appropriation Account ; Financial report of the Department on a monthly 
basis giving expenditures, encumbrances and balances in the Appropriation Accounts. 

Consumer Price Index; Series published by the U.S. Department of Labor, Bureau of 
Labor Statistics, Quarterly, for Boston, showing changes in prioe levels for goods 
and services purchased by a defined family. 

RS I Series ; A series of reports, manually produced and processed, from data 
submitted by the local offices prior to April 1972. Mostly Caseload and 
Expenditure data. 

F.Y. 1975 Budget; Summary of Programs and Recommendations or The Budget in English ; 
A report sent out by the Governor's Office of Administration and Finance, 
January 23, 1974. 

Computer printout - 50 Leading Drugs - Data derived from the system administered 
by Pilgrim Health Applications Inc. - A system for the payment of drug bills for 
welfare cases contracted to Pilgrim Health Applications Inc. 

Public Assistance Statistics . April 1974, Report A-2, Published by the Department 
of Health, Education and Welfare, National Center for Social Statistics. 

Medical Vendor Payments System Reports . A report, in existence since October 1973, 
giving the medical vendor payments, by month ,by program, by vendor,, for each Welfare 
Service Office, Regional Office and State and including most, but not all, medical 
vendor payments. 

Work Incentive Program Activity and Participant Characteristics ; Form MA-5-99 
Division of Employment Security and MA-5-98, DES. 

Purchase of Service Contract System. A system of controlling social service 
delivery through the use of a computer orientated recording system. 

Revenue By Fiscal Year . Actual and Estimated Revenue of the department described 
on an unnumbered form prepared by the Finance Division of the Welfare Department. 

Child Welfare Services Data, Derived from a manually processed reports prepared by 
Social Workers on a regional basis. 

Administrative Unit Data ; Information regarding the workload of individual units 
is reported on often unnumbered memos and reports to Management and other state 
departments. 



CASELOAD AND EXPENDITURES 



Total Expenditures - Fiscal Year 1974. 

In the Fiscal Year 1974, total expenditures by the Massachusetts Department 
of Public Welfare were $1,073,4-82,853. After adjustments were made for encumbrances, 
(1974. appropriated funds not paid in the 1974 Fiscal Year) and accounts payable, 
(1973 appropriated funds paid in the 1974 Fiscal Year) total expenditures were 
$1,070,401,150. This grand total figure can somewhat arbitrarily be broken down 
into four major segments as follows: 

Income Maintenance - Public Assistance $ 508 686 964 

Medical Assistance 459 658 936 

Administration, including Food Stamps 60 535 308 

Social Services 41 519 942 

Total 1 070 401 150 

The various sections that follow in this report will treat each of these 
major segments in turn^but not necessarily in the same order. Compared to the 
last Fiscal Year, the adjusted dollar amount was up 18.4 percent and 164 million 
dollars. A large portion of this increase was due to payments for prior years 
claims. In fact just under #50 million in prior years bills were paid from a 
special appropriation and almost $97 million in accounts payable from the previous 
year. In addition, other factors should be considered in appraising the increase 
in both percentage and dollar terms. Before moving into the reasons for the large 
increase we should consider the effect of Federal reimbursement as it affects the 
taxpayer in the Commonwealth. 



Revenue Estimates for Fiscal Year 1974. 

In general terms the Department of Public Welfare spends about one-third of 

the total state budget but less than one fourth of the Massachusetts tax dollar 

1. 

is used for welfare. The reason for this seeming. contradiction is that a large 
portion of welfare expenditures is reimbursed by the Federal Government. 

In Fiscal Year 1974- these federal revenues amounted to just under 4-50 million 
dollars or 4-1.6 percent of the total adjusted expenditures. 

As a rule, with some exceptions, the Federal Government reimburses fifty 
percent of expenditures for public assistance (payments and administration). There 
is no federal matching for the General Relief Program and certain Social Services 
and administrative costs are matched at 75 percent. 

To show the actual cost of a particular program to the Commonwealth the 
following table is prepared. 

Program Expenditure 1974- Revenue From Federal State Share 

(In Million Dollars) 

Medical Assistance 459.7 230.7 229.0 

Assistance Payments 

OAA-SSI Aged 61.0 16.6 44.0 

DA- SSI Aged 40.8 12.6 28.2 

AFDC 323.4 147.1 176.3 

General Relief 82.0 82.0 

Source: Revenue by Fiscal Year. 
Other revenue was received for the Care and Maintenance of Children, 

* 

Administration and Social Services, from the Federal Government and other sources 
such as donations. 

1. The Budget in English - Governor's Office - In this report also called the FY 75 
Budget: Summary of Program and Recommendations # Public Welfare in FY 73 accounted 
for $996.5 minion of the total expenditures of $2,754.3 million or 36j£ but only 
24.4 percent of the total $2,107.7 million tax based Budgetary Requirements or 
$515.1 million. 



-2- 



Comparison - Total Payments. Consumer Price Index and Adjusted Payments 

A careful inspection of the chart entitled "Comparison - Total Payments, 
Consumer Price Index and Adjusted Payments" reveals the significant effect changes 
in prices have on the expenditures for welfare. Not only is the Department under 
some pressure to keep up with the cost of living, as far as direct payments are 
concerned, but increases in living costs are reflected in the rates the Department 
must pay for medical and social services and other vendor payments. 

Last year ' s total expenditure of $904,24.5,883 could be expected to rise to 
about $990 million based on the increase in the Boston Consumer Price Index alone. 
Although this year's appropriation included only $5,000,000 for a cost of living 
increase, per se; large disbursements were made through the vendor payment systems 
for higher rates that reflected the increase in living costs due to higher prices 
for fuel, postage, labor, supplies and equipment. 



3- 



a 

o 

CD 



G3 a 

CD ^ 

W t+ 

„ 3 
fo CO 

D> c+ 

03 O 

SB 



P9 

a 



& B 5 

o o 
4 



o 

c 

cr 
o 

CO CO 

O P 
M c+ 
c+ H- 
03 
r+- 
H" 
O 
CO 



o 

03 



(D 
i33 




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C/3 
•-3 
03 

a 

> 



HI 
O 



o 



Total Payments - Fiscal Y ears 19 69 - 1974 





1969 


1970 


1971 


1972 


1973 


1974 


111 Programs* 


£452.5 


$564.0 


$724.2 


$772.0 


$825.6 


$966.9 


Old Age Assistance 


56.4 


77.0 


85.3 


91.3 


71.5 


61.0 


Medical Assistance 


226.9 


252.9 


304.8' 


348.5 


371.0 


459.7 


Aid to Families With 
Dependent Children 


128.1 


172.3 


245.1 


239.8 


286.2 


323.4 


Disability Assistance 


19.7 


25.2 


32.4 


37.1 


45.0 


40.8 


General Relief 


21.4 


36.1 


56.6 


55.3 


51.9 


82.0 



* Excludes other forms of Assistance - Mostly Cuban Relief which was $1.5 million 
in 1974 with 100 percent federal matching. 

Total Payments - Fiscal Years 1969-1974 

As seen from the chart, "Expenditures for Public Assistance Programs ^Fiscal 
Years, 1967-1974", total expenditures and all programs except Old Age Assistance 
and Disability Assistance ^both now part of the Supplemental Security Income 
Program t experienced an increase in Fiscal Year 1974. For total expenditures this 
continues a trend apparent over the past several years. Likewise Medical Assistance 
expenditures have continued to rise each year and AFDC expenditures every year with 
one exception, Fiscal Year 1972. Expenditures for General Relief in 1974 ,a large 
portion of which is used for Medical Services, reversing a downward trend evident 
for the past two years, increased significantly in the past year. 

The table giving total payments for the past six years by program points up 
the variation in increases by program and the fact that total payments in Fiscal 
Year 1974 were more than double those made in Fiscal Year 1969; only five years 
earlier. 



-5- 



Expenditures For Public Assistance 



Programs - Fiscal Years 1 967-1 974 



Millions 
of Dollars 

1000 



900 



800 



700 



600 



500 



400 



300 



200 



100 




1967 1968 1969 1970 1971 



1972 1973 1974 



Source: RS 1 Data (1967-1972), Status of Appropriations (1973-1974) 



Expenditures By Program and Percent Change. Fiscal Years 1973-1974. 





FY 1973 


FY 197/, 


Difference 


Percent Change 


All Programs 


825.6 


966.9 


+141.3 


+17.1 


Old Age Assistance 


71.5 


61.0 


- 10.5 


-U.7 


Medical Assistance 


371.0 


459.7 


+ 88.7 


+23.9 


Aid to Families With 
Dependent Children 


286.2 


323.4 


+ 37.2 


+13.0 


Disability Assistance 


45.0 


40.8 


- 4.2 


- 9.3 


General Relief 


51.9 


82.0 


+ 30.1 


+58.0 



Source: Status of Appropriation Accounts June 1973 and 1974 adjusted for 
Account Payable and Encumbrances. 

Expenditures By Program and Percent Change, Fiscal Years 1973-1974 

Compared to 1973, total expenditures in 1974 for public assistance increased 

1. 

$141.3 million or 17.1 percent. The table above shows that the largest increase in 
dollar terms was for the Medical Assistance Program^ reflecting the increase in 
payments due to cost of living increases, prior years bills and a slight increase 
in caseload. In percentage terms the largest increase was in the General Relief 
Program where a large portion of total payments is paid out to vendors for Medical 
Care and includes prior years bills and rate increases. 

Compared to the prior year expenditures declined over 10 million for the aged 
and over 4 million for the disabled or a decline of 14.7 percent arid 9.3 percent 
respectively. Again this was due to the transfer of administration of the programs 
to the Social Security Administration and an increase in the portion of total 
payments borne by the Federal Government. 

1. These data do not include Social Services or Administration. 



-7- 



The decrease in expenditures for the Old Age Assistance and Disability 
Assistance caseloads can be accounted for when ve consider that these two programs 
were absorbed by the Federal Supplemental Security Income Programs on January 1 , 
1974 t with certain limits on the amounts that the state would have to pay as a 
supplement to the Federal payment. 

Expenditures for AFDC and GR increased mostly due to large increases in the 
caseload in addition to cost of living changes and prior years claims. 

Differences in the size of the programs can also be discerned from this table. 
Medical Assistance alone accounted for about 4.8 percent of the total expenditure 
and Aid to Families with Dependent Children for about 33 percent. Increases in 
the high expenditure programs more than offset decreases in the lower expenditure 
programs. 



-8- 



Total Medical and Net Direct Payments 
By Region By Program 1. 



June, 1974 



(in dollars) 



AFDC 



GR 



Medical Vendor Payments 



Boston 
Springfield 
Worcester 
Lawrence 
Greater Boston 
Brockton 
New Bedford 
All Regions 



9 866 747 

4 428 156 

2 862 620 

3 636 117 

5 508 055 
3 112 650 
3 234 058 

32 648 403 



1 743 164 

533 646 
127 944 
278 639 
5U 967 
240 286 
250 391 



10 975 865 
5 417 784 

4 743 934 

5 973 306 
9 136 691 
4 475 765 
3 569 464 

44 292 809 



3 689 037 



1. Excluding Direct Payments for Cuban Relief, Medical Only Cases, Emergency 
Assistance and Retroactive payments under 0AA. and DA. 

Total Medical and Net Direct Payments by Region by Program, June 1974 

The table above is included to show the relative size of expenditures by 
Welfare Regions by major programs. As in Fiscal Year 1973, the Boston Region had 
the largest payments, both direct and vendor % followed by the Greater Boston Region. 
The Boston Region accounted for 30.2 percent of the total AFDC payments and 47.3 
percent of the total General Relief payments. Greater Boston accounted for 16.9 
and 14.0 percent , respectively. The Springfield Region had the second highest GR 
payments or 14.5 percent of the total. In 1973, the Boston Region accounted for 
29.4 percent of the direct payments and Greater Boston 18.1. It appears that the 
Boston and Brockton Regions are accounting for an increased share of total payments 
and Greater Boston and Worcester Region a smaller share. In 1974, Direct Payments 
in the Brockton Region are no longer the smallest as direct payments were less in 
the Worcester Region. 

Medical Vendor payments were highest in the Boston Region (24*8 percent of 
the total) and lowest in the New Bedford Region (8.1 percent of the total) in 



June 1974. 



-9- 



Average Monthly Caseload * 





FY 1973 


FY 1974 


Difference 


Percent 

Change 


All Direct Payment Programs 


18V 033 


206 333 


1 / 300 


+ 9.2 


Old Age Assistance ^SSI;* 


5/ 148 


58 Oo i 


933 


+ 1.6 


Aid to Families with 
Dependent Children 


83 952 


91 738 


/ /8O 


+ 9.3 


Disability Assistance (SSl) 


25 252 


29 654 


4 402 


+17.4 


General Relief** 


22 681 


26 S60 


4 179 


+18.4 


Medical Assistance*** 


250 283 


255 043 


4 755 


+ 1.9 



* In FY 1973 the case count included 591 cases under the Mental Health Program 
and seven in Tevksbury Hospital. In FY 1974 the case count does not include 
these 'cases due to the takeover of SSI - they are included in the count for 
Medical Assistance for 1974. 

I* Does not include GR Vendor Medical Only Cases. 

P* Eligible - Does not include GR adults or children in Private Agency Foster 
Homes. 

Source: Monthly Summary Expenditure Report for FY 1974 and May and June 1973 - 

Prior - Payroll Recap Sheets - Mental Health Fortion of Medical Assistance - 
Bureau of Accounts and Report RSC-1 - Child Welfare data. 

Average Monthly Caseload. FY 1973-1974. and Percent Change 

Compared to the year before, the caseload receiving a direct payment in Fiscal 
Year 1974 was up 17,300 cases and 9.2 percent. The Medical Assistance caseload, 
including both direct payment and medical only cases but excluding GR adults (not 
eligible under Title XIX) t was up 1.9 percent. 

The largest year to year increase was experienced in the GR caseload, about 
13 percent of the total direct payment caseload in 1974 f where the caseload increased 
4,179 persons in the average month or 18.4 percent. Only a slight increase was 
experienced in the Aged caseload and the Medical Assistance caseload. 

Percentagewise the AFDC caseload accounts for 44.5 percent of the total, the 
Aged 28 percent and the Disabled 14.4 percent ^ in Fiscal Year 1974^for an average 
month. 

-10- 



p 



DISTRIBUTION OF PUBLIC WELFARE 
CASELOAD BY PROGRAM FY 1974 



TOTAL ELIGIBLE CASELOAD 
281 ,903 
AVERAGE MONTHLY 




eligible caseload 

Source: Monthly Summary Expenditure Reports 



-11- 



Distribution of Public Welfare Caseload by Program^F.Y. 1974 

The chart preceeding this section with this same title shows at a glance 
that most of the caseload in 1974- was under the Aid to Families With Dependent 
Children Program. If this chart was based on recipients or all the members of a 
family being assisted, then the portion allotted to AFDC would be even greater 
as the average AFDC case includes about 3.5 persons, Next in size is the Medical 
Care Only caseload which includes many cases with more than one person and the 
Aged caseload where each case is a person. This chart also includes the children 
under the care of the department and the Aged cases under the Mental Health 
Program. All the people in the 281 ,903 cases except parents of medically indigent 
children under 21 years of age are eligible for medical care and except for the 
General Relief cases the assistance is funded by both the Federal and State 
Governments. General Relief expenditures are totally a state responsibility. 

Caseload by Program by Region ^ 
June 1974 





AFDC 


GR 


MA- 


-AGED 


MA-AFDC 


MA-DA 


Under 21 


Boston 


27 


146 


13 


632 


5 


080 


677 


1 


058 


2 


344 


Springfield 


13 


362 


4 


229 


6 


129 


703 


1 


025 


1 


938 


Worcester 


8 


849 


1 


034 


5 


331 


489 


1 


090 


1 


606 


Lawrence 


10 


932 


2 


208 


6 


514 


665 


1 


073 


1 


783 


Greater Boston 


16 


148 


4 


274 


9 


348 


980 


1 


706 


2 


410 


Brockton 


9 


430 


1 


954 


5 


466 


656 




820 


1 


407 


New Bedford 


9 


995 


2 


195 


3 


901 


709 




686 


1 


586 


All Regions 


95 


862 


29 


526 


41 


769 


4 879 


7 


458 


13 


074 



p Not including - SSI-DA or SSI Aged 
Caseload by Program by Region. June 1974 

The table above describes the caseload by Program by Region for June, 1974. 
This table is further refined in the Appendix by the addition of caseloads by 
local welfare service office. 



-12- 



Caseload by Program by Region, June 1974, (Cont.) 

Compared to a year earlier, caseload changes on a regional basis are very 
noticeable. In June 1973, . including the aged and disabled, the Brockton Region 
accounted for only 9.3 percent of the direct payment caseload and Boston, 26.1 
percent of the clients ' the highest and lowest percentages of the total direct 
payment caseload. 

After the transfer of OAA and DA cases to SSI and increases in total caseload 
we find that the Boston Region now accounts for 32.5 percent of the total direct 
payment cases (AFDC and GR combined) and the lowest percentage was in the Worcester 
Region^which only had 7.9 percent of the total direct payment cases (AFDC and GR) . 
The difference in regional workloads increased after the transfer of OAA and DA 
cases. In order of direct payment caseload size t the Boston Region was the largest 
followed by Greater Boston, Springfield, Lawrence, New Bedford, Brockton and 
Worcester.. 

The Medical Assistance Only caseload was highest in the Greater Boston Region 
with 21.5 percent and 14, 444- cases ^ followed by Lawrence Region with over 10 
thousand cases or just under 15 percent of the total MA cases. 

For all cases, Medical Only and Direct Payments under AFDC and GR, the 
Boston Region led in June with over one quarter of the cases followed by the 
Greater Boston Region with over 18 percent of the total 192,568 cases in June 1974. 



-13- 



MEDICAL ASSISTANCE 



Total and Percent Distribution of Medical Expenditures by Type of Vendor. Title XIX 
Only 

The Medical Assistance program covers the medical needs of clients who are 
aided financially in the direct payment programs (OAA-Aged SSI, DA -Disabled SSI, 
Aid to Families With Dependent Children and General Relief Children Under 21 years 
of age) as well as those low income families and individuals who cannot afford 
medical care even though they have enough income for their maintenance , such as 
food, clothing and shelter j (Medical Only-Aged, Medical Only-Disabled, AFDC 
related and children under 21 years). The types of medical care needed and provided 
can be seen as follows: 

The table following describes the vendors to whom medical payments are made. 
The Federal Government under Title XIX of the Social Security Act reimburses to 
the state approximately half of the cost. Only General Relief medical payments are 
exempt from this matching. 

It will be noted that of the expenditure of over $4-60 million, General 
Hospitals alone account for over $164 million or 35.7 percent. Long term care, 
Licensed Nursing Homes, Intermediate Care Facilities and Mental Health Care (but 
excluding chronic Hospital Care) accounts for almost $184 million or almost 40 
percent of the total. 

Some shifts from the previous year can be detected. Physicians accounted for 
only 5.2 percent in 1973 (FY) or $19.5 million. In Fiscal Year 1974 they accounted 
for 7.4 percent or $34.2 million. The Dentists proportion increased slightly from 
4.4 percent to 4.9 percent but the Drug Suppliers share declined from 6.3 to 5.4 
percent. The share paid to out-patient departments and clinics also declined. 



-14- 



Total and Percent Distribution of Medical Expenditures 
By Type of Vendor, Medical Assistance, Title XIX Only 

Fiscal Year 1974 



iype 01 vencior 


Expenditures 


x ercenL uis ir iuui<ion 


iox.a.± rtxx venciors 


^60 


987 


008 


lUU.U 


W /~1 r-> J X.J fi «4 + Q i c 1 

uenerax nospi T/dxs i . 


164 


470 


082 




ijicensea Nursing nomes 


123 


128 


428 


9A 7 


±LL lei III'.. U. i.d Lti \jci± t; raOlii O.LC £3 


48 


981 


747 


m 6 


Ufiv oi c»i one 


34 


152 


411 


7 y 


D'r^i i it g 

U.I U.£i3 


24 


715 


560 






22 


468 


691 


y q 

4.7 


Mental Health Care (inpatient) 


11 


613 


184 


2.5 


Other Licensed Medical Pract. 


8 


088 


729 


1.8 


Outpatient Depts. and Clinics 


14 


379 


962 


3.1 


Lab. and Radiological Services 


1 


348 


121 


0.3 


Other Vendors N.E.C. 2. 


7 


640 


093 


1.6 



1. Includes Chronic and Acute Hospitalization. 

2. Includes Other Items not elsewhere classified, transportation for Medical 
Care, Personal Needs Items, Home Health, Family Planning and third party 
payments. 



Source: Distribution based on reports from the Vendor Payment System and 
Statement of Appropriation Accounts, June 1974. 



-15- 



Total and Percent Distribution of Medical Expenditures 
By Type of Vender, General Relief 
Fiscal Year 1974 



T ype of Vendor 

Total All Venders 

General Hospitals 1. 

Licensed Nursing Homes 

Intermediate Care Facilities 

Physic: an s 

Drugs 

Dentists 

Mental Health Care (inpatient) 
Other Licensed Medical Fract. 
Outpatients Depts. and Clinics 
lab. and Radiological Services 
Other Vendors N.E.C. 2. 



Exp ci id i tares 
24 754 569 
16 'j22 692 
593 629 
49 469 
2 102 438 
1 OSS 321 
1 681 950 

395 753 
1 954 030 
49 469 
296 SIS 



Percent Distribution 
100.0 
66.8 
2.4 
0.2 
S.5 
4.4 
6.8 

1.6 
7.9 
0.2 
1.2 



1. Includes Chronic and Acute Hospitalization 

2. Includes Home Health, Medical Transportation and Other Items not elsewhere 
class: f ied. 

Source: Distribution based on the printouts from the Vendor Payment System. 
Total and Percent Distribution of Medical Expenditures by Type of Vendor. General 
Relief 

The distribution of medical payments by vendor for General Relief Cases (Adults) 
above is markedly different from the distribution of payments under Title XIX. For 
General Relief f over two-thirds of the payments went to hospitals. Long term care 
was relatively insignificant. Other large portions were paid to Physicians and 
Dentists, together accounting for 15.3 percent of the total of $24,734,569. 



-16- 



Medical Payraon is , FjjBcal Yenr 1974. 
fin Thousand Dollars) 



Exp. of Funds Less Plus Accounts Payments 

A ppropria ted Encumbrances P ayable FY 1973 FY 1974 



irect Medical A sol stance 


453 B15 


73 038 


67 216 


447 993 


evksbury Hospital 


45 





7 


52 


lental Health 


11 998 


2 350 


1 965 


11 613 


lOiieral Kolinf- 


16 914 


«-t- 


12 145 


24 734 


Mid Welfare* 


1 328 


913 


913 


1 328 


'otal 


484 100 


80 626 


82 246 


485 720 



Estimated 

Source: Status of Appropriation Accounts, Jur^e 1974 

Medical Payments. Fiscal Year 1974 

The table above describes total vendor medical payments by appropriation 
account jWith the adjustments made for encumbrances and accounts payable. Because 
of the lag in payment relative to the time payment is claimed ; it will always be 
necessary to have some encumbered funds which become accounts payable in the next 
year. 

Compared to Fiscal Year 1973, total payments in Fiscal Year 1974 are up just 
under 100 million dollars. Accounts Payable are likewise up about 78 million 
dollars with encumbrances about the same as last year. Most medical payments are 
from the Direct MA account which compared to last year is up about $93 millions. 
Payments from the Tewksbury Hospital and Mental Health accounts are down from last 
year as was payments from the Child Welfare account but payments for medical care 
from the General Relief Account was up over $9,000,000. 



-17- 



Medical Vendor Payments, Total and By Percent, Hospital, Nursing Home and Other 
As seen on the chart on the next page, two types of vendors, Hospitals and 
Nursing Homes are estimated to account for over three-quarters of the total 
expenditures for medical care. This is up from the two-thirds experienced last 
year. Until Fiscal Year 191 %, Nursing Home payments never accounted for more than 
30 percent of the total medical payments, (in Fiscal Year 1973 they were 29.5 
percent). Hospital payments however have been higher as a percentage in past 
years, (in F.Y. 1972 they were £0.5 percent of total medical payments compared 
to 39.8 percent in F.Y. 1974.) . 

Tables showing the breakdown of total medical payments by type of vendor were pre 
sented in this report for Medicaid (Title XIX) and General Relief^ seperately j but 
with the two programs combined, Nursing Homes accounted for about $124 million and 
Hospitals $181 million of the total medical expenditure of $4-85 million. 



-18- 



o 
o 






-J 








* 




* * 




• 












o 



M 
>-3 



O 




9 # * » # 




© Vjj 

^ u« O ♦ 


to 
-J 




• 












o 



o 



Average Monthly Caseload Eligible for Medical Care | By Program fiscal Year 1974. 



Program 


Direct Payment Cases 


Medical Only Cases* 


Total 


Aged (Inc. SSI) 


58 081 


42 248 a# 


100 329 


Disabled (inc. SSI) 


29 654 


7 048 


36 702 


AFDC Family 


91 738 


4 138 


95 876 


General Relief 


26 860 


3 500 b# 


30 360 


Other Needy Children 




22 552° * 


22 552 


Cuban Relief 


397 




397 


All Programs 


206 730 


79 486 


286 216 



* Based on a 10 month average, September 1973 - June 1974 

a. Includes 1,882 cases in state mental hospitals. 

b. Estimate 

c. Includes 10,380 indigent family cases, 10,672 children under care of the 
Department and an estimated 1,500 General Relief Children cases 

Source: Monthly Summary of Expenditures Report and Internal Financial Records. 

Average Monthly Caseload Eligible for Medical Care 

Compared to last year the number of cases eligible to receive medical care 
has increased only slightly - from 280,450 to 286,216. Once again the aged cases 
account for the highest proportion of total eligible cases (more than one-third of 
the total) but more direct payment cases are under the AFDC program. 

Whereas the number of direct payment cases eligible increased 14,715, mostly 
due to a 8 thousand increase in the hFDC program and 4 thousand in the Disability 
Program, the number of medical only cases actually decreased by 9 thousand cases, 
mostly the aged and children under 21 cases. The Disability Assistance medically 
only caseload increased by over 2,000 from the 4,788 assisted last Fiscal Year. 

In total, compared to last year, the number of aged cases declined, the 
number of disabled cases increased and Family cases (AFDC, AFDC-Related and Children 
under 21) actually declined - from 120,106 to 118,428. The number of General Relief 
cases increased by 4,697 to 30,360. 



Eligible Rot 5 ni ^nt3 and M edical Poymsnis by Typo of C.^e 



Ave. Mo. No. Medical Payments Percent of 
Type o f Case Eli gible Recj pients (Kill io n £) Total Payments 



Aged (OAa & SSI) 

Direct Parent 58 081 33.7 6.9 

Medical Or. 1 .; 42 248 175.1 36.1 

D.'sab 1 J ?• Ton? 

)j . . I« ii .i.rsnt 29 *»'./. 56.9 11.7 

I,- 1 c ■■: . ilj 7 048 31.8 6.5 
Fersnrv jii ' nliej* 

D'r-! p-.y. exit 310 855 135.7 27.9 

i>d Oi.ly 14 03? 8.1 1.7 

0'. ,. cdy Children-* 49 818 19.7 4.1 
1 i?f 

ul h Only*** 31 860 24. 7 5.1 

lof.i U n.clpientfj 543 602 485.7 100.0 

* i i iSfi on Tiorlh average September 1973 - June 1974. 
Irdufter * i ,ie for Foster Car? Children (10,500) and GR Children (4,000). 
lnc.i-,dbr • si urate ior MA Only cases (3,500) and eligible spouses over 21 years (1,500). 

Eligible Recipients and Medical Payments by Type of Case 

The table above shows the people rather than the number of cases eligible for 
medical care and the payments (estimated) made for the various groups. Of the 
total 543,602 people eligible approximately 276,000 are children and 106,000 over 
65 years of age. These are similar to the numbers eligible last year. 

Based on averages for the last ten months of Fiscal Year 1974 /the aged eligible 
cases account for 43 percent of the payments even though they represent only about 
18 percent of the eligible recipients. Over 36% of the total payments are made for 
the aged medical only people who represent only about eight percent of the people. 
In Fiscal Tear 1973 aged cases accounted for 55 percent of the total medical 

-21- 



expenditure even though they accounted for 19.8 percent of the eligible recipients. 
Therefore you can see a significant shift of expenditures from the aged to the 
family cases. In Fiscal Year 1973, 2U percent of the payments were for eligible 
persons in family cases. In Fiscal Year 1974- over one-third or 33.7 percent were 
for eligible persons in family cases. 

There is also a shift in the type of cases for whom payments are made. In 
Fiscal Year 1973, Direct Payment cases incurred 45.0 percent of the medical 
expenditures. In Fiscal Year 1974. 51.6 percent was for persons in this type case* 



-22- 



Average Monthly Payments by Category of Assistance, Medical Care 

In the table below it should be remembered that the average payments are 
based on the number of eligible recipients (persons) and not on the basis of 
cases or the number of cases or persons who actually received medical assistance 
in the month. 

Compared to last year the average monthly payments per person per case was 
higher for every type case except aged cases receiving a direct payment ($48.35 
compared to $67.61) and the medical only disabled cases. In total, the average 
payment for persons receiving a direct payment increased from $35.73 to $4-8.59, 
(a 36 percent increase) and the average payment for a medical only person 
increased from $140.60 to $172.85, (a 23 percent increase). 

Average Monthly Payment for Medical Care 

Category of Assistance Direct Payment Medical Only Recipient 

Aged (OA A & SSI) $ 48.35 $345.38 

Disabled (DA & SSI) 159.90 375.99 

Family Cases (AFDC) 36.38 48.08 

General Relief 64.61 

Other Needy Children 32.95 

All Categories 48.59 172.85 

Great variations exist in the average payment by type of case. The highest 
average payment is found with the Disabled Medical Only Cases as was true last 
year. These cases are bf definition permanently and totally disabled and did not 
benefit from the federal program of medicare as do the aged cases, medical only. 
Many are in long term care facilities which are very expensive and the percentage 
of eligible cases actually receiving medical care is extremely high. 



-23- 



The lowest average payment is experienced by the recipients under 21, medical 
only ) where all the children in the family that has been deemed eligible are 
considered eligible but usually only one is receiving medical care at a given time* 
to any degree. 

As a rule the medical only cases have higher average payments because they 
would not become eligible without a medical need whereas all direct payment 
recipients are eligible whether or not they can forsee the need for medical care 
in the future. Also by far a larger proportion of cases described as medical only 
are disabled and aged compared to the direct payment cases. 



-24- 



Top Twenty Drugs Paid for by the Department of Public Welfare, by the Number of 
Prescriptions Supplied 

On the table following are listed the leading twenty drugs supplied by the 
Welfare Department is the period November 1973 through June 1974. 

In the eight month period just under 3 million prescriptions were supplied 
so that the number in an average month would be about 400,000 prescriptions for 
the approximately 500,000 persons eligible for medical care in a given month. 

In total, the top twenty drug prescriptions accounted for about twenty 
percent of the number supplied or 80,000 per month. Just under a million 
prescriptions of these drugs are supplied in a year. 

The average payment for all prescriptions was $4.51 in the eight month period. 
Wide variations in the wholesale price, quantity per prescription and strength is 
reflected in the cost of a particular drug. 

The most frequently prescribed drug is Valium Tablets with a strength of 5 MG. 
Two other Valium prescriptions are also among the 50 leading drugs, one with a 
strength of 10 MG's and one with a strength of 2 MG's. Together these three 
prescriptions were supplied over 118 thousand times in the eight month period and 
accounted for 4.1 percent of all the prescriptions supplied. 

The second most common drug was Darvon Compound (65 Pulv) and Darvon Pulvules 
with a strength of 65 MG's. Together these two prescriptions accounted for 88,036 
prescriptions or about 3 percent of the prescriptions supplied in the November - 
June period. 

Two different Librium prescriptions were among the top fifty. One in the form 
of capsules with a strertgth of 10 MG's and one with a strength of 5 MG's. Together 
these two accounted for about 1.6 percent of the total prescriptions. 

The only other drugs accounting for more than one percent of all drugs supplied 
were Lasix Tablets (52,117 Rx) , Maalox (32,555) Lanoxin (30,853) and Aldomet Tablets 
(29,837 Rx) in the ten month period. 



-25- 



Top Twenty Drugs Paid for Under Welfare 
By the Number of Prescriptions 
November 1973 - June 1974- 

No. of Expenditure 
Description Prescriptions 8 months 



1. Valium Tablets 


5 


mg 


72 


834 


$418 


659 


2. Darvon Compound 


65 


Pulv. 


U 


707 


305 


323 


3. Lasix Tablets 


40 


mg 


52 


117 


252 


706 


4. Librium Capsules 


10 


mg 


33 


050 


175 


299 


5. Maalox Susp. 


12 


oz 


32 


555 


72 


190 


6. Lanoxin Tablets 


0.25 


mg 


30 


853 


72 


524 


7. Aldomet Tablets 


250 


mgs 


29 


837 


199 


248 


8. Dilantin Kapseals 


100 


mg 


27 


434 


93 


806 


9. Percodan Tablets 






26 


729 


108 


275 


10. Orinase Tablets 


0.5 


mg 


24 


663 


169 


426 


11. Valium Tablets 


2 


mg 


24 


178 


125 


699 


12. Digoxin Tablets 


0.25 


mg 


23 


429 


54 


328 


13. Darvon Pulvules 


65 


mg 


23 


329 


118 


892 


14. Benylin Expecect 




oz 


23 


157 


70 


267 


15. Dimetapp Elixir 




oz 


22 


432 


68 


648 


16. Valium Tablets 


10 


mg 


21 


167 


147 


770 


17. Indocin Capsules 


25 


mg 


20 


391 


125 


307 


18. Aldactazide Tab. 






19 


523 


136 


583 


19. Oural-Zi Cycle 


21 


tabs 


18 


392 


71 


674 


20. Divral Tablets 


500 


mg 


18 


000 







Source: Computer Printout - 50 Leading Drugs, Pilgrim Health Applications Inc. 



-26- 



INCOME MAINTENANCE - PUBLIC ASSISTANCE 



The following section describes in detail the various direct payment programs 
including the data for Fiscal Year 1974, the comparison with data from Fiscal Year 
1973 and to some extent the reasons for the year-to-year changes. 

The most significant development as far as Income Maintenance programs are 
concerned was the transfer of the Aged OAA caseload and the Disabled DA caseload 
to Federal administration. Even though the direct payments are made by the Social 
Security Administration^ the Commonwealth of Massachusetts is still committed to 
supplement the federal payments ^which more or less stand as a floor^ nationwide. 

In the following pages the Aged and Disabled under the Supplemental Security 
Income program since January 1 , 1974-^are treated as being still direct payment 
cases under OAA and DA. In fact, these cases are still the states responsibility 
as far as medical care under Medicaid and Social Services is concerned. 

Another important change that took place at the very end of 1974 but continues 
a program in existence for sometime, was the decision to make all AFDC and GR 
cases, by definition, eligible to participate in the Food Stamp Program, Because 
the program did not commence officially until July 1, 1974, data regarding the Food 
Stamp Program is not available for Fiscal Year 1974. 



-27- 



- 




OLD AGE ASSISTANCE - SSI 



C omparison of the Average OAA Caseload and Payments Fiscal Year 1973-1974. 

1973 1974 
Fiscal Year Fiscal Year Percent Change 



Average monthly caseload 57 14.8 58 081 + 1.6 

Total Payments (in Millions) $ 71.5 $ 61. -14.7 

Ave. Annual Payment Per Case $ 1251 $ 1050 -16.0 

Ave. Monthly Payment Per Case $104.23 $87.52 -16. 

On January 1 , 1974 the Old Age Assistance Program was incorporated into the 
Federal Supplemental Security Income Program under the Social Security Administration. 
The Commonwealth continues to assist the aged persons in the state by reimbursing 
the Federal Government, through the Social Security Administration, for a share of 
the total expenditure. The caseload and expenditure figures given above therefore 
are a combination of six months Old Age Assistance data and six months Federal SSI 
data. 

The aged caseload continued to increase over the 1974 fiscal year so that the 
average monthly caseload was up 1.6 percent over the average for the preceding year. 
Some factors causing this increase was the publicity given to the new program, its 
acceptance by the aged population and the effects of inflation on the economy 
especially to persons living on fixed incomes. Total payments declined as the Federal 
Government took an increasing share of the direct money payments, especially for new 
cases added. 

The average payment per case per month and per year declined as Social Security 
benefits increased in the first six months and the states share declined in the last 
six months of the fiscal year. 

n past years the percentage increase in aged caseload has decreased until last 
year when the size of the caseload actually declined. In 1974- however the caseload 
again began to increase, but fortunately only be a small margin. 



-28- 



-2- 



Average Monthly OAA (Aged) caseload. Fiscal Years 1970-1974 

Fiscal Year Average Monthly Caseload Change from Prior Year 

1970 55 347 49.6 

1971 58 994 +6.6 

1972 62 737 +6.3 

1973 57 148 -8.9 

1974 58 081 +1.6 

Part of the decline in Fiscal Year 1973 however was the transfer of cases in 
Intermediate Care Facilities (about 5,000) to the Medical Assistance Only program. 



-29- 



DISABILITY ASSISTANCE - SSI 



Comparison of Average DA Caseload and Payments FY 1973 and 1974 

Fiscal Year Fiscal Year 

1973 1974 Percent Change 

Average Monthly Caseload 25 252 29 654 +17.4 

Total Payments (in Million $) 45.0 40.8 - 9.3 

Ave. Annual Payment Per Case $1781 $1376 -22.7 

Ave. Monthly Payment Per Case $148.43 $114.67 -22.7 

On January 1 , 1974 the DA caseload was absorbed by the Federal Supplemental 
Security Income Program administered by the Social Security Administration. Data 
above combines the two programs statistics. The State still assists Disabled 
persons by reimbursing the Federal Government for a portion of the payments made 
to DA cases in the state. 

Even though the caseload for the Disabled increased 17.4 percent, the total 
expenditure for the state declined as did the average payment per month and per 
year. The increase in the caseload can be attributed to the publicity surrounding 
the new program of SSI for the disabled, the relaxed income eligibility requirements 
of the new program and the effects of inflation and general economic depression 
in Fiscal Year 1974. Many clients likewise took advantage of the more liberal 
medical eligibility requirements in the first six months when administered by the 
state. 

Expenditures and payments reflect the increased portion of total direct 
payments, especially for, new cases added, carried by the Social Security Administration, 
whereas reimbursement to the federal by the Commonwealth was limited to a fixed 
amount. 

The caseload for disabled persons has continued to increase over the past 
five years as seen in the table below. Although the rate of increase has been 
fluctuating^ the 1973 to 1974 increase is the largest experienced in the past five 
years. 

-30- 



Average Monthly DA Caseload. Fiscal Years 1970-1 974 

Fiscal Year Average Monthly Caseload Percent Change from Prior Year 

1970 16 685 + 8.4 

1971 18 951 +13.6 

1972 22 168 +17.0 

1973 25 252 +13.9 

1974 29 654 +17.4 



-31- 



AID TO FAMILIES WITH DEPENDENT CHILDREN 

Comparison of Average AFDC Caseload and Payments « Fiscal Years 1973-1974 

Fiscal Year Fiscal Year 

1973 1974 Percent Change 

Average Monthly Caseload 83 952 91 738 + 9.3 

Total Payments (in Millions)* $286.2 $323.4 +13.0 

Average Annual Payment Per Case $3409 $3525 + 3.4 

Average Monthly Payment Per Case $284.11 $293.75 + 3.4 

* Includes expenditures for the Work Incentive Program 

The average monthly caseload for AFDC increased 9.3 percent from Fiscal Year 
1973 to' Fiscal Year 1974 while the total payments increased thirteen percent. The 
caseload increase reflected the depressed economic conditions in the state, large 
strikes and unemployment, court ordered policy changes and higher income 
eligibility levels. Despite the best efforts of the Department through Corrective 
Action procedures,, more staff, an increasingly effective WIN program and policy 
changes / these outside factors and other subtle cultural changes resulted in a 
net increase in caseload. 

The increased expenditures reflected this increased caseload growth plus 
the inflationary trend in the cost of living. The net result was a modest 3.4 
percent in the annual and monthly payment per case. 

Over the past five years the AFDC caseload has continued to increase and in 
fact has almost doubled since 1970. The table below shows that Just as the rate 
of increase declined and a leveling off was taking place new forces of an economic 
nature caused an increased rate of caseload increase. 

It can also be seen that the increase from 1973 to 1974, although involving 
almost 8,000 cases, was less than the year to year increase in any year since 1970 
with the exception of one last year when the increase was only 5.4 percent. 



-32- 



Average Monthly AFDC Caseload. Fiscal Years 1970 - 1974 

Fiscal Year Average Monthly Caseload Increase Over Prior Year 

1970 56 392 +2^.2$ 

1971 71 016 +25.9$ 

1972 79 618 +12.1$ 

1973 83 952 + 5.4$ 

1974 91 738 + 9.2$ 



-33- 



I 

: 

( 

h 
I 



I 



■ 



AID TO FAMILIES WITH DEPENDENT CHILDREN 

National and State Average Payments by Rank 
April 1974 



State 


Rank 


Average Payment 


New York 


1 


$294.38 


Hawaii 


2 


285.84 


Wisconsin 


3 


278.05 


Massachusetts 




277.20 


Illinois 


5 


260.53 


l BHUpy X VauiB 


6 


2*58 83 


Vermont 


7 


255.39 


New Jersey 


8 


252.65 


Minnesota 


9 


250.27 


Michigan 


10 


249.13 


National Average 




197.35 



Source: Public Assistance Statistics . April, 1974, Report A-2, NCSS, DHEW. 



In April, 1974 the average grant in Massachusetts for the AFDC program was 
$277. 20 t placing Massachusetts fourth in rank. This includes one-third of the 
Quarterly Flat Grant paid in March for the April-June Quarter. The average 
payment in Massachusetts was $79.85 above the national average when the flat 
grant is included. 



-34- 



AID TO FAMILIES WITH DEPENDENT CHILDREN 



Work Incentive Program Activity Summary for Fiscal Year 1974 

Fiscal Year 1974 Fiscal Year 1973 

Number of Registrants 31 364 30 960 

Number interviewed and appraised 16 165 17 384 

Total Participants 13 503 11 176 

Number Attaining Employment 6 1 29 3 274 

Grant Reduction (Estimated) $6 643 000 $5 322 000 

Characteristics of WIN Participants, June 1974 

Number Percent 

Total Participants 13 503 100.0 
Sex 

Male 5 106 37.8 

Female 8 397 62.2 
Education 

7th Grade or less 1 274 9.4 

8th-11th Grade 6 241 46.2 

High School Graduate 4 844 35.9 

More than High School 1 144 8.5 
Age 

21 years or under 2 203 16.3 

22 years - 44 years 9 774 72.4 
45 years - 54 years 1 399 10.4 
55 years and over 127 .9 

Source: Forms MA5-98 and MA5-99, Division of Employment Security. 



-35- 



GENERAL RELIEF 



Comparison of Average GR Caseload and Payments. FY 1973-1974 



FY 1973 



FY 1974 



Percent Change 



Average Monthly Caseload* 



22 681 



26 860 



+18.4 



Total Payments (in Millions) 



51.9 



82.0 



+57.9 



Ave. Annual Payment Per Case 



$2288 



3 053 



+33.4 



Ave. Monthly Payment Per Case 



$190.69 



$254.41 



+33.4 



* Medical Vendor Only cases are not included 

The 18.4 percent increase in the General Relief caseload reflected the 
depressed economic environment and the indirect effects of the implementation of 
the Supplemental Security Income Program for the aged and disabled. Large long 
term strikes, the increased level of income for eligibility determination and 
inflation also had there effect on the caseload. Unemployment reached a high level 
in Massachusetts and disabled clients unable to meet the eligibility requirements 
for the SSI program, were referred back to the Welfare Department and placed on 
General Relief in Fiscal Year 1974. 



Total payments and average payments likewise increased significantly but 
included in this total are both Direct and Vendor payments for medical care and 
other items. The increased cost of living, especially for medical care is reflected 
[ in the total expenditure figure for 1974. A large proportion of back bills were 
also paid in the 1974 fiscal year causing an increase in total expenditure. The 
caseload increase likewise drove up the total direct payments if not the average 
payment per case. 



-36- 



GENERAL RELIEF 



Average Monthly Caseload 
Fiscal Years 1970 - 1974 



Fiscal Year 



Average Monthly Caseload 



Percent Change from Prior Year 



1970 



19 722 



+48. 6 



1971 



29 423 



+49.2 



1972 



32 006 



+ 8.8 



1973 



25 663* 



-19.6 



1974 



30 360* 



+18.3 



* Medical Vendor Only Cases Estimated 

When we include an estimate for the medical only cases to the General Relief 
direct payment cases each year we find that in the Fiscal Year 1974 the caseload 
was up 18.3 percent from the previous year and about 54 percent from the caseload 
in Fiscal Year 1970. 

Largely responsible for this caseload increase was the medical assistance 
only cases on General Relief who found themselves unable to meet the medical 
eligibility requirements of the Federal SSI program but who still required 
assistance because of the lack of income and resources and being unable to work 
because of their disabilities. 

An estimated 5,500 medical only cases were eligible by the end of June, 1974 
compared to about 1,500 at the end of June 1973. 



-37- 



* 



GENERAL RELIEF 



National and State Average Payments 
April 1974- 



State 


Rank 


Average Payment 


Hawaii 


1 


$188.19 


Michigan 


2 


161.62 


New York 


3 


158.58 


New Jersey 


4 


U5.23 


District of Columbia 


5 


143.56 


Pennsylvania 


6 


134.06 


Massachusetts 


7 




Washington State 


8 


128.76 


Connecticut 


9 


122.75 


Minnesota 


10 


121.61 


National Average (44 States) 




123.61 



Source: Public Assistance Statistics . April, 1974, Report A-2, DHEW, NCSS. 



The table above shows the position of Massachusetts relative to the other 
nine states having the highest average payments, excluding medical vendor 
payments, for General Relief. The Massachusetts average payment of $133.83 places 
Massachusetts in seventh place compared to fourth place in June 1973. The amount 
given was $10.22 higher than the national average for all states in the same 
month. In June 1973 the Massachusetts average was $22.61 higher than the national 
average. 



-38- 



I 



SOCIAL SERVICES 



Expenditure by Program, Fiscal Year 1974. 



Care and Maintenance of Children 



$26 253 167 



Aid to Families with Dep. Children (Day Care) 



6 424 471 



Certain Public Social Services 



3 422 012 



Donated Funds Program 



2 489 889 



Tuition and Transportation of Children 



1 663 852 



Administration of Social Services 



731 871 



Grove Hall Project 



534 680 



Total - All Social Services 



141 519 942 



Source: Status of Appropriation Account. 
Expenditures by Program, Fiscal Year 1974 

The table above lists the various expenditures for Social Services as 
distinct from Public Assistance or Medical Assistance expenditures by type of 
expenditure. Some listings could be classified under administration but because 
these listings are unique and directly connected to the delivery of Social Services 
they are listed here. 

The largest Social Service expenditure was for Day Care. Not only was Day 
Care supplied out of the AFDC account with an expenditure of just under $6.5 million 
but under the Purchase of Service (over $1.2 million) and Donated Funds Program. 

The certain Public Social Services provided include Homemaker Care, Family 
Life Education, Foster care, Emergency and regular, Services related to 
Retardation, and services for Alcoholics and Drug addicts as well as Day Care. 

The Tuition and Transportation of Children Account provides funds for the 
education of children under the care of the Department and reimburses the cities 
and towns where the children reside. 

The Grove Hall Project is a specially funded demonstration project to determine 
and discover new social work techniques relative to the linking, intergrating and 
strengthening of Social Services in a neighborhood service center. 



-39- 



Purchase of Service Unit - Donated Funds 

Clients Serviced by Program 
Fiscal Year 1974 

Service Area Contracted Services Donated Funds 

Day Care 
Homemaker 

Family Life Education 
Foster Care 
Retardation 

Day Care (Retardation) 
Emergency Foster Care 
Drug Addicts 
Alcoholics 
Unmarried Mothers 
Protective Services 
Emergency Care 
Care and Maintenance 
Source: Unnumbered report for Purchase of Service Contract System. 
Purchase of Services Unit - Donated Funds 

In addition to the services provided through contractors, the Department in 
Fiscal Year 1974 provided all types of Social Services through a social work staff 
employed by the Department. 

It is estimated that between a fifth and a quarter of all children under the 
AFDC program and one-third of the cases received a Social Service such as 
counselling, referrals to meet health needs, housing services, education and 
training referrals and assistance with employment related activities. 

Likewise services were provided to the aged and disabled especially before the 
transfer of these cases to the SSI program on January 1, 1974. 



4 948 
35 
1 125 
231 
25 
8 
64 
79 
8 
901 



1 074 
416 
842 



97 
4 083 
477 
319 



CHILD WELFARE SERVICES 
in Fiscal Year 1974 



Caseload and Expenditures 

Both the caseload and expenditures for Child Welfare showed a significant 
increase when compared to the preceeding year and in fact reached an all time 
high as far as expenditures for Care and Maintenance and Tuition and Transportation 
combined^is concerned. This program, administered by the Division of Children and 
Family Services, provides care for children supervised by the Department in lieu 
of their own parents. 

In 1973 (Fiscal Year) expenditures for Care and Maintenance and Tuition and 
Transportation (to school) reached just under $25.3 million. In 1974. (Fiscal Year) 
this figure reached over $29.8 million. 

This increase of eighteen percent follows a decline experienced in Fiscal 
Year 1973 when expenditures, not including administration, declined from $26,701,4-76 
to $25,284,809. 

Proportionally, Child Welfare expenditures differed from those in previous 
years in FY 1974. Almost 70 percent of the total expenditure was for payments to 
foster mothers and non-medical institutions that provide care to the children^in 
both years jbut expenditures for clothing almost doubled and by 1974 were 6.7 
percent of Total Expenditures. Hospital care and other medical costs actually 
declined. Tuition and Transportation costs to school likewise more than doubled 
as did the "other" portion of Care and Maintenance. This is because of the increase 
in kindergarten tuition. Tn Fiscal Year 1974 the "other" portion of total 
expenditures reached 4.3 percent of the total and Tuition and Transportation costs 
12 percent of total expenditures. Medical costs accounted for 7.7 percent of 
total costs in Fiscal Year 1974. 



-41- 



Child Welfare Expenditures, by Type, Fiscal Years 1973-1974 
Type Fiscal Year 1973 Fiscal Year 1974 



Total All Types 


$25 284 809 


$29 866 101 


Care and Maintenance 


23 581 538 


26 253 762 


Board Etc.* 


19 355 690 


20 702 094 


Clothing 


1 092 373 


1 986 370 


Hospital Care 


1 995 063 


1 445 525 


Doctors, Dentists, Etc, 


574 878 


762 692 


Medical Supplies 


95 704 


83 674 


Other** 


467 830 


1 273 407 


Tuition and Transportation 


1 703 271 


3 612 339 



* This item represents payments to Foster Mothers, and to Non-Medical Institutions 
for the care of children. 

** This item includes Travel, Advertising, Tuition and Kindergartens, Personal 
Needs, Funerals, etc. 

Child Welfare Expenditures, Fiscal Years 1973-1974 

The table above illustrates these variations and year to year changes in the 
type of care for which expenditures are made. It will be seen that these 
expenditures reflect increases in rates and items subject to cost of living 
increases such as Board payments to Foster Mothers and Institutions who have to 
pay higher prices for fuel, food and other commodities that have increased in 
price significantly over the past year. 



-42- 



CHILD WELFARE SERVICES 
Percent of Total Expenditure By Type 
1974 Fiscal Year 

Total Expenditure $29 866 101 




Source: Raymond Trial Balance, Care and Maintenance Accounts ^Expenditures Plus 
Accounts Payable. 



-43- 



I 



The chart entitled "Percent of Total Expenditure by Type" leads and shows 
how the total Child Welfare budget is split by type of expenditure. The expense 
of administering this program is included in the next section Administration. 

The second chart, on the prior page ) shows the Expenditures for Child Welfare 
over the past six years. Expenditures continued to rise each year until 1973 when 
they dropped about $1.5 million along with a decline in caseload. Until FY 1971 
the caseload continued to rise as it did from FY 1973 to FY 1974. 

Not only was caseload an important cause of the increase, but additional 
services and higher prices and rates paid also caused total expenditure to rise. 
Prior to this year, the caseload fell two successive years but in Fiscal Year 1974- 
reversed itself again. Average payment per child has continued to rise each year 
however , before adjustments are made for price changes. 

As seen on the next table, the total caseload being served on the last day of 
the Fiscal Year,* June 30th f 1974-was up 393 over the number being served a year 
earlier, but still down from the 11,150 being served on June 30, 1972. 

Regional differences from year to year can also be observed. Although the 
total caseload increased from 1973 to 1974, a declining caseload was experienced 
in the Worcester Region and the Adoption Placement Unit. All other regions and 
units had a caseload increase. Compared to 1972 (June 30) however the Springfield, 
Lawrence, Brockton, New Bedford Regions and the Group Placement Unit have higher 
caseloads even though the total caseload for the state is down 477 cases. Losses 
tfere suffered in the Worcester and Boston Regions and in the Adoption Placement 
Jnit. 



-45- 



Region or Unit 



All Regions 
Springfield 
Worcester 
Lawrence 
Boston 
Brockton 
New Bedford 

Adoption Placement Unit 
Group Care Unit 
Adoption Subsidy 



CHILD WELFARE 
Caseload by Region, Fiscal Year 1973-1974 

Caseload 

June 30. 1973 
10 280 
1 057 
1 345 
990 
3 038 
821 
704 
793 
1 532 



June 30. 1974 
10 673 
1 208 
1 276 
1 007 
3 230 
934 
746 
597 
1 616 
59 



-46- 



Applications and Referrals 

In the 1974. Fiscal Year, 4,800 applications and referrals were received by 
the Department's Child Welfare section of which by far the greatest number were 
dependent applications with the remainder referrals, usually from the courts, 
regarding neglected children. 

Of the total applications and referrals available to be processed (the 
number received plus those on hand), 4, 497 or 80.5 percent were processed in the 
year with 3,227 or 71.8 percent of the A & R's processed resulting in children 
being accepted for care by the Department. 



Applications and Referrals 
on hand July 1, 1973 

Added during year 

Total available 

Processed during year 

Accepted 

Not accepted 
Remaining June 30, 1974 



NUMBER OF CHILDREN 
Total 

788 

4 800 

5 588 
4 497 
3 227 
1 270 
1 091 



Status 



Dependent 
766 



Neglect 
21 



1 033 



58 



Compared to last year, Fiscal Year 1973, a much higher percentage of the A 

and R's processed were accepted for care, (71.8 compared to 61.4 percent in 1973). 

* 

A slightly higher percent of those available for processing were processed in 1973 
compared to 1974 and the number awaiting processing has increased from 788 on June 
30, 1973 to 1,091 on June 30, 1974. 



-47- 



Location of Children 
June. 1974 

Bo arding Terns 



Location 


All Terms 


Board Clothing or Both 


Free 


Other 


Foster Home 


5 329 


5 280 


27 


22 


Group Care (Non-Med) 


1 990 


1 943 


41 


6 


With Parent 


1 64.1 


6 


1 608 


27 


Adoptive Home 


642 


80 


479 


33 


Medical Inst. 


307 


303 


3 


1 


With Relative 


459 


12 


410 


37 


Elsewhere 


305 


136 


134 


35 


Ail Locations 


10 673 


7 760 


2 702 


211 



Location of Children by Boarding Terms 

The table above is designed to describe the setting in which the child under 
care is placed and what part of a childs care is paid for by the Department. At 
the end of the 1974 fiscal period^ of the 10,673 children who were under care, just 
about half were living in Foster Homes and almost all of these had their material 
needs, such as food, clothing and shelter, paid for by the Department of Public 
Welfare. 

Another large group of children (18.6 percent) were living in Group Care 
Facilities, mostly non-medical institutions, that provided the childrens care and 
charged the Department different rates depending on the extent of the care received. 
Likewise most of these children had all their material needs supplied by the 
Department through the Group Care Facility. 

Almost 20 percent of the children were living with parents or relatives and 
in these cases as with most children in Adoptive Homes, the children were supplied 
with their material needs by the persons with whom they were living. 



-48- 



In total, over a quarter of the children were not receiving their regular 
maintenance from the Department as has been true in past years. Compared to last 
year, the number of children in all locations except Adoptive Homes has increased 
but whereas 9.3 percent of the children were in Adoptive Homes at the end of 
Fiscal Year 1972, only 6 percent were in this setting two years later. 



-49- 



p 




Age and Years Under Care by Age 

The children under the care of the Division of Children and Family Services 
ranged in age from under 6 months to over 20 years. At intake, the childrens ages 
covered almost the same span. As of June 30, 1974, 718 children were 18 years of 
age or older and 2,168 were 5 years or younger with the average age of all children 
under care, 10.2 years. This is slightly lower than a year earlier when the average 
child was 10.7 years old. 

The average child has been under care for 2 years and four months. A year ago 
the average child had been under care for 3.4 years. At the present level the years 
under care is more nearly comparable with past years as the length of time under 
care in June 1973 was a relatively high average time compared to past years. The 
table below shows a breakdown of the children by age groups and by length of time 
under care. 



Age 






Years 


Under Care 














1 yr. 


5 yrs. 


9 yrs. 


13 yrs. 


17 yrs. 




All 


Under 


to 


to 


to 


to 


to 




Persons 


1 yr. 


Under 5 


Under 9 


Under 13 


Under 17 


Over 


All Ages 


10 673 


2 375 


4 461 


2 396 


1 040 


340 


61 


Under 1 yr. 


206 


206 












1 -Under 5 


1 448 


499 


949 










5-Under 9 


2 252 


453 


1 105 


694 








9-Under 13 


2 598 


479 


1 014 


759 


346 






13-Under 17 


2 942 


631 


1 016 


642 


464 


189 




17 and Over 


1 227 


107 


377 


301 


230 


151 


61 



* As of June, 1974. 



More children are aged 13 than any other age despite the median age being 10, 
and more children have been under care for from one to two years. 



REASONS FOR DISCHARGE OF CHILDREN 
FISCAL, YEARS 1970 - 1974 



Reason for Discharge 
All Reasons 


1974 


1973 


1972 


1971 


1970 


2 856 


3 187 


3 571 


3 605 


2 741 


To Parent 


1 543 


1 786 


2 115 


2 230 


1 548 


To Court 


135 


105 


113 


93 


87 


Adopted 


527 


556 


536 


571 


565 


SpI i'~ fii'jTDort/3 x\& 


1^A 


228 


200 


207 


136 


To Relative 


134 


169 


212 


222 


149 


Tn AtttiF'ci Forces 


2L 


31 


48 


37 


38 


Married 


42 


53 


50 


53 




Became o r Age 


181 


93 


108 


65 


45 


Pied 


21 


28 


31 


33 


34 


Whereabouts unknown 


56 


65 


64 


46 


29 


Other 


39 


63 


44 


48 


47 



Reasons for Discharge 

The table above shows the number of children who were discharged from care 
and for what reason they were discharged. In the past Fiscal Year 2,856 children 
were discharged with the largest number and percent being returned to their 
parents. In 1974, 54 percent were discharged for this reason, slightly lower than 
the percent last year (5&%) and in Fiscal Year 1972 (59. 2$). The number discharged 
in the 1974 Fiscal Year was the lowest since 1970 when 2,741 children under care 
were closed. 

More children are being discharged to the Courts each year both in percentage 
and in number and less are leaving because of marriage. The number leaving because 



-51- 



5 




of self" support dropped off noticeably in Fiscal Year 1974 after continuing to 
rise each year percentage- wise and in number except for a slight drop in Fiscal 
Year 1972. 

The most significant change was the number of children who were closed 
because they came of age in Fiscal Year 1974.. Over six percent of the closings was 
for this reason and it reflects the change in the law regarding age of majority. 

The number of cases closed because the child became adopted has remained 
relatively stable over the years regardless of the size of the caseload - from 
527 in Fiscal Year 1974 to 586 in Fiscal Year 1972 when the number of children 
discharged was 25 percent higher than in Fiscal Year 1974. 



? 



-52- 



Applications Received and Services to Unwed Mothers 

Both the applications received for these specialized services has declined 
and the number of persons accepted and receiving these services has declined. This 
reflects to some degree the development of the new Family Planning Services given 
under Medicaid, Regular Social Services and Purchase of Service contracts. 

Services were completed for 103 cases of the 176 that received some service, 
as seen in the table below, or 59 percent of the total. 



Applications 


197A 

'.7 ll i 


Fiscal 
1971 


Year 

197? 


1971 


Arvnl i (*& t inn^ r>£>nH i n cr .Till v 1 


12 


78 


105 


116 


i IG V- \Z- J- V \^'-.J_ 


93 


1Z.0 


269 


//Q 


Processed 


99 


206 


296 


460 


Accepted for Service 


81 


130 


24.8 


399 


Not Accepted 


18 


76 


AS 


61 


Pending, June 30 


6 


12 


78 


105 


Services 










Receiving Service July 1 


95 


276 


385 


396 


Accepted in Year 


81 


130 


248 


399 


Services completed 


103 


311 


357 


4-10 


Receiving Service June 30 


73 


95 


276 


385 



As seen on the table, the high point of this program was reached in Fiscal 
Year 1 ?71 when 4.10 mothers finished with their counselling services while another 
385 were receiving services at the end of the year. Even at the end of Fiscal Year 
1974 however, 73 mothers were receiving this type of social service under this 
program. 



-53- 



ADMINISTRATION 



The following section describes the administrative costs of the Departments 
and additional data regarding selected units involved with the administration of 
Public Welfare in Massachusetts. 

Admini st rat ion 
Adjusted for Encumbrances and Accounts Payable 

Regular Administration of Programs $55 704- 134 

Hospital Admission Surveillance System 959 243 

Vendor Payment System 3 854 561 

Food Stamps 17 369 

Total Administration $60 535 307 

Source: Status of Appropriation Accounts 

The table above shows that administrative costs in total were just over $60.5 
million or 5.7 percent of the total expenditure by the Department. In Fiscal Year 
1971, three years earlier, Administrative costs for Public Assistance were 53.8 
million or about 7.4 percent of the total Public Assistance Budget. 

The Regular Administration of the Programs includes salaries of social workers, 
supervisors and others in the delivery of social services and medical care to 
clients as well as the determination of eligibility and administrative work 
connected with the remittance of direct payments. Also included is the cost of 
supplies, postage, business equipment, rent, travel and other costs connected with 
the management of an agency with expenditures in excess of one billion dollars. 

The Hospital Admission Surveillance System or H.A.S.S. is a system of insuring 
that clients who are receiving hospital care receive all the hospital care they 
need but are not extending the time spent in Hospitals beyond their needs. 

The Vendor Payment System is a system being developed to insure that Vendor 

Payments for Medical Care, Social Services and Other Needs are made promptly, 

correctly, accurately and are fair to the client, Department and Vendor and 

processed in the most efficient manner. 

-54- 



The Food Stamp Program Administrative Costs were incurred in Fiscal Year 1974., 
actually before the program had commenced in its present form, and were used for 
preparation and planning. 

On the following pages no attempt has been made to report in detail what all 
the Expenditures for Administration entails. However some selected data is included 
to show the widespread considerations that must be given in spending the funds 
wisely. 

As most of the administrative costs are related to personnel some idea of the 
size of the work force is given. As funds must be used to assist the clients and 
general public, the activities of the Inquiry and Referral Unit is given even 
though -the smallest part of the total administrative costs are incurred by this 
unit. To show that administrative funds must be used to manage the programs 
efficiently, one unit involved in that task is included, the Support Unit, although 
other units, some requiring much greater funds are also engaged in that task. 



-55- 



DEPARTMENT OF PUBLIC WELFARE 
Staff As of June 30, 1974 By Region 







Clerical 


Social Workers 


Admi n i s t rat ive 


TV 

Region 


Total 


and Non-Professional 


and Supervisors 


Management & Executive 






^ UK yJ j—l 1 y 


^UR i2-1o; 


\GR 1 / and above; 


Boston 


1 286 


4-86 


715 


85 


Greater Boston 


84.1 


»!// 

366 


427 


48 


Lawrence 


567 


233 


303 


31 


Worcester 




213 




Of) 

<o 


New Bedford 


432 


178 


227 


27 


Springf i e Id 


681 


299 


346 


36 


Brockton 


500 


218 


254 


28 


Westboro 


227 


215 


3 


9 


Central Office 


704 


310 


274 


120 


Total All 










Regions 


5 751 


2 518 


2 821 


4.12 



Source: Report prepared for the Massachusetts Commission Against Discrimination for 
June 1974. 

Staff, June 1974 « By Region, By Broad Functional Groupings 



Thi table above is intended to give some idea of the size of the staff that 
adminis 4 ers the welfare programs in Massachusetts. Based on a report to the Commission 
against Di scrimination^ it includes those persons actually employed in the month 
without regard to their civil service status and does not include vacant positions. 

As would be expected ^by far the greatest number of employees are in the 
Boston Region, where the greatest size caseload is concentrated . The size of the 
work force more or less follows the size of the caseload, by region. Other large 
groups of welfare employees are found in the Westboro Medical Payments Center and 
the Central Office where many administrative functions are performed. 

The breakdown of the employees by broad function was simply to illustrate that 
about half the employees were actually performing social work activities such as 
counselling, determining, eligibility, computing grants, supervising the care of 
children etc. with a direct client to worker relationship. Included with this group 
however would be consultants and other supportive staff not actually engaged in 
social work. Another large group of employees were assisting the social workers by 
performing clerical tasks; filing, keeping records, typing and secretarial services 
for example. Also included with this group would be the administrative clerical staff. 
The remaining group of employees includes the various directors, department heads and 
other executive personnel. -56- 



Inquiry and Referral Unit 

Each month in Fiscal Year 1974 the Inquiry and Referral Unit handled about 
800 requests f inquiries , referrals and complaints. Most of these revolve around 
the AFDC program but questions about the Food Stamp program and General Relief 
also entered into a significant number of the inquiries. 

All interested parties are served ? especially prospective clients, taxpayers 
and legislators, federal state and local. Most of the communication is by 
telephone but in any month the number of office visits and letters together are 
over 120. 

Most requests are from the Boston Region followed by Greater Boston. An 
example of the average months activity is as follows for June 1974. 
Program No. of Inquiries Area No. of Inquiries 



AFDC 



267 
120 
110 
81 
68 
279 
925 



Boston 

Greater Boston 
Brockton 
Lawrence 
New Bedford 
Springfield 
Worcester 
Out of State 
Not Given 
Total 



374 
168 
58 
38 
18 
18 
17 
11 
223 
925 



Food Stamps 
General Relief 
SSI 



Medical 

Other 

Total 



Method 



Telephone 
Office Visit 
Mail 
Total 



807 
59 

925 



Source: Internal, unnumbered, monthly report prepared by this unit. 



-57- 



mm 



Child Support Enforcement Unit 

In the 1974. Fiscal Year, $18,664,131 was received by the Department of Public 
Welfare for the support of families aided by the Department from legally liable 
fathers. Over 2,000 cases were closed as a result of the activities of the Support 
Unit in tracking down responsible fathers for an additional savings of over $8 
million. 

In the last quarter of Fiscal Year 1974 alone the Support Unit accomplished 
almost 4 thousand actions resulting in increased support payments to the Department 
or to the case being closed without additional direct assistance. A breakdown of 
the actions for the period April 1, 1974 to June 30, 1974 are as follows: 



Uniform Reciprocal Actions Completed 186 

Voluntary Agreements Made 1 438 

Probate Court Orders Executed 710 

District Court Orders Executed 939 

Voluntary Arrangements Made Through Probate 302 

Withdrawals at Intake (Voluntary) 151 

Cases Referred to Welfare Audit (fraud) 56 

Total Support Actions for Quarter 3 782 



Source: Internal Unnumbered Quarterly Report of the Unit. 

Support payment receipts are greatest in the Boston Region followed by 
Greater Boston and Lawrence whereas the top three regions in caseload are Boston 
followed by Greater Boston and Springfield. The highest average recovery per case 
per quarter for support is obtained in the Lawrence Region followed by Worcester. 
The lowest is in the Boston Region. The best record for closing cases, because 
support was not received, was in the Worcester Region. 



-58- 



APPENDIX I 



Massachusetts Department of Public Welfare 
1973 Calendar Year Direct Payments 
By Category, By WSO, By Region 



City or Town 


OAA 






AFDC 




DA 




GR 




Boston 


|15 741 


864 


$87 


335 


232 


♦11 


357 


053 $18 872 


547 


Total Boston Region 


15 7A1 


864 


87 


335 


232 


11 


357 


053 1 


8 872 


547 


Adams 


588 


660 


1 


787 


926 




378 


150 


159 


207 


Chicopee 


468 


759 


2 


536 


475 




327 


132 


267 


084 


Great Barrington 


161 


757 




230 


521 




68 


626 


20 


799 


Greenfield 


552 


744 


1 


680 


572 




364 


938 


218 


418 


Holyoke 


874 


915 


4 


378 


622 




507 


081 


808 


326 


Northampton 


441 


089 


1 


719 


814 




378 


592 


411 


198 


Palmer 


179 


140 




653 


047 




113 


158 


76 


182 


Pittsfield 


939 


588 


3 


170 


156 




490 


867 


571 


968 


Russell 


57 


738 




278 


119 




42 


102 


27 


486 


Springfield 


2 862 


422 


18 


385 


565 


3 


235 


902 


2 930 


163 


West Springfield 


302 


136 


1 


301 


157 




219 


313 


129 


657 


Westfield 


283 


485 


1 


479 


362 




214 


917 


188 


007 


Total Springfield Region 7 712 


433 


37 


701 


336 


6 


340 


778 


5 808 


495 


Athol 


92 


740 




449 


928 




62 


219 


34 


626 


Boylston 


35 


773 




75 


754 




11 









Clinton 


257 


693 




6Z.5 


975 
7 • j 




179 


989 

707 


11 


955 


Fitchburg 


884 


01 5 


j 


161 


704 




538 


155 


124 


710 


Gardner 


427 


on 


•1 

1 


154 


733 






018 

V IO 


121 


071 


Grafton 


90 


621 




152 


227 




50 


713 


3 


984 


Holden 


57 


3?9 




63 


Z.67 




11 


635 




222 


Leicester 


135 


115 




/ 07 


?// 




93 


9?5 

y<-j 


16 


728 


Leominster 


282 


AOO 




869 


587 




130 


??1 


Z8 
A-o 


237 


Med way 


619 


3?9 




391 


5/0 




Z52 


876 


102 


741 


North Brookf ield 


72 


{VI Q 
O 17 




320 


822 




76 


746 


2 


535 


Northbridge 


167 


1 £\J 




813 


573 




110 


?50 


38 


184 


Orange 


108 


253 




374 


887 




32 


8?? 


?/ 


372 


Rutland 


52 


971 




235 


636 




37 


One 
ol/o 


12 


642 


Shrewsbury 


70 


037 




206 


A/? 




zo 


333 


? 


436 


Southbridge 


656 


ZOA 


1 


97? 






39Z 


l«C / 


101 


538 


Spencer 


116 


A38 






807 




56 


?8A 


/ 


683 


Sutton 


38 


37? 




91 






21 


one 
<x»p 







Templeton 


75 


013 




?10 


130 




51 


53? 


Q 

7 


291 

*-7 • 


West Brookf ield 


100 


0<-7 




313 


81 Z. 




9Z 


577 


7 


350 


Worcester 


3 0U 


70Q 


10 


967 




<. 


821 


116 


484 


671 


Total Worcester Region * 7 355 


8?? 


?5 


135 


189 


K 

J 


Z81 


991 


1 151 


976 

7 * w 


Amesbury 


318 


881 


1 


050 


901 




176 


246 


56 


217 


Beverly 


402 


324 


1 


503 


859 




191 


292 


169 


278 


Billerica 


127 


972 




948 


855 




87 


316 


68 


037 


Chelmsford 


134 


184 




378 


692 




83 


145 


11 


796 


Concord 


304 


172 




820 


536 




140 


870 


79 


869 


Danvers 


198 


747 




390 


776 




86 


221 


40 


503 


Dracut 


180 


411 




665 


768 




105 


830 


16 


311 


Essex 


125 


848 




223 


865 




56 


665 


8 


538 


Georgetown 


77 


383 




202 


681 




42 


674 


8 


196 


Gloucester 


689 


689 


1 


500 


136 




250 


666 


109 


038 



-59- 



( \ +."¥" ot* Tnun 

■ vj vJ. X vNIl 


OAA 




AFDC 






un 




XXSk V vl 11 XJLX 


773 


132 


j 


051 


153 


37<> 


cAy, 

7W<(. 


301 


Toy 
r 74 


JUHH1 wUvv 


1 673 


A73 


K 

J 


637 

vJ.7 ' 


36A 


982 


2A9 


A78 


716 




1 793 


086 


8 


218 


350 


888 

000 


91 *> 

7 "P 


652 


125 




285 


03A 




856 


836 


182 


Q81 


6A 


A28 


I'v PI WWU T L/vl \f 


251 


168 




755 


768 


1Z.1 


598 
770 


96 

7D 


960 


North And over 

livA VII Km m inm V V OA 


90 

7»7 


A92 




217 


363 


A3 


286 

4COV7 


2 


673 
017 


Peabodv 


39A 

-77*f 


310 
.7 *\f 


1 

I 


073 


232 


163 


503 

pup 


116 


298 

<7« 


Salem 


551 


052 

V7 «✓ *v 


1 

1 


89/ 


654 


3 I >*> 
j j j 


535 
j j j 


200 


736 


Tevksburr 


137 


083 




483 


343 


101 


307 

TV ( 


29 
<-y 


622 


Westford 


43 


303 




158 


440 


15 


513 




285 


Wilmington 


72 


911 




353 


812 


60 


979 


10 


014 


Wo burn 


LLh 


252 




381 


759 


205 


232 


169 

"77 


062 


Total Laurence Region 


9 070 


907 


31 


768 


143 


L 737 


587 


2 690 


A96 


Arlington 


434 


876 




867 


589 


176 


678 


76 


OAA 


Brookline 


578 


703 




745 


488 


Z.30 


01. 8 

w»mw 


195 

• 7^ 


180 


Cambridge 


1 575 


462 


5 

✓ 


325 


529 


1 263 


373 

.7 • -7 


398 

770 


00A 


Chelsea 


829 


606 


3 


507 


819 

v • 7 


y./c; 


110 


A91 
^7 • 


33A 


Everett 


572 


8ft/ 


2 


501 


581 


3A1 


317 
.7 1 1 


351 
77 • 


<~*f7 


Framinffham 


5A7 


1A5 


2 


250 


280 


A56 


903 

7"7 


1 105 


562 


Hudson 


89 


A15 




282 


026 


Z.8 


71/ 


A 
w 


957 

7? « 


Lynn 


2 359 


617 


10 


059 


189 
1 07 


1 619 
1 vi7 


530 


1 333 


3A7 


Maiden 


796 


608 


j 


Z06 


28Z 
■coif 


cni 


377 


506 
j\jyj 


388 


Marlboro 




960 


«1 
1 


A13 


6ZO 


102 


850 

0.7 \j 


6A 


0A1 


Medford 


839 

ojy 


58*5 


2 


2A6 


579 




015 


170 


322 




on-i 


ZQ9 




*>73 


032 


Q8 
70 


155 


51 


fty n 


Natick 

ltd vlvIV 


P5n 


A73 
O #P 




6an 

oou 




«?7 


ny 7 


27 


363 
pop 


Nf*ut nn 


/JO 

447 


Q17 


-1 
I 


up I 


5 '4 


02 


■370 
2 (7 




3PP 




P4' 


44P 


I 


AQC 

U72 




175 


n r 7Q 


IU2 


OP7 


1U3 V ol O 


A5y 


q on 

P7U 


O 

<c 




544 


-7-7 / 




361 


poo 




1 AQ1 


QOQ 

7<-7 


n 
1 




y <v 




yon 
47U 


7np 


ft31 
OP • 


Via left f -i d 


185 


736 




437 


494 


ft1 


5H7 
2W f 


16 


236 
<PO 


Waltham 


643 


581 


2 


043 


047 


470 


680 


190 


584 


Watertovra 


y 0/ 


QAn 
70U 








195 


549 


57 


318 


nxii UliX UU 


2ft6 


47 • 




/ 00 


QQQ 

777 




joy 


do 
07 


1)0 

44^ 


To+Jil Of Rofl+nn ftoari e\r\ 


1 / n/ 5 


673 
jp 


/Q 
47 


7/n 


#7 


Q «J73 
7 2 »2 


A57 
o24 


5 y 3/ 

2 4P4 


371 
P * • 


At, "hi AhoTn 


666 


Q57 

7-/ r 


-a 


118 
1 1 


876 


*>37 

P-7 f 


Q73 

7'7 


87 


069 




1 939 

I 7.77 


7Q9 
tyy 


m 

I u 


127 


928 


1 3A*; 
i .pop 


470 


QQ8 

770 


751 


i#vPU BBMW 


3A6 

_7*+U 


288 




71 Q 

« '7 


/70 


172 


755 


29 
*~y 


553 


Wfl 1 IfiMII 


168 


ft/Q 






15^ 


138 

I JO 


Q8Q 

yoy 


26 


058 


Hull 




802 




1 

1 


130 




n 

V7 




A29 


Norunoil 

1VV/WWL 


A37 

<K7 ' 


A39 

*K77 


1 


391 


A98 


2ft7 


3Q2 


53 

P-7 


919 

7 '7 


Quincy 


1 385 


160 


/ 


029 


645 


813 

O 1,7 


605 


379 

p » 7 


A55 


Randolph 


194 


488 




598 


015 


125 


827 


16 


749 


Taunton 


821 


459 


3 


079 


172 


589 


340 


164 


763 


Weymouth 


509 


286 


2 


345 


423 


296 


713 


126 


540 


Total Brockton Region 


6 470 


527 


25 


962 


312 


4 348 


092 


1 883 


286 



-60- 



City or Town 


OAA 




AFDC 




DA 






GR 




Barnstable 


461 906 


2 


275 


606 




258 


285 




248 


352 


Bourne 


54 831 




480 


863 




38 


134 




25 


875 


Fairhaven 


342 247 


1 


062 


827 




244 


726 




85 


662 


Fall Hirer 


3 149 228 


7 


035 


338 


2 


257 


078 




333 


369 


Falaouth 


173 247 


1 


183 


240 




117 


588 




46 


158 


Marshfield 


186 085 


1 


155 


680 




143 


966 




62 


757 


Nantucket 


43 597 




162 


122 




28 


195 




42 


078 


New Bedford 


3 041 372 


9 


591 


900 


1 


919 


100 




966 


810 


Oak Bluffs 


72 867 




192 


933 




46 


242 




9 


507 


Orleans 


232 314 




799 


938 




181 


212 




224 


739 


Plymouth 


457 957 


1 


102 






259 


698 




101 


427 


xiocJcLand 


276 157 




860 


467 




132 


on 




34 


626 


Wareham 


148 901 


1 


458 


624 




152 


779 




84 


669 


Total New Bedford Region 


864 709 


27 


361 


960 


57 


790 


014 


2 


266 


029 


Totals 






















Boston 


15 741 864 


87 


335 


232 


11 


357 


053 


18 


872 


547 


Springfield 


7 712 433 


37 


701 


336 


6 


340 


778 


5 


808 


495 


Worcester 


7 355 822 


25 


135 


189 


5 


481 


991 


1 


151 


976 


Lawrence 


9 070 907 


31 


768 


143 


4 


737 


587 


2 


690 


496 


Greater Boston 


14 045 673 


49 


740 


879 


9 


573 


854 


•* 

5 


434 


371 


Brockton 


6 470 527 


25 


962 


312 


4 


348 


092 


1 


883 


286 


New Bedford 


8 640 709 


27 


361 


960 


5 


779 


014 


2 


266 


029 


Grand Total 


69 037 935 


285 


005 


051 


47 


618 


369 


38 


107 


200 



-61- 



II 



APPENDIX II 



Caseload By Program By 
Welfare Service Office, Region and State 
June 30, 



Medical Only 



AFDC Children 

AFDC GR Aged Disabled Related Under 21 



Total State 


j j 


0*4-7 


29 




Z.1 


769 


7 A51 




13 12? 


i tal 




















Boston Region 


27 


1A6 


13 


636 


6 


129 


1 025 


703 


1 938 

• 7 JO 


East Boston 


2 


056 


1 


403 




15 


3 


12 


10 


vUUlVsi.1 Utl GCl> 


<« 
i 


53o 


3 


Oof 




12 


•9 







Roxbury Crossing 


5 


124 


2 


378 




1 





1 


2 


hancock Street 


3 


134 




671 




4 


7 


11 


168 


Adams Street* 


/ 


396 




134 




5 


1 


2 


34 


Grove Hall 


/ 


Z92 


2 


196 




7 


11 


2 


11 


Inst. & Nursing Hones 








75 


/ 
«► 


/Of) 


507 


3 


1 

1 


Hawkins Street 




o 




1 




66 


o 








Columbia Point 




A/0 




76 




o 


Q 
V/ 


n 


Q 

7 


West Howell 


1 

■ 


636 


1 

1 


616 




on 


19 


2 


21 


D Street 












U 


r\ 
U 


1 


IU 


Morton Street 




3 




791 




16 


12 





18 


So, Huntineton Ave. 




76*» 
(Oy 




^1 

51 




1 
1 


ft 

U 


u 


1 


Westview 


1 


P90 




OJ 




u 




U 


9^ 


Roslindale 


I 


Owe / 








•a 


1 


U 


JO 


Other 










1 






oov 




Total 




















Springfield Region 


13 


362 


4 


229 


5 


080 


1 058 


677 


2 344 


Adams 
Chicopee 




639 




150 




344 


70 


50 


94 




939 




182 




388 


63 


26 


115 


Gt. Barrington 




114 




28 




138 


19 


9 


19 


Greenfield 




686 




218 




330 


58 


76 


187 


Holyoke 
Northampton 


1 


550 




512 




610 


213 


149 


349 




719 




370 




400 


85 


72 


191 


Palmer 




265 




87 




189 


111 


30 


92 


Pittefield 
Russell 


1 


093 




445 




604 


98 


78 


266 




99 




14 




40 


19 


3 


36 


Springfield 


6 


166 


2 


009 


1 


457 


241 


122 


768 


Westfield 

Springfield 
Other 




495 




100 




233 


49 


34 


119 




597 




114 




201 


32 


28 


108 














146 












-62- 



AFDC Children 



AFDC 


GK 


Aged 


Disabled 


Related 


Under 2' 


8 84-5 


1 034 


5 331 


1 083 


489 


1 606 


169 


20 


81 


30 


15 


50 


28 


2 


37 


5 


5 


5 


220 


10 


180 


36 


12 


52 


1 123 


101 


504 


83 


53 


236 


4.12 


108 


304 


33 


12 


84 


35 


2 


40 


7 


5 


3 


14.6 


9 


114 


22 


23 


31 


365 


31 


135 


26 


30 


✓ — 

63 


875 


rtZ 

86 


487 


104 


52 


138 


103 


7 


44 


22 


2 


42 


303 


44 


286 


71 


19 


85 


136 


10 


40 


13 


28 


39 


90 


13 


61 


11 


8 


26 


83 


1 


92 


11 





14 


763 


81 


444 


122 


53 


233 


102 


4 


73 


34 


7 


26 


87 


10 


65 


21 


17 


38 


111 


9 


76 


10 


18 


21 


3 694 


486 


1 898 


428 


124 


420 








370 


1 








10 923 


2 208 


6 514 


1 073 


665 


1 831 


400 


55 


205 


27 


37 


40 


540 


173 


318 


49 


20 


✓ • 

64 


299 


39 


147 


39 


70 


53 


144- 


8 


137 


17 


17 


18 


363 


83 


279 


39 


23 


68 


152 


40 


206 


19 


7 


30 


228 


24 


147 


22 


25 


33 


93 


8 


94 


17 


7 


81 


71 


11 


67 


18 


11 


22 


547 


85 


236 


44 


37 


97 


1 020 


224 


718 


130 


41 


238 


1 934 


361 


797 


131 


86 


284 


2 5U 


535 


1 034 


185 


91 


254 


333 


66 


319 


37 


32 


85 


276 


105 


182 


34 


6 


71 


85 


7 


161 


15 


7 


14 


403 


91 


260 


65 


26 


74 


695 


119 


277 


64 


15 


83 


151 


22 


123 


26 


23 


45 


46 


3 


52 


7 


3 


21 


118 


30 


71 


21 


12 


48 


511 


119 


511 


66 


69 


108 








173 


1 









-63- 



I 



Medical Only 



AFDC Children 





AFDC 


GR 


Aged 


Disabled 


Related 


Under 21 


Total 














Gr. Boston Region 


16 148 


4 274 


9 348 


1 706 


980 


2 410 


Arlington 


295 


66 


300 


57 


49 


62 


Brookline 


247 


130 


407 


73 


32 


46 


Cambridge 


1 699 


390 


737 


119 


39 


175 


Chelsea 


1 046 


252 


265 


71 


18 


124 


Everett 


859 


271 


372 


74 


34 


140 


Framingham 


829 


134 


613 


92 


46 


168 


H Ason 


121 


29 


78 


8 


10 


26 


Lynn 


3 186 


1 138 


1 080 


187 


99 


339 


Maiden 


1 159 


386 


615 


154 


95 


192 


Marlborough 


532 


77 


417 


60 


58 


65 


Medford 


762 


157 


510 


109 


82 


163 


Melrose 


195 


43 


200 


31 


21 


29 


Natick 


229 


31 


223 


42 


32 


38 


Newton 


340 


85 


717 


72 


45 


67 


Reading 


389 


92 


306 


59 


61 


91 


Rpvpt*p 


arm 




400 








Somerville 


2 120 


490 


794 


188 


98 


294 


Wakefield 


163 


21 


175 


38 


17 


28 


Waltham 


Aon 




jjv 


111 




ion 


Watertown 


246 


46 


243 


26 


7 


51 


Winthrop 


241 


79 


211 


29 


32 


55 


Other 








67 











Total 














Brockton Region 


9 430 


1 954 


5 466 


820 


656 


1 407 


Attleboro 


1 127 


147 


499 


67 


54 


147 


Brockton 


3 756 


926 


1 585 


219 


121 


435 


Dedham 


235 


29 


285 


46 


67 


59 


Hinghnn 


180 


55 


143 


19 


27 


29 


Hall 





1 














Norwood 


488 


105 


629 


137 


106 


123 


Qaincy 


1 449 


387 


1 104 


146 


84 


168 


Randolph 


215 


27 


191 


29 


43 


17 


Taunton 


1 123 


132 


568 


107 


63 


321 


Heyauulh 


857 


145 


396 


50 


91 


108 


Other 




• 





66 












AFDC Children 





AFDC 


GR 


Aged 


Disabled 


Related 


Under 2' 


jtal 








686 






»v Bedford Region 


9 995 


2 195 


3 901 


709 


1 586 


unstable 


903 


318 


247 


46 


90 


209 


(tune 


154 


33 


45 


2 


9 


32 


drhaven 


385 


62 


158 


21 


16 


69 


ill River 


2 597 


301 


1 128 


152 


146 


313 


jliouth 


443 


86 


94 


31 


46 


89 


irshfield 


416 


51 


151 


34 


62 


108 


antucket 


54 


57 


26 


4 


3 


11 


ew Bedford 


3 308 


769 


1 200 


257 


161 


345 


ik Bluffs 


74 


11 


41 


5 


12 


22 


rleans 


307 


289 


77 


24 


37 


69 


lymouth 


475 


105 


213 


54 


47 


155 


dckland 


376 


35 


264 


33 


61 


72 


lareham 


503 


78 


92 


23 


19 


92 


Ither 








165 












I 



-65-