Wednesday, November 30, 2016

Even Foster Care can harm children


Removing children from families can also cause harm

This is a student reaction paper about the issues around removing children from families and putting them into foster care.

In the assigned reading for class I came across the article Foster Care vs. Family Preservation: The Track Record on Safety and Well-being. This article argues that family preservation is based upon one overriding assumption: If you remove a child from the home, the child will be safe. If you leave a child at home, the child is at risk. The risk can go both ways, for instance real family preservation programs have a better record for safety than foster care. Studies have shown that children left in their own homes typically do better than comparably-maltreated children placed in foster care. According to the article, a study of reported abuse in Baltimore, found the rate of "substantiated" cases of sexual abuse in foster care more than four times higher than the rate in the general population.  Using the same methodology, an Indiana study found three times more physical abuse and twice the rate of sexual abuse in foster homes than in the general population.  Studies were found that In group homes there was more than ten times the rate of physical abuse and more than 28 times the rate of sexual abuse as in the general population, in part because so many children in the homes abused each other.

Thomas Morton argues in his article “Foster care vs. Family Preservation” is the wrong debate because neither foster care nor family preservations is absolute in its safety outcomes.  The purpose of having child welfare is to ensure physical protection and emotional security for all children.  Emotional security is compromised when children are being neglected or abused. However, removing children from a home where they are neglected or abused so the child can be safe can also cause damage by the trauma experienced when the child is removed from their caregiver and placed into foster care. When a child is removed from their home, away from their primary caregiver and placed into foster care, this violates the basic trust existing in child’s life.  These occurrences can affect the child’s overall performance in life. 


For more information visit, 


I just want to point out that while foster care situations (or even adoptive situations, for that matter) are riskier than family situations in the general population, the comparison group here is not the general population.  The comparison group here is families where a child protective worker was so concerned about the situation that they decided to remove a child from the household to protect the child from harm.  What is the risk of abuse or neglect or harm to a child in the sample of homes where a social worker decided that removing a child was necessary because of the risks to that child of staying in the household?  I have strong feeling that the risk of abuse in such households is probably more than 28 times higher than it is in the general population, and far, far greater than it is in the foster care family households or adoptive households.  
Yes, abuse and neglect can happen, and sometimes do happen, in foster care families.  But, such abuse and neglect also happen in some very small fraction of biological families or families of origin.  In that small fraction of "natural" homes where abuse takes place, the risk of further abuse or continuing abuse is very high, and much higher than the risk in foster care.
The contribution of this article is to make us remember that the very act of removing a child from a dangerous home is likely to harm that child.  Chemotherapy harms cancer patients; it may save them, or it may not, but it may also kill them, and it's always dangerous.  Removing children from their families is like that.  Even a vaccination is obviously good, in the general sense, but every one and a while someone who is vaccinated will have an allergic reaction to the vaccine, and some people will even die from vaccines.  But, for most of us, the vaccines protect us, and create a society that is protected from diseases that will do more harm, in total, than vaccines will.  Is the child protection method of removing children from homes going to be disastrous and wrong every once and a while?  Yes.  There will certainly be cases, hopefully very few and isolated cases, where children will be wrongly removed from fairly good homes, where the child protection worker will be making a bad decision, because there will be no real risk to the children, and the natural family is loving and good, but still, sometimes child protection workers will make mistakes, and in one of these cases where the child is wrongly removed from a family, the child will end up in a placement where the child will be abused. That is the nature of the system.  What is the solution?  Maybe the solution is to have interventions where teams of people move in and live with the family around the clock so the parents and children are never alone together, thus preventing any abuse, and the teams of people who have entered the household can ensure that the child is never neglected.  That would stop the harm of removing the children from bad placements, and it would stop the harm of the abuses that some children suffer while in foster-care or group homes.  Is it plausible?  Is it feasible?  Maybe it should be, but there is no state where this sort of solution has been proposed, as far as I can tell.  Far more often when I have heard people say is "some people don't really deserve to have children."  I think most people would just rather remove children from families than spend $150,000 per year to have a team of social workers and child care workers intervening in the household and preventing the parents from harming their children.  That is not where our priorities as a society are placed.









Tuesday, November 29, 2016

Stigma of the Homeless

Stigma of the Homeless

[This is a student's reaction paper on the topic of housing, homelessness, the stigma surrounding the homeless, and the need for homeless persons to have use of a permanent street address (not a post office box) for mail while trying to get out of a homeless situation] 

Homelessness in the United States and in other countries has been an issue for many generations. The term homeless is defined as being without a permanent dwelling or living space. There is not a definite cause for a person becoming or remaining homeless, but instead a series of causative factors. Poverty is one of the major causes for homelessness, whether it's from a lack of employment or being underemployed. Another major cause of homelessness lies with the individual having a mental or psychiatric disorder where mental health services are difficult to access or are unavailable. However, once a person becomes homeless due to an unfortunate circumstance they often times turn to alcohol or other drugs (AOD) to cope. When he/she become addicted to AOD it becomes harder to obtain adequate resources to alleviate being homeless and continue to remain addicted. The issue remains a vicious cycle of deviant behavior of one form or another.

Unfortunately, the stigma of addiction is almost always connected to homeless persons as is a connection to mental instability. A society which places a stigma on such individuals only adds to their revolving problems. Local governments within the United States have, over time, enacted laws in an attempt to alleviate vagrancy amongst those who are homeless; like prohibiting sleeping/camping, eating, sitting, and begging in public spaces. The laws were meant to ensure public safety, yet are often used to coral the homeless, adding further stigma. When a person finds themselves impoverished it becomes harder for him/her to attain affordable housing or even affordable healthcare. Often times, the individual will enter a state of depression due to lack of available resources. There are federal programs designed to help end homelessness, yet there is still a large number of individuals and families without adequate housing or shelter.

There are many community organizations and social movements in the United States working together to find solutions to reduce homelessness. The U.S. Department of Health and Human Services in connection with the Department of Housing and Urban Development (HUD) are the key federal organizations which attribute to a significant decrease of homeless persons. They have sought to counteract the causes and reduce the consequences by starting initiatives that help homeless people to transition to self-sufficiency. According to the National Alliance to End Homelessness (2015);   
"On a single night in January 2014, 578,424 people were experiencing homelessness—meaning they were sleeping outside or in an emergency shelter or transitional housing program. From 2013 to 2014, a period of ongoing recovery from the Great Recession, overall homelessness decreased by 2.3 percent and homelessness decreased among every major subpopulation: unsheltered persons (10 percent), families (2.7 percent), chronically homeless individuals (2.5 percent), and veterans (10.5 percent)" 
(NAEH, p. 3).

Overall there have been great strides to alleviate the issue of homelessness, yet there is still a large number of individuals without shelter. Often times, the main issue revolves around program funding and available locations for housing. One solution by policy makers was to establish shelters meant to aid the homeless and some laws put in place to prevent impoverished persons from losing their home or obtaining one at their rate of income. Section 8 housing vouchers are utilized to assist persons in poverty with government subsidies to assist in paying for rent or housing, but are often time consuming and difficult to obtain. There are certain rules and requirements in place to warrant honesty and necessity amongst the many applicants. The hope, with government aid, is to rid society of the status of homelessness.

Currently, it is harder to find adequate shelter or available beds for the homeless. Most places that are established as shelters also have rules in place to prevent vagrancy and crime. Often times, men are turned away from many shelters due to the establishment only allowing women and children (under a set age). If these turned away individuals are without assistance from the government, where do they go? This slowly precipitates into incarceration, which is a success to some homeless persons seeking shelter.

The solution should be to educate and attempt to establish employment in succession with providing temporary shelter and/or medical care if needed. Almost no employers will legally hire a homeless person without a reoccurring address. The law is in place to prevent fraud and ensure proper taxation amongst the workforce. Policy makers may need to look past the current status of homelessness and look inward as to why.


Having a mailing address allows the person to receive mail and even the ability to maintain proper identification cards like a state I.D. and Social Security card. Employers also require proper identification to ensure citizenship and to prevent personnel fraud. Allowing government or church shelters the ability to provide a legal mailing address would ensure a greater chance of finding employment. The individual's quality of life may improve once employment is obtained, and with the end result being finding an adequate home or shelter. The policy should also include job training/education, along with supplying the address, to ensure the person is able and willing to work effectively.

The Federal government has many, many programs for promoting affordable housing, community development, and ending homelessness.  But, they are all relatively small (well, housing choice vouchers and public housing programs aren't really all that small: about 2.2 million persons live in public housing or public tribal housing, and over 5 million persons live in housing where housing choice vouchers (Section 8) are used.  But, there are no mandatory programs that deliver affordable housing. As your reaction paper shows, there are insufficient spaces (beds) in shelters for those who are homeless.  And, an emphasis on temporary housing in shelters or transitional housing is an inferior second-choice policy option to an emphasis on providing immediate permanent housing solutions.

Monday, November 28, 2016

Sundown Towns in brief.

Sundown Towns

Today in Illinois, there is estimated to be at least 500 sundown towns.  I have always heard that my home town of Pekin was one, but really never knew the history, until now. I mean, we did have the Pekin Chinks [the name of the school team was “chinks” rather than “railsplitters” or “trojans” or “tornadoes” or something like that]; nothing weird about that.  I did have one black girl in my graduating class; that’s about right; isn't it?  Even today, our football team does not play Peoria teams because of the racism involved; only white teams for us!
A sundown town is any organized town or jurisdiction that keeps African Americans or other minorities out;  or keeps towns all white, on purpose.   Many times it was done by force, such as chasing or harassing minorities out of town, and sometimes it would be done informally.  African Americans just knew not to come to Pekin.  Before 1968, my town would have signs at the entrance that stated:  N* Don't Let the Sun Go down on you in Pekin.  I have always heard the police would run blacks out of town if they were found; but, I have never seen this happen, this was just common knowledge.   As of 1968, the federal government passed the Civil Rights Act; commonly referred to as the “Fair Housing Act”. The action of keeping blacks out of communities went underground after that.  Sundown Towns had to take their signs down, and harass minorities informally.  
I thought this was interesting; in 1940, Victor Green wrote the “Negro Motorist Green Book.”  Victor Green was a travel agent in 1940.  He wrote a guide book that gave Blacks a way to avoid Sundown Towns when they traveled; which included hotels, taverns, garages, night-clubs, restaurants, and service-stations where Black readers of the guide would be warned of hostility and danger or assured a welcome in safety.
Sundown Towns varied in size, from very tiny Ava, IL which has 662 people to Arlington Heights, IL with has 76,000 people.    

Many communities remain all white today; whether blacks can live at ease and comfortable within them, I feel, that I remain doubtful.    

I am glad you have addressed this topic, and being from Pekin, a notorious sundown town, it is especially gratifying to know that you investigated James Loewen's website and/or book on the topic.  My own experience with this was one that involved my exposure to racism in housing and culture in stages.  As a young child growing up in a very progressive family in southern California, I did not notice racism, and had very little understanding of it.  As a child growing up in Indianapolis, I was not yet in a place that had quite the history of racial discrimination, although I remember my parents marking with scorn that the Elks Club near our neighborhood was a prejudiced place that would not allow African-Americans to join (this was in the 1970s).  By the time I was in middle school, I was exposed to several some very progressive teachers (Jack Monninger and Fred Farrell stand out in my memory) who taught things that were not in textbooks (about a Ku Klux Klan governor in Indiana, or the discrimination against veterans who were African-American or Hispanic).  Then, when I moved to Saint Louis in 1982 as a 14-year-old, I encountered the strange southern legacy... Missouri had been a slave state, and it seemed very different from Indiana.  I remember once riding on a greyhound bus from Indianapolis to Saint Louis, how the (African-American) woman next to me explained to me that when she had been a girl and her family rode the bus to Saint Louis, the rule had been that all the African-American passengers had to move to the back of the bus when they crossed the Mississippi and entered Missouri.  In Saint Louis I met classmates and adults who possessed quaint notions of virulent race hatred and base racism of the worst kind.  African-American friends and a Native American friend told me about towns in Missouri that were "no go" places for them.  A Jewish friend mentioned how her family had been essentially chased out of Sullivan, Missouri.  I remember getting physically ill when exposed to some of these overtly racist persons who seemed obsessed with their prejudices against a whole class of people.  But this was all over 30 years ago.  I really do wonder what has changed in the attitudes of some of these people, if anything.  

Of course, now as an adult I know more about how to address prejudice and racism when it is exhibited around me.  And, having lived as a racial minority (among Africans in Kenya; among East Asians in Taiwan and China), I have a better sense of what it is like to be a minority, although I can't experience being a member of an historically oppressed minority unless I try to go live in Iran and flaunt my religious identity there. Still, I must admit, the struggle to end racism and deconstruct prejudices has not been the main cause in my life.  I care about it, and have been involved to some degree, but it is a more difficult challenge than, for example, trying to end the deprivation of poverty.  I continue to believe that the main way to reduce prejudices is to increase cooperative contact across races, getting people with different backgrounds to work together for common goals, so that natural friendships and alliances build from that.  Then, I expect natural friendships to develop, and from that, prejudice to be reduced.  I've had some interest in the intellectual movements against prejudices, including the post-modernists, the feminists, the LGBTQ social critics, the political radicals, the leftist or anarchist counter-cultures, and some of the more progressive religious movements (I would count mainstream Western Islam here as one of those). The recent rhetoric after the election of Trump has not surprised me, and I'm sort of glad to see more of the hidden things come out into the light of day where we can see how people really feel.  There have been some problems in the grand strategies and rhetoric and thought processes used by intellectuals in the struggle against prejudices, and I hope that the era we now enter will see more of the anti-racist work take a more practical and applied direction.  We shall see.

Sunday, November 27, 2016

A reaction to Oregon's Death with Dignity Act

Here is a student's reaction paper about a law that allows terminally ill people to commit suicide when they are facing a long and painful death.
Oregon's Death with Dignity Act
In October of 1997, Oregon passed the Death with Dignity Act (Oregon Health Authority, 2016). This legalizes assisted suicide for terminally ill residents in Oregon. Terminally Ill residents are prescribed lethal medications by a physician, which will be self-administered (CGA, 2002). In order to begin this process, they must first meet the following requirements: Must be a Resident of Oregon, be 18 or older, capable and able to make health care decisions, diagnosed with a terminal illness that will lead to death within six months (CGA, 2002). After meeting these requirements, the individual must meet the following requirements to obtain a prescription for the lethal drug: Must orally make two requests to the physician (each request must be 15 days apart), Must make written request, with two witnesses present, to the physician; the diagnosis, prognosis, and patient's capability must be confirmed; patient must be informed or alternatives; and the physician must request that the patient notify his next of kin of this request (CGA, 2002). 
This is a beneficial law because it allows the terminally ill to die with dignity. It allows them to make the choice of living through something very painful or ending their lives. I fully support this and wish that it was legal everywhere. Each person should be able to make this decision for themselves. They should not be forced to live through such a painful end of their life if they do not wish to. Terminally ill patients are usually facing a lot of pain, costly medical bills, and dependency on others. Instead of waiting for their lives to painfully end, they should be able to avoid it and end it when they wish to. 
Though I believe that this should be legal, I understand that there are a lot of ethical issues surrounding this topic. Some people believe that death should be natural and that there might be a possibility of the patient recovering. Though this might be true, each person should be able to decide this for themselves. No one should be forced to suffer through this pain because someone else is sensitive to the topic. They are not the ones that have to endure the pain or the other negative effects of a terminal illness.

Sources:


I will point out a few things about this.
For some chronic illnesses that kill very slowly, such as Alzheimer's Disease, this won't quite allow suicide, because in those cases a person will lose the ability to make health care decisions more than six months before death is likely to occur.  Also, there are sudden quick declines (for example, with strokes) where the 15 days between requests will exceed the time it takes to die (it might take a week or two).  But, for persons with late-stage cancer, or persons with organs failing or a degenerative disease that is destroying their body, but not their mind, this sort of option can reduce suffering.
I wonder about the terms "murder" and "suicide" in relation to persons who are near death.  If a person is in horrible agony, and will die in a matter of minutes, hours, or perhaps days, and someone kills that person out of mercy, it doesn't seem like murder to me.  Likewise, if someone will be dying soon, and will suffer unimaginable torment in the final weeks or months of that dying process, this sort of self-killing doesn't seem the same as a suicide. 
In 2015, only 132 persons used this act to end their lives (See the annual report in PDF).  That is a substantial number, but not really a very large number. There were, in total, 32.737 deaths in all of Oregon in 2015, and  761 suicides (see the report here).  If those death with dignity deaths are classified as suicides, that's 132 of 761. Nearly one-out-of-six suicides in the state that year.  But, I'm not satisfied with classifying these as suicides.

Tuesday, November 22, 2016

Adoption and Safe Family Act of 1997

Here is a student paper about the Adoption and Safe Family Act.

The Adoption and Safe Families Act was signed on November 19, 1997. This law says that the health and safety of children should be the main concern of adoption agencies. They should also focus on making sure that they move children from foster care into permanent homes very quickly.
This act helps young children who are in foster care and need a permanent home. With this act, more children are being put in homes instead of having to live in foster care until they turn eighteen and age out. If a child is in a home that puts them at risk they should be taken out of that environment. With this act, the federal government puts pressure on child protection agencies to work more quickly to make good decisions about removing children from families and reuniting them with their families. If social workers and family courts decide that a child should not be put back into their home environment, this act also helps speed up the process for the child to be placed in foster care or a permanent adoptive home.

When a child is taken out of their home, there are specific things that need to be taken into account when deciding if the parental rights should be terminated. When considering the last 22 months, if the child has been in foster care for at least 15 months, they should not be put back into their homes. If the courts decide that an infant has, by law, been abandoned, then they must be taken away from their parents. Adults’ parental rights will be terminated if they are found guilty of injuring or killing one (or more) of their children.

When there is a child that is being placed into their new permanent home, a hearing will take place. This act also helps to make sure that these hearings are done quickly so that the child does not have to stay in foster care for too long while waiting for a hearing. Once the hearing has taken place to determine where the child should be placed, there are strict time limits on when the child should be placed in their new home. This new home could be with their parents, a relative, or a foster home.
If the family court decides that the child should be reunited with his or her family, there are many services available to that family. They can go through counseling, substance abuse treatment, mental health services, and assistance for domestic violence. This will help the agency (and all the rest of us who depend on professional child protection workers to prevent child abuse and child murder in our society) feel comfortable with placing the child back in their home with their parents.

 The adoption agencies receive incentive payments from the state so that the agencies can place these children in permanent homes. They get paid about $4,000 dollars per foster child that they place. With these incentive payments, agencies have made $20 million from government pay-outs since the law was enacted. These incentive payments help to provide the children with any service they might need before being placed in their new home.


The Adoption and Safe Families Act helps keep children in the safest environment for them. If the child has to be taken out of their home, then this makes it an easier and faster process for putting them in their permanent (adoptive) home. If the child will eventually be put back in the home with their parents, then this act also makes it easier and faster to be put back into their home.

Death With Dignity

This is a student paper about laws to allow terminally ill persons to kill themselves. 


What is Death with Dignity?


            If you live in Oregon, California, Washington, Vermont, or Montana, you have choices available to you if you are diagnosed with a terminal illness. According to the organization, Death with Dignity, these states have legislation in place which allows people with certain terminal illness diagnoses options for ending their lives while they still retain human dignity. But just receiving a diagnosis is not all that is needed. The states have outlined certain criteria that must be met in order to qualify for assisted suicide.
            All states have some of the same general requirements. First, a person must be a resident of the state in which they are seeking to end their lives. Also, each state requires the person be over the age of 18 and mentally competent, which might require a psychological evaluation at the order of the person’s physician. Lastly, the terminal diagnosis must be expected to lead to the individual’s death within six months.
            In Oregon, the first state to pass legalized assisted suicide legislation, there are very specific requirements to make before a patient is allowed to complete their desired departure from their physical life. The above conditions must be met, but then they must also do the following:  make three requests, two verbal and one written and signed by witnesses, to their physician at least 15 days apart; their diagnosis must be confirmed by the physician prescribing the lethal medication and a consulting physician; the prescribing physician must confirm that the patient is capable of self-administering the medication; and the physician is legally obligated to inform their patient of alternatives available for end-of-life care (Oregon Health Authority, n.d). All of these requirements must be met before the prescribing doctor can issue the prescription(s) to the patient, and then the physician must submit all the required forms and proof to the Oregon Health Authority.
            California, the most recent state to pass the End of Life Option Act [until a referrendum in Colorado passed in November of 2016], has many of the same guidelines as Oregon. As detailed by the Coalition for Compassionate Care of California (2016), multiple requests must be made to the physician, written and oral, and one of the requests must be made privately to the physician with no one else in the room (unless an interpreter is necessary). The patient must also have a second physician confirm the terminal diagnosis and estimated life expectancy, and they must also be capable of self-administering the medication(s) prescribed. California also requires the physician discuss several topics with their patient, like alternative care methods, whether the patient will notify family of their decision, if they will have someone with them at the time of taking the medication(s), the prohibition of taking the drug in public, and that they can cancel their request at any time. Patients in California must also sign a form called the Final Attestation for Aid-in-Dying before self-administering the medications dispensed to them, verifying they are voluntarily ending their lives.
            In addition to Oregon and Colorado, Washington and Vermont also have aid-in-dying legislation governing the requirements for physician assisted suicide. Their laws are similar to those of other states. According to the Washington State Department of Health’s website (n.d.), state residents must make 3 official requests, one oral, one written, and then at least fifteen days later, another oral request. The written request must have two witnesses, of whom they cannot be related to, have the intention to bequeath the individual any property or possessions in their will, or be a physician or health care facility employee. Vermont’s policy is called the Patient Choice and Control at End of Life Act. Like Washington, the Vermont Ethics Network (2011) says the patient must be a resident of Vermont, have two oral requests, and one written request with 2 witnesses following the same criteria. Both states also require a second physician evaluation as well.
            Montana, however, is different from the other states with assisted suicide legislation. In 2009, the Supreme Court ruled to expand the Rights of the Terminally Ill Act to include physician-assisted suicide, but did not make clear guidelines on how the ruling functioned (Patient Rights Council, n.d). It is often viewed as simply protecting physicians from prosecution if they choose to assist a patient in compassionate suicide (Patient Rights Council, n.d.).  
            With this information, it is possible to see responsible legislation being developed by states, most modeling after Oregon’s pioneering and effective implementation of the Death with Dignity Act. More states will soon see voters requesting similar legislation be passed. It is important to be armed with the knowledge of what these laws do and what they do-not do before you head to the ballot box.


Another source to learn about these policies is the Oregon Health Authority's annual reports.  In 2014 (the most recent year for which I can find information, in the 2015 report), it seems 155 persons went through the process of getting the lethal dose of medicine, and 105 actually ended their lives. 

Colorado passed the initiative 106, which means they will follow the lead of Oregon and other states.  The voters passed this option with nearly 65% voting in favor

References
Coalition for Compassionate Care of California. (2016) End of Life Option Act in California. Retrieved on October 1, 2016 from http://coalitionccc.org/tools-resources/end-of-life-option-act/.
Death with Dignity. (n.d.) How to Access and Use Death with Dignity Laws. Retrieved on October 1, 2016 from https://www.deathwithdignity.org/learn/access/.
Oregon Health Authority. (n.d.). Death with Dignity Act Requirements. Retrieved on October 1, 2016 from https://public.health.oregon.gov/ProviderPartnerResources/Evaluation Research/DeathwithDignityAct/Documents/requirements.pdf.
Patients Rights Council. (n.d.) Montana. Retrieved on October 1, 2016 from http://www.patientsrightscouncil.org/site/montana/.
Vermont Ethics Network. (2011). Physician Assisted Death. Retrieved on October 1, 2016 from http://www.vtethicsnetwork.org/pad.html.

Washington State Department of Health. (n.d.) Death with Dignity Act – Frequently Asked Questions. Retrieved on October 1, 2016 from http://www.doh.wa.gov/YouandYourFamily/ IllnessandDisease/DeathwithDignityAct/FrequentlyAskedQuestions

Medicaid as Part of the War on Poverty.

This is a student paper about Medicaid.

“This administration today, here and now, declares unconditional war on poverty in America.” these words spoken by President Lyndon B. Johnson began an era of change for our country. It was during his first State of the Union address that he spoke them and started the War on Poverty. This war would continue to rage on for years. New programs would be formed such as Head Start, which would make sure that some children of poor families had access to early education, and the Food Stamps Program, whose goal was to provide nourishment for those who could not afford it. Another of these programs was the Medicaid program. This program would provide healthcare at no cost to those that desperately needed it. Children of poor families, the elderly, and the disabled would all be covered under this new program. 

It was in 1964, after the assassination of President John F. Kennedy, that Lyndon B. Johnson was sworn into office. During the time of Johnson’s presidency, the war in Vietnam was in full swing. Soldiers were dying in record numbers and Johnson signed a bill to send more soldiers to fight. These soldiers would often return from war and need medical care. Also, the Civil Rights Movement was gaining momentum. Martin Luther King Jr. was becoming a well known name, and in 1965 he led the now famous march from Selma to Montgomery, Alabama. It was that year Johnson signed bills that would help change American history forever. One of those was the Voting Rights Act, which gave African Americans the (practical) right to vote (which they had had in theory since the passage of the 15th Amendment in 1870). Another was the bill that amended the Social Security Act of 1935 and created the Medicaid program. This program was designed to ensure that with the help of the federal government, individuals that lived below the federal poverty line would be given free healthcare by their state. After this legislation was passed, Illinois, along with many other states, accepted the program. 
While the original purpose of the program was only to provide healthcare for the children of poor families, the elderly, and the disabled living in poverty, many reforms were made over the years to increase the number of people that receive the benefits of the program. Over the years, many changes to the program have been made at the federal level and the states have had the opportunity to expand on those changes and cover more people than the federal government requires. Many times, Illinois has been one of the states that has gone above and beyond by opening the program to more people. For example, the federal requirement for eligibility states that: 

"The minimum income level of 133% of the federal poverty level for nearly all people under 65" qualifies a person for medicaid. In Illinois, those percentages go as high as 208% of the federal poverty level." (medicaid.gov)
In fact, as of 2016, the eligibility requirements for Medicaid in the state of Illinois are as follows: 

     "Children ages 0-18 with family income levels up to 142% of the Federal Poverty Level (FPL). 

      Pregnant women with family income up to 208% of the FPL. 

      Adults with family income up to 133% of the FPL." (healthinsurance.org)

As long as a person meets the income requirements put forth by the state and is under the age of 65, he or she is eligible for enrollment in the Medicaid program. 

Once a person is enrolled in the Medicaid program he or she will begin receiving a wide range of benefits. These benefits may include, but are not limited to: necessary doctors visits, prescriptions for both drugs and medical devices, yearly check-ups, required immunizations, preventative health screenings and family planning. All of these services and more, such as dental work, are all offered to the Medicaid client at no cost to him or her. Each states' medicaid program is funded by the state and federal government. While it varies by state the federal government funds, on average, a little more than half of the program and the state covers the rest. A bill to fund the Medicaid program through the use of block grants was vetoed by President Bill Clinton in 1995. 

Illinois Medicaid has issues with their program. One of these is that it is hard to find providers that take the insurance provided by the Medicaid program. Clients that use the program are having to sometimes travel an upwards of 100 miles away from their homes in order to find a doctor. Another issue is the limited coverage. While Illinois allows more people to be eligible for the program, the services that are offered, such as dental, are the bare minimum. For instance; the dental plan in Illinois only covers preventative care and cleaning. If the client is in need of any type of orthodontic services or dentures, he or she is unable to receive them under the current Medicaid plan. This is also true of their general health plan. Anything that the state deems as cosmetic or unnecessary, is not covered.

There are many good things and a few bad things about the current Illinois Medicaid plans. Since it was implemented in the 60s, the program has helped thousands of people receive health care coverage. While the plan may need to be overhauled and coverage expanded, it is still a much needed program that helps ensure that all those in Illinois that were previously unable to afford health care are covered. 


  Here are some more details about the relative size of Medicaid nationally and in Illinois:

Nationally, I think about 72 million people are getting health insurance through Medicaid (The figure of 72 million comes from the Henry J. Kaiser Family Foundation http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/ ). 

Some older numbers from back before the ACA boosted enrollment by so many millions in states where the program expanded, when the enrollment was merely 59 million, showed a break-down of enrollments like this: 
31 million children
11 million non-elderly non-disabled adults
8.8 million non-elderly individuals with disabilities
3.7 million people with disabilities who are enrolled in Medicare (elderly)
4.6 million low-income seniors   (see https://www.medicaid.gov/medicaid-chip-program-information/by-population/by-population.html )
The expansion of Medicaid will have increased the proportion of recipients who are adults; this is because before the Patient Protection and Affordable Care Act, poor families with children or disabled persons could often benefit from Medicaid, but poor households in which no one was disabled and no children were living could usually not qualify for Medicaid.  Medicaid expansion allowed many of these low-income non-disabled adults who have no dependent children to qualify for Medicaid. 

Federal Medicaid expenditure in 2015 were about $332 billion (http://www.hhs.gov/about/budget/fy2015/budget-in-brief/cms/medicaid/index.html#

There are about 3.2 million people in Illinois who receive health insurance through Medicaid.

I believe in Illinois about $8 billion (or perhaps it's up to $8.5 billion now) gets allocated for health care expenditures, and the vast majority of that goes to Medicaid or the Health Care Management Organizations that handle health insurance for nearly two-thirds of Illinois persons receiving Medicaid.  That is about a quarter of the state budget. Even so, the last I heard, the state has debts approaching $600 million that it owes to health care providers who have accepted Medicaid payments for services.  



Websites with good information about Medicaid.  These were sources for this article.