Fall 2015 - 59745 - PA680PA - Policy Research Project

Community Care in Multi-ethnic Austin

The Welfare State at Risk?

The welfare state represents one of the major social and political achievements of the Twentieth Century. Even in the United States, in which welfare state programs are far more limited than in Europe, individuals look to government for protection against major social risks, including poverty in old age and illness. Yet despite its success at reducing poverty and increasing health levels, programs for the poor, the disabled, and the elderly are the targets of attempts to control growing governmental debt at all levels. Publicly funded programs face growing resistance from overburdened taxpayers. In the past Austin voters have regularly supported educational and transportation bond initiatives. As the cost of living in Austin has increased, such bond initiatives have been voted down. As property values in the city increase, citizens rebel at growing property taxes and older residents find that they are simply overwhelmed. As dependent as we all have become on the welfare state, its growing cost, which is driven in large part by the aging of the population present federal, state, county, and municipal governments with major challenges.

Medicaid: A Major Tax Burden

Unlike Medicare which is a fully financed by the federal government, Medicaid, the major governmental medical program for the poor, is jointly funded by federal and state governments. Given the aging of the population and the growing cost of medical care this program consumes an ever larger portion of state revenues. The fact that the state must bear a significant portion of the cost assures that Medicaid is politically contentious in state legislatures, and currently twenty-two states, including Texas, have refused to expand Medicaid as part of the Affordable Care Act. Yet the poor of all ages depend on this program. While the majority of Medicaid enrollees are children in poor families, two-thirds of total expenditures go to the elderly and disabled. Total spending on long-term care services for the disabled and elderly was over $234 billion in 2011.

Objective:

This policy research project examines political processes at the state, county and municipal levels that determine how people with disabilities are cared for in the community. Approximately 18.7 percent of the U.S. population, or an estimated 56 million people with disabilities lived in the community in 2010. The state of Texas, Travis County, and the City of Austin mirror these national trends and face additional challenges resulting from a rapidly growing minority population. In this PRP we will explore the opportunities and challenges of providing community care for the most vulnerable Austinites. The main objective of the research is to identify how experiments in community-based long-term care based on federal waivers could be employed to improve support services to both the old and young people in need in the City of Austin. One example is the Program of All Inclusive Care for the Elderly (PACE, Texas Senate Bill 7 (83R)). This program, which we will investigate in great detail, serves individuals age 55 or older who need nursing home care, but prefer to live safely in the community. Our objective is to assess the extent to which such a program could benefit older low-income Austinites in an equitable cost-effective manner. As part of this assessment we will assess the programs potential impact on minority elders and determine which non-governmental and faith-based organizations might participate. Our objective is to identify best practices in terms of organizational features, client identification, volunteer participation, and funding for this and similar programs.