Harnessing Flexibility in the Delivery of Human Services
Despite an accompanying funding cut, a block-granting experiment in Pennsylvania is showing promise for improving the way vulnerable populations are helped.
The first year of a new Pennsylvania block grant program for human services is complete, and the results are, unsurprisingly, in dispute. In talking to those involved, I could not help but think back to what I believe was the first "blocking" of a set of related categorical programs - the creation of federal Community Development Block Grants (CDBG).
I was part of a team at the U.S. Department of Housing and Urban Development that created the CDBG program. Decades later, one still could spark a good debate over whether it was an improvement over the categorical programs it replaced, but among local officials there are few who question its utility, flexibility and importance to their revitalization efforts.
I think of that period every time block grants are proposed for other programs with strong categorical underpinnings or heavy regulatory frameworks. We worked hard in that period to figure out a formula that was fair and politically viable. Nowadays, though, "block" is rarely mentioned without an accompanying "chop." A case in point is Pennsylvania's Human Services Block Grant (HSBG), piloted in 20 of the state's 67 counties over the last fiscal year.
HSBG combined seven programs with state fund appropriations totaling $845 million, including programs addressing mental health and substance abuse, homelessness, intellectual disabilities, and some child-welfare programs. However, the program was proposed at the same time as a 20 percent reduction in state human-services funding, which had already experienced incremental reductions over the prior decade.
Eventually, the cut in funding was scaled back to 10 percent. That, however, did little to assuage worries that block granting would inevitably lead to reallocation of increasingly scarce resources to more popular programs, with inadequate attention paid to the consequences of service cuts for highly vulnerable populations. In increasingly underfunded human-services programs, good administrators have wrung out as much cost through administrative efficiencies as they can. Combining funding sources may simplify administration, but will never cover budget cuts of this magnitude.
While the state agency administering the block grant touts its initial success (disclosure: I headed the state's Department of Welfare between 1995 and 2002), others are concerned about the absence of rigorous evaluation of consumer outcomes and watchful attention to the equity of priorities established by counties.
A look at what the pilot counties have done in the first year nonetheless suggests that there is merit to the block-grant approach in human services - that the traditional categorical funding is a rigid vehicle for responding to the complex needs of families and individuals living in communities. The majority of individuals and families receiving services are multiple-system clients, and experienced human-services administrators have made good use of the flexibility provided under the pilot.
Many counties, for example, streamlined delivery of services to consumers with "single-door" access to programs and family-resource caseworkers who help families navigate otherwise complex systems. Some began innovative programs that intervene earlier with high-risk populations, such as prison inmates about to re-enter the community, or deployed outreach workers for children coming in and out of shelters. And some were able to offer coverage to individuals with substance-abuse problems that did not meet categorical eligibility but who in the future were likely to be high-cost consumers of services.
These are encouraging steps. No one can predict how this program experiment will evolve, but it appears from my vantage point that program design should facilitate rather than impede a flexible response to the complicated problems facing our most challenged citizens.