Moving from Dependence to Independence
Long before welfare reform was approved at the federal level, the Edgar administration was taking action to move public aid recipients to self-sufficiency. It ended benefits to single, able-bodied adults and created the nationally recognized Earnfare program to provide them with work experience.
Welfare recipients were no longer penalized for holding part-time jobs. Families were no longer denied aid when the father remained in the home. Teenaged mothers were required to complete their high school education through the Teen Parent Initiative. As a result of these initiatives and others, Illinois outpaced the nation in moving people from dependence to independence.
These reforms resulted in more than 200,000 people moving from the welfare rolls to payrolls. At the end of Edgar’s term in office, Illinois ranked 1st among Midwestern states and 10th in the nation in improving the lives of poor families through welfare reform.
Impact by the Numbers
decrease in state mental hospital admissions
families moved from welfare to jobs
Edgar signed sweeping welfare reform legislation in 1997 at the United Airlines in Chicago to help thousands to move from welfare to work.
Created six decades ago as a Depression-driven plan for widows’ relief, the nation’s welfare system in the 1990s no longer made sense. The program did not require beneficiaries to work. It did not promote stable families. It often did not help those for whom it was intended. It fostered reliance on government for handouts. It was in need of change.
Under Governor Edgar’s leadership, Illinois took steps to bring “common sense where nonsense prevailed” and transformed the way welfare operated in the state long before Washington decided to reform welfare. The Governor saw welfare as a job ladder for public aid recipients to climb out of dependency and into work and self-sufficiency. “The principle is simple but powerful,” Edgar said. “Public assistance should be a lifeline, not a lifestyle.”
In a sweeping reversal of well-worn past practices, the Edgar administration introduced programs requiring recipients to work as a condition for aid. And while work was the ultimate goal, Edgar also realized there was no single approach to getting the job done. Some families might need income incentives, others education, training, substance abuse treatment or transportation. So Illinois developed varied experimental programs Earnfare, Work Pays, Opportunities, Teen Parent Initiative, Targeted Work Initiative, Get a Job, Unemployed Parents Work Experience, School Attendance Initiative, the Family Responsibility Project and Work First.
By putting Medicaid on sound financial footing, Edgar was able to bolster access to care for clients because more providers were willing to participate knowing they would get paid on time.
In early 1991, the state learned what the Governor had discovered shortly after his election. General Assembly in 1990 and previous years had deliberately underfunded the Medicaid program.
During Edgar’s first term, hallways in the Illinois Department of Public Aid were jam packed with boxes of unpaid Medicaid bills. Medical providers were waiting an average of 100 days to receive state payment for doctor visits, hospital stays and nursing home living, at rates they claimed did not meet the cost of the services. In some instances, providers faced going out of business and others, unable to extend the state credit, dropped out of the program, which serves more than 1.3 million low-income Illinoisans mostly children, young mothers, the disabled and the elderly.
The backlog of old bills peaked at $1.4 billion in 1994.
By the close of the Edgar administration, however, more than 42,000 Medicaid providers physicians, hospitals, nursing homes, pharmacies, laboratories and others were receiving their payments in seven to 30 days, the fastest in at least a dozen years. The hallways — and the providers — were finally free of overdue bills.
In 1996, the state introduced an electric debit card to make it easier and safer to distribute benefits to welfare clients. The card cut administrative costs, fraud and food stamp misuse.
To fight welfare fraud, the Edgar administration turned to the latest electronic technology.
In 1996, the state began Illinois Link, an electronic debit card that distributes more than $125 million in benefits monthly to 450,000 welfare clients, who can withdraw cash assistance from automated teller machines or use food stamp allotments at grocery stores. The card makes it easier and safer for clients to retrieve benefits, while cutting administrative costs, fraud and food stamp misuse.
The Governor also supported pilot projects testing an electronic system using a scanner to record each client’s fingerprint. Another scanner makes electronic images of a person’s retina, the tissue lining the rear surface of the eye. In 1999, the state will determine which is more effective and efficient in combating fraud.
To strengthen the fiscal integrity of Medicaid and other social services programs as well, the Governor signed legislation creating the independent Office of Inspector General within the Department of Public Aid in 1994.
From July 1991 through February 1998, 9,303 allegations of recipient fraud and abuse were investigated and $24 million in overpayments were identified and pursued for collection.
Since 1995, Edgar’s programs for refugees and immigrants have helped more than 100,000 learn English, fill out citizenship papers and prepare for citizenship tests.
While Illinois sought to move people off welfare, the state always stood ready to help those who needed assistance. Such was the case in 1998 when Congress stripped benefits from needy legal immigrants. The Governor stepped in to provide $6 million in state benefits for about 15,000 elderly and disabled immigrants and immigrant children eliminated from the federal foodstamp program.
Edgar also went to bat for refugees and immigrants wanting to become U.S. citizens. As the nation’s first state- sponsored program of its kind, the Refugee and Immigration Citizenship Initiative was singled out as a model by the U.S. Immigration and Naturalization Service. Since 1995, the state has helped more than 100,000 individuals from 94 countries to learn English, to fill out citizenship papers and to prepare for citizenship tests. The program became even more relevant in 1997 when a new law decreed that naturalized citizens can qualify for federal benefits in their transition to independent lives.
Illinois established the Refugee Resettlement Program to coordinate community-based services to promote economic self-sufficiency and social self-reliance. Bilingual mental health services, the Bosnian Refugee Center and help for elderly refugees all joined Illinois’ resettlement efforts. When federal funding waned, Edgar committed state funds so refugees would not suffer. In the last three years of his administration, state funding grew to $1.2 million.
In 1996, the Governor awarded nearly $7 million in grants to resettle more than 10,000 legal immigrants in Illinois from 30 different countries. The refugees received English language instruction, job search and placement assistance, mental health services, plus an overview of state services, taxes, public transportation, and their legal rights and responsibilities.
Besides welcoming these immigrants to Illinois, programs to find them jobs obviated their ending up on welfare. In 1997 alone, nearly 4,000 immigrants came to Illinois — about 2,500 found jobs through state programs. Their employment saved the state $7.7 million in potential welfare costs.
While admissions to state mental hospitals declined, the number of forensic patients in state facilities grew. This necessitated construction of new treatment building at Alton and at Elgin (left), which is to accept its first patients here in late 1998
In the early days of the Edgar administration, the Governor set out to reform and improve the mental way health services were delivered in Illinois. No longer would the state rely on warehousing patients in state facilities. Instead, the mentally ill would be cared for in the family home, homelike residences or small community settings, rather than prison-like hospitals. Only those requiring intensive care would be hospitalized.
By 1996, state spending on private community-based medical services exceeded that spent on state institutions for the mentally ill and developmentally disabled. A year later, for the first time, community treatment beds out-numbered state hospital beds. During Edgar’s eight years, funding nearly doubled to $312 million and the number of mentally ill persons in residential settings rose from 100,000 to nearly 150,000. At the same time, state mental hospital admissions dropped by more than half to 9,500 patients. Staff-to-patient ratios at state hospitals increased reform reflects the approach by more than 30 percent during Edgar’s tenure.
“We have transformed the system from one that relied heavily on state hospitals and institutions, to one where most who need our help are cared for in community-based facilities. Near their loved ones. In settings where they often can work, can be productive, can be self-sufficient as possible,” Edgar told lawmakers in his 1998 State of the State address.
Each year, Edgar saw to it that more than 200,000 people with disabilities were provided assistance so they could be included in all aspects of community life.
Much like the mental health reforms, Edgar sought to change the state’s method of caring for persons with developmental disabilities from one relying on state-operated institutional centers to one based on family and smaller community options.
Funding for community-based services increased from $190 million to $383 million during the Edgar years, and the number of persons living in the state’s 11 developmental centers dropped by more than 25 percent. Private intermediate care facilities for the developmentally disabled also recorded a 25 percent decrease to about 7,600 clients, and those cared for in nursing homes dropped by more than 50 percent to about 1,800.
A key to Edgar’s initiatives was community-integrated living arrangements (CILAS), providing needed support and services in an individual’s own home or in a home serving no more than eight persons. Since 1990, more than 2,000 persons with developmental disabilities have moved to such settings and by 1998 more people lived in CILAS than in state developmental centers.
Innovative programs also were created to assist individuals living at home. One provided a monthly stipend for families caring for a child with severe mental disabilities. Another allocated money so that adults with severe mental disabilities and their families can choose the help they need to become more independent.
Edgar aggressively pursued federal Medicaid money to expand the community service system. Through this effort, federal funding grew from less than $8 million in 1990 to more than $61 million in 1998.
Although the Governor placed greater emphasis on community living, he did not ignore the state’s developmental centers, which provide residential support for about 3,400 persons with multiple developmental and physical impairments. Significant improvements were made. All 11 centers are licensed, certified and professionally accredited, compared to just six in 1990. Staff-per-resident ratios were greatly increased and improvements made in clinical and medical expertise. The centers are partners with community organizations in efforts to return residents to their communities when appropriate and to prevent unnecessary admissions to state centers or nursing homes.
State funding linked businesses and job-ready employees with disabilities, helping more than 48,000 disabled people a year to get jobs.
Each year, Illinois serves more than 200,000 people who are visually or hearing impaired, disabled by AIDS or HIV infection, or suffering from other physical or mental disabilities. They receive assistance to live as independently as possible and to enter the competitive work force.
A premier effort was the $138 million Home Services Program, which allowed 18,500 Illinoisans
with severe disabilities to remain at home rather than in less desirable and more costly institutions. The program offers services such as home-maker assistance, personal assistant care, electronic home response, home-delivered meals, home modification and respite care. Its cost is one-third what the state would pay for institutional care and is eligible for Medicaid reimbursement. The state also provides similar in-home help for a growing population of Illinoisans with AIDS or HIV.
Vocational rehabilitation assists disabled people to obtain or maintain employment. Funding supports skills evaluation, guidance, job development, assistive devices, medical services and educational assistance, as well as a state link between businesses and job-ready employees who are disabled. More than 48,000 disabled people a year get help finding a job.
When it came to substance abuse, protecting children was Edgar’s primary focus.
In the battle against alcohol and drug abuse, Edgar deemed children’s interests as a priority. The Governor sought to prevent the problems of substance abuse — crime in the streets, gangs, domestic violence and child abuse. He also began programs to discourage children from experimenting with drugs and alcohol and to help those already addicted.
Intent on high visibility for these efforts, he appointed Lt. Gov. Bob Kustra to head the Partnership for a Drug Free Illinois. Kustra worked to raise awareness about the pitfalls of alcohol and drug use: school dropouts, suicides, crime, motor vehicle crashes, general health problems and AIDS. To be effective, the prevention programs coordinated with those affected most by the problem teens, their families and their communities.
Edgar also directed the Illinois State Police to work with local law enforcement agencies in focusing community policing efforts on parks, swimming pools, recreational centers and other areas where children gather.
Edgar, with Dr. John R. Lumpkin, state public health director, joined others in November 1991 in signing a card pledging to help prevent new AIDS cases, which dropped for the first time in 1995.
Prevention was the linchpin in Edgar’s efforts to combat disease, whether they were new scourges such as HIV/AIDS and E. coli 0157:H7 or century-old ones like tuberculosis and measles.
“I talked about the importance of prevention on my first day as governor,” Edgar said in his 1998 State of the State address. “Every dollar we spend on prevention means dollar after dollar we don’t have to spend tomorrow correcting our failure to act.”
Significant progress was made during the Edgar years to reduce the incidence of diseases. In 1996, the number of reported tuberculosis cases dropped below 1,000 for the first time in more than 100 years and TB deaths dropped to an all-time low of 974. Measles cases fell from 1,356 in 1990 to just two in 1995. And, for the first time since AIDS emerged as an epidemic in 1981, the annual number of reported cases and the number of deaths declined.
To deal with such public health problems, the Governor budgeted millions of dollars to buy vaccines against childhood diseases, including hepatitis B, which was added as a school admission requirement in 1997. He nearly quadrupled state AIDS education and prevention funding and he boosted spending on TB control and treatment.
Governor Edgar believed the cultural diversity of Illinois is one of the state’s greatest strengths. He often attended ethnic festivals, here a 1994 Mexican celebration in Chicago’s Little Village neighborhood.
In 1980, the Illinois Human Rights Act created the Department of Human Rights to investigate charges of civil rights violations in housing, employment, public accommodation, and financial credit and of illegal discrimination against persons based on race, minority, sex or disability. The act also created the Human Rights Commission to adjudicate complaints.
When Edgar took office, the human rights system was overwhelmed. A backlog of 7,000 complaints posed a three-year wait to assign a case for investigation. There were delays up to 24 months for hearing cases ready to be adjudicated. In 1995, Edgar announced a $1.2 million, three-year plan to expedite current charges, to eliminate the backlog and to provide for a more efficient hearing of cases. Staff investigators were doubled and commission staff increased. By 1998, for the first time in the agency’s dollar we don’t have to spend history, all cases had been assigned for investigation and those on both sides of the charges could finally expect cases to be concluded within a year.
Besides clearing backlogs, the agency introduced an outreach program to educate businesses about their responsibilities under the Human Rights Act, particularly in the area of sexual harassment. Recognizing that sexual harassment in the workplace was not just a problem common to larger businesses, in 1991 Edgar extended the act’s jurisdiction to employers who only have one worker. Previously, an employer had to employ 15 or more workers to be covered by the act. Seminars were conducted with local chambers of commerce spread throughout the state. Due to their success, they were also offered to local governmental bodies. The topics expanded to include compliance with the American with Disabilities Act and cultural diversity.
During his first year in office, the Governor also signed legislation extending the Human Rights Act to include protection against job discrimination based on a person’s citizenship. This was especially important to the 130,000 immigrants who were citizens or had work authority but were denied employment.