$25 in Welfare Rides on Children’s Shots

Well-baby checkups have never been a way of life for some of Dr. John Morgan’s patients in this rural county along the Chesapeake Bay.

But now, he says, they’re finding ways to get into town from their trailers and tin-and-tar-paper shacks, some for the first time in years.

If they don’t show up for their appointment with Kent County’s only pediatrician, the state will take $25 from their monthly welfare checks for every preschool child not up to date on shots and checkups.

Maryland officials believe they’ve begun to change the priorities of mothers who put their children’s health at risk by falling behind on doctor’s visits and immunizations.

In the first six months of the program, health providers have found children with elevated levels of lead in their blood, a boy about to go blind and a youngster on the brink of a diabetic coma, said Carolyn W. Colvin, Maryland’s secretary of human resources.

But children’s advocates say Maryland’s experiment with welfare reform is punitive and unfair to families with an average monthly income of $359.

Members of Congress, however, are eyeing Maryland’s approach to preventive health care as President Clinton’s five-year, $2.1-billion immunization proposal moves through the Senate.

The legislation seeks to boost immunization rates of children under 2, now estimated at 37% to 56%, by providing free vaccines to uninsured families and those on Medicaid.

Some Republicans believe the solution is also in motivating parents.

Sen. John Danforth (R-Mo.) wants to let other states copy Maryland’s Primary Prevention Initiative without having to get permission first from the Department of Health and Human Services, which runs Aid to Families with Dependent Children.

HHS Secretary Donna Shalala said she is “willing to listen to any proposals that sound reasonable, that don’t withhold food from the mouths of children.”

Maryland won approval for its five-year experiment from Shalala’s predecessor, Republican Louis Sullivan, last summer.

Under the program, children must attend school at least 80% of the time and get their immunizations and a certain number of checkups.

The stick: a $25 sanction, which families can avoid if they show good cause or receive counseling. The carrot: $20 a year for any school-age child and adult who gets an annual checkup, and $14 a month for pregnant women who get prenatal care.

State officials say 90% of the 75,000 families in the program are in compliance. Most of those sanctioned have lost benefits for a month or two, but about 3% have been out of compliance longer.

A family sanctioned for three months will get a call from a social services worker, who will ask to visit the home and help resolve the situation and any other problems.

The Children’s Defense Fund, on whose board Shalala served for a dozen years, believes many Maryland families have been injured by the reductions in their AFDC check and argues that it is “very punitive and very unfair to focus on the poorest children and the poorest families.”

“There are a lot of barriers to getting children immunized and the answer is to eliminate those barriers, not beat up on parents who are trying to do their best,” said CDF’s Eileen Sweeney.

But Colvin, the state’s human resources secretary, argues that Maryland has the right to expect something in return for giving its AFDC families health care and transportation to the doctor.

“Many of them just needed a push to do what is expected of them as responsible parents,” she said.

Since the state got serious about sanctions in January, Morgan and his wife, Bonnie, a social worker, say patients have come out of the woodwork.

“We found 10 families who had to come in and get physicals and lots and lots of shots,” said Bonnie Morgan.