ADVOCATES FOR YOUTH

Executive Summary Trends in Teenage Pregnancy & Childbearing Methodology Estimates of Federal Expenditures Estimates of Federal Investments Conclusion & Recommendations Endnotes Appendix A: Percent Change in Teen Birth Rate Appendix B: Expenditures & Investments Cost Formulas Appendix C: Key Differences Between AFDC & TANF Order Information

Teenage Pregnancy, The Case for Prevention [PDF]

Estimates of Federal Expenditures

Support and Services to Families Begun by a Birth to a Teen

Advocates for Youth calculated the federal expenditures in fiscal year 1996 by adding up the costs of resources allocated to provide support and services to families that began with a birth to a teen. Advocates for Youth included families headed by adult females who were teens when they had their first child. The various programs included in the expenditure calculation are discussed below.^§§

In fiscal year 1996, the federal government spent nearly $18.4 billion ($18,388,027,095) on Medicaid to support families begun with a birth to a teen. More than $16.4 billion ($16,400,376,285) was for direct benefits to recipients and nearly $2 billion ($1,987,650,810) was for administrative costs. The annual number of adult Medicaid recipients, eligible based on AFDC status, was 7,126,807 with average annual Medicaid outlay of $1,722 per adult. The annual number of child Medicaid recipients, eligible based on AFDC status, was 16,738,800 with average annual Medicaid outlay of $1,048 per child. An estimated 55 percent of Medicaid recipients were teens when their first child was born.

Program Description. Title XIX of the Social Security Act (Medicaid) is an entitlement program that pays for medical assistance for vulnerable and needy individuals and families with low incomes and few resources. Medicaid is the largest source of funding for medical and health-related services for the United States' poorest people. In fiscal year 1996, Medicaid provided health care assistance to more than 36 million people.²⁸

The Health Care Financing Administration (HCFA), established under the U.S. Department of Health and Human Services (HHS), administers grants to the states to manage Medicaid benefits. The Medicaid program allows the states considerable flexibility within their Medicaid plans. However, the federal government requires states to provide basic services—such as general health care, prenatal care, vaccines for children, and family planning services and devices—to categorically needy populations. Groups eligible to receive Medicaid coverage include: recipients of Aid to Families and Dependent Children and Supplemental Security Income (SSI) as well as pregnant women and children under age six whose family income is at or below 133 percent of the federal poverty level. By 2002 under the states' Child Health Insurance Program (CHIP), all children will be covered who are under age 19 in families with incomes at or below the federal poverty level.²⁸

In fiscal year 1996, the federal government spent about $12.7 billion ($12,698,000,000) on Aid to Families with Dependent Children (AFDC). An estimated 55 percent of AFDC recipients were teens when their first child was born. The federal government, therefore, spent approximately $7 billion ($6,983,900,000) on AFDC to support families begun with a birth to a teen.

Program Description. Aid to Families with Dependent Children was established in 1935 as a matching grant program to enable states to aid needy children without fathers at home. AFDC was repealed 61 years later by The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104-193). A block grant to the states for Temporary Assistance for Needy Families (TANF) replaced AFDC, effective July 1, 1997, by which time most states had already implemented TANF.²⁷

Federal fiscal year 1998 was the first full year in which all states implemented TANF. Because federal fiscal year 1996 is October 1, 1995 through September 30, 1996, Advocates for Youth used figures associated with AFDC to calculate fiscal year 1996 expenditures and investments. Appendix C summarizes some major differences between the old (AFDC) and new (TANF) cash welfare programs for families with children.²⁷

Before the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, AFDC provided transitional financial assistance to needy families. Federal and state governments shared the costs associated with AFDC. The Administration for Children and Families, Office of Family Assistance, U.S. Department of Health and Human Services administered the program, and the federal government provided broad guidelines and program requirements. States were responsible for program formulation, benefits determinations, and administration. Eligibility for benefits was based on the state's standard of need as well as the income and resources available to the recipient.²⁹

In fiscal year 1996, the federal government spent over $10.6 billion ($10,614,904,072) through the Food Stamp Program to support families begun with a birth to a teen. Nearly $9.7 billion ($9,697,322,602) was in direct benefits and over $917 million ($917,581,470) was in administrative costs. The average monthly number of Food Stamp recipients was 26.9 million, and each recipient received an average monthly Food Stamp allocation of $73.30. About nine out of 10 AFDC recipients also received a Food Stamp allocation. Experts estimate that 47 percent of Food Stamp recipients were teens when their first child was born.

Program Description. The Food Stamp Program's purpose is to end hunger and improve nutrition and health. The program helps low-income households buy the food needed for a nutritionally adequate diet. State and local welfare offices operate the Food Stamp Program and the Food and Nutrition Service of the U.S. Department of Agriculture oversees the states' operations. The amount of benefits an eligible household receives depends on the number of people in the household and the amount of the household's income.³⁰

Generally, recipients in the two primary cash welfare programs—AFDC and Supplemental Security Income (SSI)—are automatically eligible for food stamps if the household is composed entirely of AFDC or SSI beneficiaries.²⁷

In fiscal year 1996, the federal government spent over $3.6 billion ($3,688,200,000) on the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). An estimated 55 percent of WIC recipients were teens at the birth of their first child. The federal government, therefore, spent more than $2 billion ($2,028,510,000) through WIC to support families that began with a birth to a teen.

Program Description. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food, nutrition counseling, and access to health services for low-income women, infants, and children. Established in 1974, WIC is administered at the federal level by the Food and Nutrition Service of the U.S. Department of Agriculture. Formerly known as the Special Supplemental Food Program for Women, Infants, and Children, WIC's name was changed in the mid 1990s to emphasize its role as a nutrition program.³¹

WIC is effective in improving the health of pregnant women, new mothers, and their infants. Women who participated in the program during their pregnancies have been shown to have lower Medicaid costs for themselves and their babies than did women who did not participate. WIC participation has also been linked with longer gestation periods, higher birth weights, and lower infant mortality.³¹

In fiscal year 1996, the federal government spent over $11.9 million ($11,905,000) through the Social Services Block Grant to provide pregnancy and parenting services.

Program Description. Title XX of the Social Security Act, also referred to as the Social Services Block Grant (SSBG), is a capped entitlement program, which gives funds to states to help them achieve a wide range of social policy goals. States determine which services they will provide and the groups eligible for these services. The federal government, however, places some restrictions on the use of Title XX funds. States cannot use these funds to provide—among other services—medical care except family planning, drug rehabilitation, or detoxification services, and educational services that are generally provided by schools.

SSBG funds provide both family planning services and pregnancy and parenting services for teens. Advocates for Youth included the percentage of funds (0.5 percent) spent to provide services for pregnant and parenting teens in the calculation of expenditures.

In fiscal year 1996, the federal government spent nearly $2.5 million ($2,487,000) through the Maternal and Child Health Services Block Grant to provide pregnancy and parenting services.

Program Description. Title V of the Social Security Act establishes the Maternal and Child Health Services Block Grant, the basic authorizing legislation for the Maternal and Child Health Bureau (MCHB). Title V is a federal/state partnership that supports and develops community-based programs to improve the health of mothers and children, ensure quality health care for families, and create safe and healthy communities.³² The fiscal year 1996 appropriation for the Maternal and Child Health Block Grant was over $678 million ($678,204,000).

Eighty-five percent of the block grant passes directly to the states and 15 percent is reserved for the Maternal and Child Health Bureau to operate federal projects, such as Special Projects of Regional and National Significance (SPRANS), Community Integrated Service System (CISS), and the Healthy Tomorrows Partnership for Children Program. MCHB jointly funded 147 demonstration projects with the Center for Substance Abuse Prevention of the Substance Abuse and Mental Health Services Administration under the Pregnant and Postpartum Women and their Infants initiative.

Special Projects of Regional and National Significance (SPRANS) is a set-aside federal program to which approximately 15 percent of the Title V funds are allocated. Five categories of projects fall under SPRANS: (1) applied research; (2) training; (3) genetic disease testing, counseling, and information dissemination; (4) hemophilia diagnostic and treatment centers; and (5) maternal and child health improvement projects (MCHIPs). MCHIPs cover a range of activities and support the demonstration of innovative services and new techniques for the delivery of services. Several SPRANS programs address teen pregnancy prevention and services for pregnant and parenting teens.³³

The Community Integrated Service System (CISS) program seeks to reduce infant mortality and improve the health of mothers and children, including those living in rural areas and those with special health needs. CISS supports projects to develop and expand integrated services at the community level. These systems are public/private partnerships of health-related and other organizations and individuals. The partnerships collaborate in using community resources to address community-identified health problems.³⁴

The CISS program was authorized by the Omnibus Budget Reconciliation Act of 1989 (OBRA 89) as a separate set-aside federal program of the Maternal and Child Health Services Block Grant (Title V of the Social Security Act). It did not become operational, however, until fiscal year 1992 when the total MCH Services Block Grant appropriation exceeded $600 million for the first time. Under OBRA 89, 12 ¾ percent of the appropriated amount above $600 million is earmarked for CISS projects. CISS program funds may be used for programs to support pregnant and parenting teens.³⁴

Healthy Tomorrows Partnership for Children Program (HTPCP) is a collaborative effort of the federal MCHB and the American Academy of Pediatrics. HTPCP aims to ensure access to quality health care for all children and pregnant women by promoting innovative, community-based child health care projects. Of the 54 HTPCP projects funded in fiscal year 1996, 14 focus on improving the health status of adolescents. Community projects may offer primary or secondary pregnancy prevention programs and/or provide services to support families begun with a birth to a teen.³⁵

Center for Substance Abuse Prevention's (CSAP) mission is to provide leadership in the federal effort to prevent alcohol, tobacco, and illicit drug problems that are also linked to other national problems such as teen pregnancy. CSAP connects people and resources to innovative ideas and strategies and encourages efforts to reduce and eliminate alcohol, tobacco, and illicit drug use problems in the United States and internationally. In a joint initiative with the MCHB, CSAP funds 147 demonstration projects. Several CSAP programs target teen parents.³⁶

In fiscal year 1996, two-thirds of the Adolescent Family Life Program's total budget ($7,698,000) was dedicated to programs that support families begun by a birth to a teen. Advocates for Youth calculated that the federal government spent nearly $5.2 million ($5,157,660) on the Adolescent Family Life Program to provide programs for pregnant and parenting teens.

Program Description. The Adolescent Family Life (AFL) Program was enacted in 1981 as Title XX of the Public Health Service Act. AFL is administered by the Office of Adolescent Pregnancy Prevention in the U.S. Department of Health and Human Services. Funding for AFL is divided between pregnancy prevention initiatives and care programs for pregnant and parenting teens. AFL programs focus on developing and promoting abstinence-only programs and helping teens avoid sexual intercourse. In fiscal year 1996, the AFL program funded 17 projects in 14 states. Advocates for Youth included only those programs that focus on providing care services for pregnant and parenting teens in the expenditure calculation.³⁷

______________________________
§§ Administrative costs are broken out separately only for those for programs where benefits equal the monthly or annual allocation and do not include administrative costs.

††† Columns may not total due to rounding.

Source/Citation:
Feijoo AN. Teenage Pregnancy, the Case for Prevention: An Updated Analysis of Recent Trends & Federal Expenditures Associated with Teenage Pregnancy. Washington, DC: Advocates for Youth, 1999.

Click here to view the Publications Catalog and/or to order this publication.