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<8" UNIVERSITY OF MICHIGAN
ae Se SCHOOL OF SOCIAL WORK
et oe? ANN ARBOR, MICHIGAN
Fee AURI, DEAN
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August 15, 1957

The Honorable dchn Fogarty
House of Representatives
Washington, D. C.

Dear Johns

Some time ago I wrote you for copies of your bill H.R.6982,
the "Rehabilitation Act of 1957." At that time, you expressed an
interest in having the comments I would obtain from the. discussions
i was having of the proposed legislation among welfare administrators.

The attached comments (No. 1) representing the views of welfare
department personnel. is sent for your information,

I am also enclosing the comments and constructive suggestions
(Noe 2) of one of my colleagues who has worked in both the State
Vocational Rehabilitation and State Welfare Departments.

In view of the statements which you included in the fiscal
1958 Committee report on HEW appropriations (poe lh, 2-25) I think
you will be interested in his constructive suggestions for broadening
the VR program to make possible the rehabilitation of more persons
from the welfare rolls,

I trust these comments may be helpful to you. I am continuing
my study of this problem and will be glad to be of any further
assistance I cane

With best personal wishes.
Sincerely yours,
CALLA
Wilbur J. Cohen

Frofessor of Public Welfare
WJCem Administration
(1) Comments on H.R.6982

Titie II would make major changes in the purpose and direction
of the federal-state vocational rehabilitation programs. The vocational
rehabilitation agencies would expand their present activities by moving
into a medical care program for needy persons receiving institutional
care or attendance in their households continuously or for a very sub=
stantial proportion of the time, but who can be reasonably expected, as
a result of rehabilitation, to achieve such ability of independent living
that they will no longer require institutional care or attendance. For a
number of reasons, this is not sound legislation.

Because of the close relationship between the program wiich would be
established by the new Title II, "Independent Living Rehabilitation Ser-
vices," and the present responsibilities of public welfare departmamts in
medical care and related fields in public assistance, sericus considera~
tion should be given to the implications of this legislation. Both the
objectives of the present vocational rehabilitation program and of the
public assistance programs, as outlined by Congress in the 1956 Secial
Security Amendments, would be affected. We would like to ask, therefore,
whether the new directions which would result from this proposed legisla-
tion would ultimately achieve the best program for meeting the medical
and social service needs of disabled persons who are not going to be able
to return to regular employment.

Inasmuch as the state vocational rehabilitation agencies have not
been able to reach the level of operation predicted when the federal-state
program was expanded several years ago through greatly increased federal
funds, serious question is raised about the desirability of these agencies
taking on a major additional responsibility of this kind.

The legislation appears to be unsound because it would create very
considerable duplication of the public assistance services provided in the
1956 Social Security Amendments, which established a means of initiating
or expanding medical care in the public assistance categories and providing
social services te recipients of assistences

The legislation is unsound because it corrects for a very limited
group of patients the end result of years of neglect and lack of medical
care. This is not an adequate substitute for a general medical care program
for needy persons which will provide care at an early stage of illness or
disability, as compared to a program which provides care only when the
patient's condition has become seriously disabling. There is, of course,
as a result of many years of activity by state and lecal public welfare
agencies, and more recently because of the 1956 medical assistance amend=
ment, machinery for such medical programs in the state and local public
welfare departments. In addition to those states that have had compre~
hensive medical care programs, approximately twenty-five states are now
in the process of initiating or expanding mdical assistance programs
made possible by the 1956 Amendment. Most of these states put their
new or expanded programs into operation on July 1, 1957 but some are
now studying their needs and planning for legislative action a little
later. The proposed rehabilitation legislation, if enacted, might well
hinder further development of medical assistance programs.

Both at federal and state levels there has been for years much
disagreement about the appropriate functions of vocational rehabilitation
programs. This has operated to deter the sound and speedy development of
appropriate rehabilitation and welfare programs. We believe that the
program proposed in H.R.6962 would cause further disagreement rather than
benefit the needy sick.
(2) Comments and Suggestions on H.»R.6982

With respect to vocational rehabilitation, their traditional role
has been assisting persons with either physical or mental impairments
who, as a result of those impairments, are vocationally handicapped.

Even with the added emphasis given to the expansion of vocational re-
habilitation programs in the last few years, it is known that a con-
siderable backlog of such individuais are not receiving the benefits of
this program. Personally, I believe that the OVR program should maintain
its stress on the vocational aspects af rehabilitation. In other words,
placing this additional responsibility on them might easily change the
foeus of the OVR program. If a change in the OVR program is to be made,
it would seem more appropriate to expand the conditions recognized as
producing a vocational handicap to include such factors as less of anploy-
ment skills as a result of not having worked for several years, lack of
specific skills through inadequate education, and loss of skills and need
for training brought on as the result of technological changes affecting
certain jobs in industry and agriculture. The state of Washington is
participating in such a program at the present time with public assist=
ance, the state employment agency, and vocational rehabilitation the co-
operating agencies at the state level. Eligibility is determined on
other factors than physical or mental disability with the public assist-
ance agency guaranteeing support of the rehahilitant's family, the state
OVR program providing vocational training and coumseéling, and the employ-
ment office carrying placenmt and job finding responsibilities. The
Aid to Dependent Children mother tho has stayed home caring for her
children for several years who will no longer receive assurance as a
result of the age of her children is helped by giving her definite skills
and assurances of regular employment. Contrast this with the plight
faced by such women elsewhere as their eligibility expires. This modifi-
cations as to the causes recognized as producing a vocational handicap
would (1) maintain the vocational emphasis as a wniqne feature of voca-
tional rehabilitation and (2) resolve some of the present gaps in
services given to public assistance recipients by vocational rehabilitation,