The Health and Human Services Department yesterday issued final regulations for seven health and social service block grant programs created by Congress last August as part of the "New Federalism" effort to transfer more authority to the states.
While HHS incorporated some comments received after interim regulations were published in October, it did not change the rules in response to criticism that they lacked specific civil rights, public participation and auditing requirements.
HHS also rejected most suggestions that the federal government impose specific paper work and procedural requirements on states, narrow definitions or tighten provisions. It did, however, agree to requests from several community health centers that a state that wants to stop funding a center be required to notify HHS. The center then would be given a chance to respond and HHS would make the final decision.
Congress created the social service block grants in the 1981 budget reconciliation bill by grouping 29 health and community service programs into seven categories and transferring the primary responsibility for their administration to the states. States were given a great deal of discretion to distribute federal money--which was reduced by about 25 percent--as they saw fit. They must, however, use it for the general purpose described.
The block grant categories are community services (which includes senior services and community nutrition programs); preventive health and health services (including rodent control, fluoridation, high blood pressure treatment and rape crisis centers); alcohol and drug abuse and mental health services; primary care; maternal and child health care (including sudden infant death syndrome, lead-based poisoning prevention and genetic diseases); social services, and low-income home energy services.
Last Oct. 1, HHS released its proposal for administering the block grants, but issued it as an interim final rule because six of the seven block grants were scheduled for fiscal 1982, which started that day. The seventh, the primary care block grant program, will start this October.
HHS received more than 200 comments on the proposal over the past eight months. Most of the opposition came from groups like the York Health Corp., a Pennsylvania community health center, which said that reliance on state laws and procedures would allow "development of 50 different sets of criteria." It suggested that the federal government set the criteria for each block grant, an idea HHS rejected.
Maynard Kreider of the Maine Ambulatory Care Coalition, which represents 22 federally supported rural health care centers, warned: "The lack of application requirements . . . would seem to render it difficult, if not impossible, for the federal government to monitor the performance of the states."
Some state auditors said the lack of specific audit standards created confusion. HHS recommended that states work with the Comptroller General of the General Accounting Office to develop standards. But HHS stressed that it wanted to give the states the maximum flexibility.
The Child Welfare League of America complained that there were no specific provisions to assure "meaningful public participation." HHS answered that Congress intended to let the states decide the form of public participation.
Several groups also said that the civil rights provisions were inadequate to protect against discrimination by states in the administration of the block grants. But HHS argued that its antidiscrimination laws apply to all its federally financed programs and thus "it is unnecessary to make them applicable to the block grant programs by specific reference. . . ." However, HHS added that its Office for Civil Rights is developing revised antidiscrimination provisions, which will be issued in the future.
According to HHS and the National Governors' Association, most state officials are pleased with the way the block grant program has been set up, but not with the money they are getting. Indicative are the comments of Dick Molpus, coordinator of state and federal programs for the governor of Mississippi. "We have mixed feelings," he said. The program has been "running very smoothly. There is no question that states are managerially capable of running our own programs.
"But the cut in federal funds has hurt," he said. "We're the ones on the front lines telling the operator of mental health centers that there's no money for them. We don't relish that delegation of authority."