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High-quality primary care is the foundation of the health care system. It provides continuous, person-centered, relationship-based care that considers the needs and preferences of individuals, families, and communities. Without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels. Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced. Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, which makes the strength and quality of the country's primary care services a public concern. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care puts forth an evidence-based plan with actionable objectives and recommendations for implementing high-quality primary care in the United States. The implementation plan of this report balances national needs for scalable solutions while allowing for adaptations to meet local needs.
Children's health has clearly improved over the past several decades. Significant and positive gains have been made in lowering rates of infant mortality and morbidity from infectious diseases and accidental causes, improved access to health care, and reduction in the effects of environmental contaminants such as lead. Yet major questions still remain about how to assess the status of children's health, what factors should be monitored, and the appropriate measurement tools that should be used. Children's Health, the Nation's Wealth: Assessing and Improving Child Health provides a detailed examination of the information about children's health that is needed to help policy makers and program providers at the federal, state, and local levels. In order to improve children's health-and, thus, the health of future generations-it is critical to have data that can be used to assess both current conditions and possible future threats to children's health. This compelling book describes what is known about the health of children and what is needed to expand the knowledge. By strategically improving the health of children, we ensure healthier future generations to come.
The Temporary Assistance for Needy Families (TANF) block grant provides federal grants to states for a wide range of benefits, services, and activities. It is best known for helping states pay for cash welfare for needy families with children, but it funds a wide array of additional activities. TANF was created in the 1996 welfare reform law (P.L. 104-193). TANF funding and program authority were extended through FY2010 by the Deficit Reduction Act of 2005 (DRA, P.L. 109-171). TANF provides a basic block grant of $16.5 billion to the 50 states and District of Columbia, and $0.1 billion to U.S. territories. Additionally, 17 states qualify for supplemental grants that total $319 million. TANF also requires states to contribute from their own funds at least $10.4 billion for benefits and services to needy families with children -- this is known as the maintenance-of-effort (MOE) requirement. States may use TANF and MOE funds in any manner "reasonably calculated" to achieve TANF's statutory purpose. This purpose is to increase state flexibility to achieve four goals: (1) provide assistance to needy families with children so that they can live in their own homes or the homes of relatives; (2) end dependence of needy parents on government benefits through work, job preparation, and marriage; (3) reduce out-of-wedlock pregnancies; and (4) promote the formation and maintenance of two-parent families. Though TANF is a block grant, there are some strings attached to states' use of funds, particularly for families receiving "assistance" (essentially cash welfare). States must meet TANF work participation standards or be penalised by a reduction in their block grant. The law sets standards stipulating that at least 50% of all families and 90% of two-parent families must be participating, but these statutory standards are reduced for declines in the cash welfare caseload. (Some families are excluded from the participation rate calculation.) Activities creditable toward meeting these standards are focused on work or are intended to rapidly attach welfare recipients to the workforce; education and training is limited. Federal TANF funds may not be used for a family with an adult that has received assistance for 60 months. This is the five-year time limit on welfare receipt. However, up to 20% of the caseload may be extended beyond the five years for reason of "hardship", with hardship defined by the states. Additionally, states may use funds that they must spend to meet the TANF MOE to aid families beyond five years. TANF work participation rules and time limits do not apply to families receiving benefits and services not considered "assistance". Child care, transportation aid, state earned income tax credits for working families, activities to reduce out-of-wedlock pregnancies, activities to promote marriage and two-parent families, and activities to help families that have experienced or are "at risk" of child abuse and neglect are examples of such "nonassistance".