According to Joshua D. Greenberg, director of the Family Advocacy Program at Boston Medical Center and a Project HEALTH mentor, not only is Crosby's intervention in her son's care crucial to his improvement, but she is still eligible for AFDC because she maintains control of decisions regarding her son's treatment and education.

Greenberg and Onie took up the task of proving that last summer to the Massachusetts Department of Transitional Assistance.

Hundreds of pages of complicated welfare regulations often confuse both applicants for aid and workers in state welfare offices. Often families are denied benefits for which they are actually eligible.

Sorting through Bureaucracy

Between 64 and 79 percent of Medicaid application denials for pregnant women, infants and children were due to applicants' inabilities to fulfill procedural requirements, reported a 1994 Massachusetts children's health study.

According to Onie, an increasing number of cases in which people were terminated from welfare because regulations were misinterpreted or overlooked have recently been referred to Massachusetts Legal Services, which provides free legal aid to income-eligible clients.

Legal Services attorneys this year requested that intake workers at welfare offices receive specific instructions on how to deal with clients like Crosby.

Greenberg says the problem lies in the federal government's method of fraud prevention.

"What [the federal government] says is [a state] will get in trouble if [it] gives welfare benefits to a family who doesn't deserve them. [The state's incentives] are to deny everyone rather than to help people who deserve them," he says.

Model Programs

Although the report by the Massachusetts Law Reform Institute, entitled "Missed Opportunities," addresses health care issues specifically, it describes two programs which may serve as models for ways in which bureaucracy can be minimized for aid applicants.

The Department of Public Health oversees a program in which case managers help families identify resources available to them and then advocate for them when necessary. This service is crucial because each family's case is different and applications are dealt with on a personal level.

In the other model, an applicant's eligibility for two mutually exclusive programs is evaluated at one point of entry.

When a pregnant woman applies for Healthy Start--a prenatal care program--the staff determines whether she is likely to be eligible for Medicaid. If she is, they begin her Medicaid application process immediately. If she is not eligible for Medicaid, a Healthy Start application is processed instead.

According to Greenberg, Crosby's problem resulted from the lack of such streamlined evaluations. When she came to him in July, she had been terminated from AFDC and was receiving "aid, pending hearing."