Trust Fund Operations, 1959

one-third of this increase, however, represented a shift from the money payment to the vendor payment. Although vendor payments for medical care for the four categories combined went up in all but six of the 42 States that made such payments in one or more of these programs, almost three-fourths of the total increase occurred in eight States.5 For the country as a whole, the increase in vendor payments for all five programs combined totaled $90 million. In 1958-59 all but seven States made vendor medical payments in one of the five programs. The number of States using direct payments to medical vendors during the year rose in each program except general assistance; Ave additional States started to use this method in old-age assistance and four in aid to the blind and aid to the permanently and totally disabled. Under each of these three programs, all but 11 or 12 States made some vendor payments for medical care. The $410 million paid to vendors of medical care throughout the Nation amounted to $2.32 per inhabitant for recipients in all five programs in 1958-59-48 cents more than in the preceding year (table 4). Old-age assistance expenditures of $1.22 accounted for more than half the total. Expenditures of 54 cents per inhabitant under general assistance made up 23 percent of the total vendor medical payments for all programs and about the same proportion of total general assistance payments. In contrast, vendor payments