The enactment of The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (welfare reform) will undoubtedly affect the safety net. However, President Clinton and Congress intended the Medicaid program to remain intact. Using a multi-method approach, this study addresses how welfare reform affects health insurance for low-income families. Data were collected in three cities from 30 in-depth interviews with TANF caseworkers and local welfare office administrators, as well as from interviews with key informants, and direct observation of job orientation sessions and welfare office waiting rooms. Also, data from the National Survey of America's Families, supplemented with state-level policy variables, were analyzed.
Findings show that welfare reform has had unintended and negative effects on health coverage for families. Generosity of a state's Medicaid does not alone explain former welfare recipients' health coverage. Welfare policies, especially diversion policies such as mandatory job search, and time limit policies play a negative role in the ability of families who have left cash assistance to maintain Medicaid. Furthermore, the administration of Medicaid and welfare were found to make a difference in health coverage -- welfare reform messages spill over to Medicaid. Finally, findings show that the frontline personnel implementing welfare reform play a very important role in families' health coverage.
Many policy tools are available to states to delink Medicaid from TANF and to facilitate Medicaid enrollment. Welfare reform has given Medicaid the opportunity to operate as a stand-alone health insurance program for low-income working families, and states need to take advantage of this opportunity.
Learning Objectives: N/A
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.