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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Cynthia Blitz, PhD, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 30 College Avenue, New Brunswick, NJ 08901, (732) 932-7500 x8123, clblitz@rci.rutgers.edu
This study focuses on the secondary effects of recent welfare reform on a sub-population of welfare recipients who are treated for substance abuse disorders in Philadelphia, Pennsylvania. In recent years, welfare recipients with substance abuse problems have been directly targeted by welfare legislation or otherwise indirectly impacted by these measures. These individuals are particularly vulnerable to changes in eligibility for welfare benefits, as they often possess a host of health and mental health problems that make it difficult for them to escape dependency on welfare. Specifically, many welfare recipients with substance abuse problems are dependent on Medicaid (MA) for access to needed behavioral health services and are unlikely to receive alternative health insurance coverage upon loss of MA. Therefore, if welfare reform measures result in MA eligibility loss (permanent or temporary) for these individuals, they are also likely to limit access to and utilization of substance abuse treatment services. The main proposition of the current study is that recent welfare reform measures altered welfare dynamics for substance abusers and, subsequently, introduced increased instability into patterns of MA receipt within this population. Consequently, these individuals’ access to behavioral health services decreased. This proposition is tested by examining the impact of three separate welfare legislation measures – the Contract with America Advancement Act of 1996, the Personal Responsibility and Work Opportunity Act, and a Pennsylvania state General Assistance (GA) initiative for a cohort of welfare recipients in Philadelphia who were receiving substance abuse treatment services in 1995 (N=12,573). Monthly Medicaid administrative data are utilized to follow patterns of welfare and MA eligibility for these individuals between 1994 and 1999. The study’s hypotheses are examined in three steps. First, the impact of welfare reform on welfare dynamics is explored utilizing longitudinal data analysis techniques. Results indicate that the introduction of recent measures increased the likelihood of welfare eligibility loss, decreased the likelihood of return to welfare, and resulted in shorter than usual stays on welfare for the majority of individuals in the cohort, particularly for individuals eligible under GA. Next, similar methods were used to test the proposition that changes in welfare dynamics contributed to changing patterns of MA eligibility among substance abusers. The results of this analysis demonstrate a significant impact of welfare reform on increased number of interruptions in substance abusers’ MA eligibility. Finally, findings concerning the association between welfare reform and substance abusers’ access to behavioral health services suggest an independent contribution of welfare reform to decreased access to care within this population.
Learning Objectives: The participants in this session will be able to
Keywords: Medicaid, Access and Services
Presenting author's disclosure statement:
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.