Impact of timing out of welfare benefits on women's access to health care

Welfare reform brought about a paradigm shift in the welfare program. The key features of welfare reform are mandatory benefit sanctions for failure to meet work requirements and a maximum time­‐limit for benefit receipt of five years or less. Welfare reform has been associated with reductions in access to health care and declining health status among socioeconomically vulnerable women; however, the mechanisms underlying the association of welfare reform with these adverse health outcomes are unclear. This study examined the impact of timing out of welfare benefits on women’s access to health care. The study population was current and former welfare recipients, age 17-55 who participated in the Survey of Income and Program Participation, 2004 and 2008 panels (n=1790). Bivariate probit models were used for this analysis. The selection equation predicted the probability of timing out of welfare benefits, using the duration of the state time limit. The outcome equations estimated the impact of timing out of welfare benefits on health insurance coverage and medical provider contact, controlling for age, race, ethnicity, education, citizenship, marital status, number of children, having an infant, severity of state welfare sanctions and year specific trends. The models were also adjusted for clustering at the state level. Timing out of welfare benefits was found to increase the predicted probability of being uninsured by 23% and to decrease the predicted probability of medical provider contact in the last year by 32%, controlling for other variables in the model. These findings were significant at the (p=.05) level.