Selected Summary Findings In Brief

Health Care After Welfare: An Update of Findings from State-Level Leaver Studies (CBPP, 2000)

• Leaver Studies Findings:
• The large majority of children in families leaving welfare remain eligible for Medicaid or SCHIP, as do most of their parents.
• In most states, roughly half of parents in families that have left welfare and more than one-third of children in those families lose Medicaid.
• Families that lose Medicaid after they leave welfare are at high risk of becoming uninsured because they have limited access to private coverage.
• Families are more likely to have unmet medical needs after leaving welfare.
• A significant minority - between 13 and 40 percent - of families are not aware that medical benefits may continue after loss of welfare.
• Several Urban Institute reports have analyzed the effect of welfare reform on Medicaid enrollment. One study of families that stopped receiving welfare between 1995 and 1997 found that half of the children in these families lost their Medicaid coverage. An even larger share of parents who left welfare between 1995 and 1997 lost Medicaid (64 percent) and ended up uninsured (41 percent).
• In a separate analysis, the Urban Institute reported that the decline in Medicaid caseloads in recent years cannot be explained exclusively by the strong economy and other factors. To the contrary, roughly half of the decline is directly attributable to welfare reform policies. This was consistent with an earlier report by the Center on Budget and Policy Priorities.
• A recent Families USA study found that among the 15 states with the largest number of uninsured low-income adults, the number of parents on Medicaid fell by more than a million. It dropped from 3.5 million in January 1996 to 2.6 million in December 1999, a decline of 27 percent.

Do Welfare Caseload Declines Make the Medicaid Risk Pool Sicker? (Urban 2000):

• For adults, Medicaid leavers were less likely to report fair or poor health and less likely to have a condition limiting work than those who remain on Medicaid.
• Medicaid leavers were less likely to have an inpatient stay (delivery and nondelivery), less likely to have a physician visit, and less likely to have an emergency room visit than Medicaid recipients. These differences remain after controlling for factors that states often use in adjusting their capitation rates.
• Thus adult Medicaid leavers are in better health and have lower utilization rates than those who remain on Medicaid.
• Compared to long-term welfare recipients, new adult welfare entrants include a large fraction of women who recently gave birth. When we limit the analysis to those adults who had not recently delivered, we find that recent entrants were healthier and used fewer services than long-term recipients after controlling for factors that states use in adjusting their rates.
• Adult returners were more likely to have a health condition, more likely to have used the emergency room, and had more mental health visits, conditional on having any, even after controlling for risk-adjusters.
• On balance, our findings suggest welfare entrants are more costly than long-term recipients.
• For children we found few significant differences, particularly after controlling for risk-adjusters.
• Medicaid leavers used more mental health services than Medicaid recipients, and new entrants were more likely to have an inpatient stay than long-term recipients.

Access to and Participation in Medicaid and the Food Stamp Program: A Review of the Recent Literature (Mathematica, March 2000)

• The 5.3 percent overall decline in Medicaid enrollment reflects a sharp drop in participation by parents and children receiving welfare (21.9 percent) that was not fully offset by the increase in participation by nonwelfare families (18.2 percent).
• Although the decline in the number of children receiving welfare (20.4 percent) was largely offset by an increase in the number of children not on welfare (16.5 percent), this was not the case for adults. The proportion of adults on welfare dropped by 24.2 percent, but the participation of nonwelfare adults on Medicaid increased by only 6.6 percent.
• Although differences in state policy options for Medicaid eligibility may explain some of the state-to-state variation, those with a large drop in their TANF caseload but a smaller decline or even an increase in Medicaid participation may also offer insight into which strategies or practices move welfare recipients into work without reducing their participation in safety net programs.
• Most TANF programs stress the importance of moving recipients into employment as quickly as possible. This focus can inadvertently interfere with the receipt of FSP and Medicaid benefits for families moving into work or for those applying for cash assistance.
• Welfare time limits and sanctions, brought about by welfare reform, have the potential to act as barriers to FSP and Medicaid participation. More research is needed to determine the extent, if any, of these policies on access and participation.
• There is some evidence to suggest that TANF diversion policies may be unintentionally contributing to lower rates of FSP and Medicaid participation by eligible families.
• Other barriers that existed prior to welfare reform but may now present a larger problem include the transition from welfare to work, stigma, costs of participating, confusion about eligibility rules and lack of awareness, and automated eligibility systems.