Welfare Reform limits access to Medicaid

NEW YORK - Since welfare reform was enacted in 1996, welfare caseloads have declined 44%, a figure that government officials cite as a success. But a new study suggests that changes in welfare eligibility contributed to the growing number of Americans, including employed people, who lack health insurance.

Women and children appear to have been most affected by the changes in welfare rules, according to the report published in the June issue of the American Journal of Public Health, journal of the American Public Health Association. And these changes may have been interpreted by the poor as meaning that there is less assistance available in other areas.

"Enrollment in other government benefit programs, such as food assistance, has also declined," the researchers write.

Previous studies have indicated that as people left the welfare rolls, Medicaid enrollment declined and the number of uninsured increased. In a new analysis of states that have guidelines that try to deter people from getting welfare, investigators found a relationship between certain discouraging policies and a reduction in Medicaid coverage.

Wendy Chavkin, of Columbia University's Center for Population and Family Health in New York City, and her colleagues analyzed the welfare programs in the United States, now called Temporary Assistance to Needy Families, and found statistical associations between deterrent policies and loss of insurance.

The team found, for example, that in those states that require an applicant to undergo a mandatory job search before obtaining benefits, there was a decrease in Medicaid enrollment.

The authors note that other studies show that many leaving welfare are finding jobs, but these jobs are often low paid and lack health benefits. In addition, "job retention and persistent poverty appear to be significant problems."

And government steps taken to help bridge the gap in health insurance for these people, such as transitional Medicaid, have not fully succeeded, the researchers explain.

"We speculate that the message communicated to the poor is the undifferentiated one that, in general, benefit programs are no longer available, although, of course, many factors are at work in such complex social phenomena," Chavkin and colleagues write.

The research team calls for more attention to be paid to the issue, and note that the welfare reform act will be up for review in 2002. "There is thus an opportunity in the next year to apply the lessons from the initial experience with welfare reform to reshape the next phase," they write.

According to Joan Alker, a spokeswoman for Families USA, a consumer healthcare organization in Washington, DC, monitoring this issue, Chavkin's findings underscore the need to get individuals who in the past had been on welfare better access to Medicaid, because they or their children may be eligible for the insurance benefit.

SOURCE: American Journal of Public Health 2000;90:901-907.


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