Final Synthesis Report of Findings from ASPE "Leavers" Grants

Chapter IV:
Program Participation

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Contents

1. Returns to TANF
2. Food Stamp Participation
3. Medicaid and Other Health Insurance
4. Other Sources of Support
5. Program Participation by Subgroup
6. Chapter Summary

Endnotes

One goal of welfare reform was to reduce families’ dependence on cash assistance and make receipt of assistance temporary. Participation in other government programs, particularly food stamps and Medicaid, can provide support for families as they make the transition from welfare to work.

For some recipients who exit TANF, the transition is not permanent. A substantial group of former recipients return to the cash assistance roles. While past research has shown that there were families cycling on and off cash assistance before welfare reform, returning to cash assistance takes on increased urgency in light of the lifetime limits on benefit receipt under TANF. The majority of leavers in the areas and cohorts examined here had not reached federal or state time limits during the study time period, but returns to TANF mean further depleting their limited benefit time.

As families leave cash assistance and strive toward self-sufficiency, some government benefits typically remain available to aid in the transition off cash assistance. These include food stamps, Medicaid, and child care assistance. Families who have sufficiently low incomes and meet other program requirements continue to be eligible for these benefits. This section examines returns to TANF and then addresses the extent to which former TANF/AFDC recipients continue to receive other government benefits over time.

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A. Returns to TANF

Despite the relatively high employment rates shown earlier, a sizeable minority of TANF exiters return to cash assistance in the first year after leaving. Figure IV.1 shows the range of these results across studies by quarter after exit using administrative data.

Figure IV.1:
Percent of Single-Parent Welfare Leavers Returning to TANF

Notes: The graph shows the minimum, maximum, and median TANF return rates as reported across the studies. The shaded box represents the range in which the middle 50% of reported TANF return rates fall. Not all studies provide data for all post-exit quarters. See table IV.1 for more information.

In the second, third, and fourth quarter after exit, the median percentage of families returning to TANF is 15, 18, and 19 percent respectively. However, there is variation across sites (Table IV.1).¹⁸ The highest rates of return in the third and fourth quarters after exit are in Iowa and Cuyahoga County, where about a quarter of leavers return to cash assistance. South Carolina and Florida have the lowest percentage of leavers returning in these quarters.

Table IV.1
Percent of Single-Parent Leavers Returning to TANF: Adminstrative Data

State/Study	Exit Cohort	Quarter Relative to Exit (%)				Receipt Any Time in Year After Exit
		Q1	Q2	Q3	Q4
Arizona1	1Q98	5	15	21	20	28
District of Columbia1,2	4Q98	7	13	17	19	21
Florida3	2Q97	7	14	13	11	25
Georgia	1Q98	3	10	14	14	22 4
Illinois3	3Q97 - 4Q98	16	19	18	16	29
Iowa1	2Q99	6	15	22	24	30
Massachusetts2	Dec 1998 - Mar 1999	3 5	11	16	16	19
Missouri2	4Q96	13	18	21	21	29
New York	1Q97	n.a	n.a	n.a	19	n.a
South Carolina2	Oct 1998 - Mar 1999	3	9	12	11	17
Washington	4Q97	8	14	16	16	23
Wisconsin2	4Q97	19	22	22	20	36
Cuyahoga Co.	3Q98	21	24	25	25	38
Bay Area	4Q98	19	21	23	n.a	n.a
1Quarterly data calculated from public use files. 2Results for all cases, not just for single-parent cases. 3Data for month after exit, not quarter. 4Results for all who exited in 1998. 5Q1 Figure represents month 3 after exit. Source: See Appendix B for a complete listing of the leavers studies referenced.

In most of the studies, returns to TANF increase over the first four quarters after exit. However, some report relatively high returns even in the first post-exit quarter. For example, Wisconsin, Cuyahoga County and the Bay Area study all report return rates around 20 percent in the first quarter after exit. Other studies report relatively low return rates in the first quarter. While some of these are reporting monthly and not quarterly rates, the 3 percent returns in Georgia and South Carolina are quarterly. In most studies, the rates of return are more closely bunched in the second through third quarters.¹⁹

There are indications that in many areas, fairly steady TANF participation rates in the second through fourth quarters after exit mask a fair degree of “cycling”— families returning to TANF and then leaving again. Eight of the fourteen studies report the percentage of families who ever received TANF in the year after initially exiting. These numbers range from 17 to 38 percent, with the median at 27 percent. In all of these, a higher percent of leavers ever returned to TANF over the course of the year than are on at the end of the year: in most cases a much higher percent. This indicates a large degree of movement off and on TANF. For example, Arizona reports that 28 percent of leavers in the study cohort return to TANF over the year after exit, but only 16 percent were on in the twelfth month after leaving. This means almost half of those who return to TANF at some point in the year after exit have left again before the twelfth month.

Using the limited information available, it is interesting to examine how return rates vary by the time limit policy in each of the study areas. As noted earlier, families may leave earlier in states with shorter time limits compared with states with the 60-month time limit. This could mean families are less likely to return because they have already hit their time limit or want to “save up” remaining months. It could also mean families are more likely to return if they were less “prepared” for the labor market when they exited TANF. In the studies examined here, there is some indications that places with shorter time limits (less than the federal 60 month limit) have lower returns in the fourth quarter. For example, Florida, Massachusetts, and South Carolina all have shorter than 5-year time limits and rates of return in the fourth quarter ranging from 11 to 16 percent. Ohio also has a shorter time limit, but Cuyahoga County's rate of return in the fourth quarter is the highest of the studies examined, 25 percent. ²⁰

Administrative data have some advantages over survey data for examining program participation, in that survey data are susceptible to faulty respondent memory and misinterpretation of questions. However, survey data on program participation does have the advantage of capturing benefit receipt for those who have moved out-of-state and no longer appear in the original state’s administrative data.

Seven studies report results on returns to TANF from their surveys of former recipients (Table IV.2). These results for TANF receipt at the time of the survey (which ranges from 6 to 34 months after exit) are generally comparable to the administrative data results for the same time period. Five of the studies also report the percent returning at any time in the year after exit. These results show that returns since exit are higher than returns at the time of the survey. They reinforce the finding that while a significant percentage of leavers return to welfare, many who return exit again in the time period prior to the survey. Of all the surveys, Missouri allows the longest-term picture of returns to TANF, by administering their survey two and a half years after the initial exit. At this time, 14 percent of leavers report they are back on TANF in Missouri and 31 percent say they received TANF at some point since exit.

Table IV.2:
Percent of Single-Parent Leavers Returning to TANF: Survey Data

State/Study	Exit Cohort	Timing of Survey Post Exit	Since Exit (%)	At Time of Survey (%)
District of Columbia2	4Q98	~ 12 months	25	19 1
Illinois	Dec. 1998	6 - 8 months	19	14
Iowa	2Q99	8 - 12 months	28	21 1
Massachusetts2	Dec 1998 - Mar 1999	~ 10 months	18	10
Missouri2	4Q98	26 - 24 months	31	14
South Carolina2	Oct 1998-Mar 1999	12 months	n.a.	7
Washington	Oct. 1998	6 - 8 months	n.a	19
1Month prior to survey. 2Results for all cases, not just for single-parent cases. Source: See Appendix B for a complete listing of the leavers studies referenced.

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B. Food Stamp Participation

Food stamp benefits can provide a significant amount of resources to a low-income family. Families with incomes below 130 percent of the federal poverty line qualify for food stamp benefits. Since income eligibility requirements are more strict for TANF than for food stamps, the vast majority of TANF recipients are also eligible for food stamps. Six studies report food stamp receipt in the quarter prior to leaving TANF using administrative data, and they all show that over 80 percent of leavers were receiving this benefit (Table IV.3).

Table IV.3:
Percent of Single-Parent Leavers Receiving Food Stamps- Administrative Data

State/Study	Exit Cohort	Quarter Relative to Exit (%)					Receipt Any Time in Year After Exit
		Q-1	Q1	Q2	Q3	Q4
Arizona1	1Q98	83	51	46	45	42	67
District of Columbia1,2	4Q98	87	40	42	40	41	53
Florida3	2Q97	n.a	45	41	38	35	67
Illinois3	3Q97 - 4Q98	85	33	35	34	33	56
Iowa1	2Q99	85	50	44	42	56	67
Massachusetts2,3	Dec 1998 - Mar 1999	n.a	42	48	46	44	51
Missouri2	4Q96	n.a	57	47	43	40	70
New York	1Q97	n.a	n.a	n.a	n.a	26	n.a
South Carolina2	Oct 1998 - Mar 1999	n.a	78	68	64	61	84
Washington	4Q97	90	46	42	40	36	n.a
Wisconsin2	2Q98-4Q98	84	70	67	65	63	83
Cuyahoga Co.	3Q98	n.a	56	48	48	47	68
Bay Area4	4Q98	n.a	26	28	28	n.a	n.a
1Quarterly data calculated from public use files. 2Results are for all cases, not just single-parent cases. 3Q1 Figure represents month 3 after exit. 4Studies report data for month after exit not quarter. Source: See Appendix B for a complete listing of the leavers studies referenced.

Twelve studies report post-exit food stamp receipt using administrative data, and they show wide variation in the percent of leavers receiving this benefit overall. Food stamp receipt drops significantly after exiting TANF. The actual percentages range from 26 percent in the Bay Area to 78 percent in South Carolina (Figure IV.2). ²¹

Figure IV.2:
Percent of Single-Parent Welfare Leavers Receiving Food Stamps

Notes: The graph shows the minimum, maximum, and median food stamp receipt rates. The shaded box represents the range in which the middle 50% of food stamp receipt rates fall. Not all studies provide data for all post-exit quarters. See table IV.3 for more information.

In seven out of the twelve studies reporting food stamp benefit receipt in the quarter after exit, 50 percent or fewer leavers are receiving food stamps. The median level of receipt is 48 percent. These generally low rates of receipt are at least in part due to some recipients no longer being eligible for food stamps. However, the extent to which a change in eligibility status is the reason for the decline in receipt after exit cannot be assessed with these data.

Over the first year after exit, the majority of studies show some decline in food stamp receipt. Figure IV.2 shows that the median percentage of families receiving food stamps falls from 48 percent in the first quarter after exit to 42 percent in the fourth

quarter after exit. The studies reporting the greatest declines, Missouri and South Carolina, have some of the largest receipt rates in the first quarter after exit (Table IV.3). In the fourth quarter after exit, New York reports the lowest rate of receipt among these studies, 26 percent, while Wisconsin has the highest rate, 63 percent. ²²

As with returns to TANF, there is evidence in these administrative data of a great deal of cycling on and off food stamps. The percentage of leavers who receive food stamps at any point over the year after exit is significantly higher than the percentage receiving in any of the individual quarters. For example, 67 percent of Arizona leavers receive food stamps at some point in the year after exiting TANF, but only between 42 and 51 percent are receiving benefits in any single quarter. This suggests that while the overall receipt of food stamps declines slowly over time, there is actually a substantial degree of turnover with recipients leaving and entering the food stamp caseload.

These food stamp participation rates include families that have returned to TANF. Thus, these numbers conceal a more extensive decline in food stamp receipt among continuous leavers (those who have not returned to TANF in the year after exit). Those who have returned to TANF are more likely to be receiving food stamps, likely due to the relative ease of accessing food stamps benefits when already receiving TANF. Those who have not returned may have lower receipt over time either because they have more earnings and, therefore, are likely to be less eligible for benefits over time or they moved out of the geographic area being studied and are no longer included in administrative TANF or food stamp data.

Seven studies report food stamp receipt for continuous leavers (Table IV.4). Figure IV.3 shows the five studies reporting receipt of food stamps at any time in the year after exit for continuous and all leavers.

Figure IV.3:
Percent of Single-Parent Welfare Leavers Who Ever Received Food Stamps In Year After Exit--Continuous Leavers v. All Leavers

Notes: See table IV.4 for more information.

In all studies in almost all quarters after exit, the percentage of continuous leavers receiving food stamps after leaving TANF is lower than the percentage of all leavers receiving food stamps. For example, in Arizona, 67 percent of all leavers receive food stamps at some point in the year after leaving TANF, compared with 55 percent of continuous leavers.

Table IV.4:
Percent of Single-Parent Leavers Receiving Food Stamps by Continuous Leaver Status Administrative Data

State	Exit Cohort	Quarter Relative to Exit (%)				Receipt Any Time in Year After Exit
		Q1	Q2	Q3	Q4
Arizona1	1Q98
All Leavers		51	46	45	42	67
Continuous Leavers		46	34	31	28	55
District of Columbia1,2	4Q98
All Leavers		40	42	40	41	53
Continuous Leavers		33	31	26	25	39
Florida3	2Q97
All Leavers		45	41	38	35	67
Continuous Leavers		38	30	26	29	61
Illinois3	3Q97 - 4Q98
All Leavers		33	35	34	33	56
Continuous Leavers		28	33	36	39	n.a.
Iowa1	2Q99
All Leavers		50	44	42	56	67
Continuous Leavers		46	31	25	41	53
Missouri2	4Q98
All Leavers		57	47	43	40	70
Continuous Leavers		49	35	30	26	n.a.
South Carolina2	Oct 1998-Mar 1999
All Leavers		78	68	64	61	84
Continuous Leavers		76	64	59	55	81
1Quarterly data calculated from public use files. 2Results for all cases, not just for single-parent cases. 3Data is monthly, not quarterly. Source: See Appendix B for a complete listing of the leavers studies referenced.

There is information on food stamp receipt from survey data in nine of the studies (Table IV.5). Where the timing of this information overlaps with that of administrative data, the results are similar, with some survey estimates somewhat lower than administrative data (e.g. Arizona). Missouri again affords the opportunity to observe program participation for a fairly long period after exit. In this study, 47 percent of leavers are receiving food stamps 26 to 34 months after exit, the same percentage receiving food stamps in the second quarter after exit according to Missouri’s administrative data. According to survey data from five studies, continuous leavers also have lower receipt of food stamps than the entire population of leavers (Table IV.6). Receipt of food stamps ranges from 3 to 12 percentage points lower at the time of the survey for continuous leavers as compared with all leavers. The percentage receiving at any time since exit is 10 percentage points lower for continuous leavers in the two studies that provide this information.

Table IV.5:
Percent of Single-Parent Leavers Receiving Food Stamps: Survey Data

State/Study	Exit Cohort	Timing of Survey Post Exit	Since Exit (%)	At Time of Survey (%)
Arizona1	1Q98	12-18 months	55	38
District of Columbia2	4Q98	~ 12 months	55	41
Georgia	Jan 1999- June 2000	~ 6 months	n.a	74
Illinois	Dec. 1998	6 - 8 months	44	33
Iowa1,3	2Q99	8 - 12 months	n.a	43
Massachusetts2	Dec 1998-Mar 1999	~10 months	53	38
Missouri2	4Q98	26 - 34 months	n.a	47
South Carolina2	Oct. 1998-Mar 1999	12 months	n.a.	61
Washington1	Oct. 1998	6 - 8 months	50	n.a
1Calculations from public use data files. 2Results for all cases; not just single-parent cases. 3Month prior to survey Source: SeeAppendix B for a complete listing of the leavers studies referenced.

Table IV.6:
Percent of Single-Parent Leavers Receiving Food Stamps by Continuous Leavers: Survey Data

State/Study	Exit Cohort	Timing of Survey Post Exit	Since Exit (%)	At Time of Survey (%)
Arizona1	1Q98	12-18 months
All Leavers			55	38
Continuous Leavers			45	27
District of Columbia1,2	4Q98	~ 12 months
All Leavers			55	41
Continuous Leavers			45	31
Iowa1,3	2Q99	8 - 12 months
All Leavers			n.a	43
Continuous Leavers			n.a	31
Massachusetts1,2	Dec 1998-Mar 1999	~10 months
All Leavers			53	38
Continuous Leavers				31
South Carolina2	Oct. 1998-Mar.1999	12 months
All Leavers			n.a	61
Continuous Leavers			n.a	58
1Data calculated from public use data files. 2Results are for all cases; not just single-parent cases. 3Month prior to survey. Source: See Appendix B for a complete listing of the leavers studies referenced.

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C. Medicaid and Other Health Insurance 

Another important benefit that can support the transition from welfare to work is public health insurance through the Medicaid program. ²³ Like food stamps, families receiving TANF are generally eligible for this benefit. This is borne out in the high rates of adult receipt, 90 percent or more, in the six studies reporting Medicaid coverage in the quarter prior to exiting TANF (Table IV.7). Most families exiting welfare through employment are eligible for Transitional Medical Assistance and most children in low-income families are eligible for Medicaid. 

Table IV.7:
Percent of Single-Parent Leavers Receiving Medicaid: Administrative Data

State/Study	Exit Cohort	Quarter Relative to Exit					Receipt Any Time in Year After Exit
		Q-1	Q1	Q2	Q3	Q4
Adults
Arizona1,2	1Q98	96	60	54	49	45	72
District of Columbia2,3	4Q98	98	44	49	49	50	58
Florida4	2Q97	n.a	55	52	48	45	74
Illinois4	3Q97 - 4Q98	93	57	52	47	40	69
Iowa1,2	2Q99	n.a	54	49	49	46	68
Missouri3	4Q96	n.a	41	39	34	31	n.a
New York	1Q97	n.a	n.a	n.a	n.a	35 5	n.a
South Carolina	Oct 1998 - Mar 1999	90	69	64	57	45	69
Washington3,6	4Q97	93	53	49	46	43	n.a
Wisconsin3	2Q98-4Q98	96	80	79	78	76	87
Cuyahoga	3Q98	n.a	60	55	50	46	70
Bay Area4,7	4Q98	n.a	74	70	66	n.a	n.a
Children
Florida4	2Q97	n.a	62	58	54	51	78
Missouri3	4Q96	n.a	81	86	97	87	n.a
New York	1Q97	n.a	n.a	n.a	n.a	34 5	n.a
South Carolina3	Oct 1998 - Mar 1999	96	88	86	80	68	88
Wisconsin	2Q98-4Q98	90	86	83	82	80	90
1Only family head enrollment considered. 2Quarterly data calculated from public use files. 3Studies report results for all cases. 4Studies report data monthly, not quarterly. 5In New York, four quarters after exit, 45% of cases have any member with Medicaid. 6All individuals are included, adults in two-parent households are counted separately. 7At least one household member is enrolled. Source: See Appendix B for a complete listing of the leavers studies referenced.

In the studies reporting Medicaid administrative data, there are varying rates of Medicaid coverage for adults after exiting TANF. In the first quarter after exit, results range from 41 percent in Missouri to 80 percent in Wisconsin (Figure IV.4 and Table IV.7).

Figure IV.4:
Percent of Single-Parent Welfare Recipients Receiving Medicaid for Adults

Notes: The graph shows the minimum, maximum, and median Medicaid coverage rates as reported across the studies. The shaded box represents the range in which the middle 50% of Medicaid coverage rates fall. Not all studies provide data for all post-exit quarters. See table IV.7 for more information.

The median percentage covered by Medicaid in the first quarter after exit is 57 percent. While these rates are generally higher than receipt of food stamps, they are far lower than the 90 plus percent receiving Medicaid benefits before exit reported in several studies.

Only five studies report separate administrative data on Medicaid enrollment for children. The coverage rates after exit vary from 62 percent in the third month after exit in Florida to 88 percent in the first quarter after exit for South Carolina. In almost all studies reporting both adult and child enrollment, coverage for children is higher than for adults. New York is the only study reporting about the same Medicaid coverage for adults and children (35 percent versus 34 percent) in the fourth quarter after exit, with 45 percent of cases having any members with Medicaid.

Similar to food stamp receipt, the percentage of leavers who have Medicaid coverage at any time over the year after exit is significantly higher than the percent receiving in any particular month or quarter. For example, in Florida, 74 percent of adults and 78 percent of children are on Medicaid at some point over the year, but only 45 percent and 51 percent of adults and children respectively are covered by Medicaid in the twelfth month after exit. This signals a fair amount of turnover in Medicaid receipt.

Over time, the rate of Medicaid coverage declines for both adults and children in almost all of these studies, except for adults in the District of Columbia and children in Missouri. As with food stamp receipt, the decline is greater for the group of continuous leavers. Six of the eight studies reporting Medicaid use by continuous leavers show this more dramatic decline (Table IV.8).

Table IV.8:
Percent of Single-Parent Leavers Receiving Medicaid for Adults by Continuous Leavers- Administrative Data

State	Exit Cohort	Quarter Relative to Exit (%)				Receipt Any Time in Year After Exit
		Q1	Q2	Q3	Q4
Arizona1	1Q98
All Leavers		60	54	49	45	72
Continuous Leavers		55	44	34	28	61
District of Columbia1,2	4Q98
All Leavers		44	49	49	50	58
Continuous Leavers		38	39	37	37	46
Florida3	2Q97
All Leavers		55	52	48	45	74
Continuous Leavers		49	41	35	39	69
Illinois3	3Q97 - 4Q98
All Leavers		57	52	47	40	69
Continuous Leavers		50	53	55	56	n.a.
Iowa1	2Q99
All Leavers		54	49	49	46	68
Continuous Leavers		49	37	33	30	55
Missouri2	4Q96
All Leavers		41	39	34	31	n.a.
Continuous Leavers		35	26	20	15	n.a.
South Carolina2	Oct 1998-Mar 1999
All Leavers		69	64	57	45	69
Continuous Leavers		66	62	57	46	66
Washington	4Q1997
All Leavers		53	49	46	43	n.a
Continuous Leavers		55	45	40	36	n.a
1data calculated from public use files. 2Results for all cases, not just single-parent cases. 3Data is monthly, not quarterly. Source: See Appendix B for a complete listing of the leavers studies referenced.

Figure IV.5 shows the percent of adult leavers with Medicaid coverage at some point in the year after exit for continuous and all leavers.

Figure IV.5:
Percent of Single-Parent Welfare Leavers Receiving Medicaid for Adults in Year After Exit--Continuous Leavers v. All Leavers

Notes: See table IV.8 for more information.

Coverage rates in the year after exiting TANF are lower for continuous leavers than for all leavers. This is true for most studies in most of the quarters after exit. The main exception is Illinois which actually shows increasing coverage for continuous leavers. Lower coverage of continuous leavers could in part be due to the fact that after six months transitional Medicaid benefits are income-tested in many states and some workers may no longer qualify. It could also be true, as noted earlier, that some leavers move out of the study area and are no longer captured in the studies’ TANF or Medicaid program data.

Survey data are valuable when collecting information on health insurance coverage other than Medicaid. They can be used to ascertain coverage by private sources as well as public and to discover the percentage of persons with no coverage at all. Ten studies report survey data for insurance coverage of adults at the time of the survey (Table IV.9).²⁴ The percentage covered by Medicaid is reported in the first column under type of coverage at time of interview. This information roughly corresponds to the administrative findings where similar time periods are available, with some survey reports of Medicaid slightly higher than administrative reports and some slightly lower. The exception is South Carolina, where the survey results include Medicaid coverage of any household member, and are thus much higher than administrative reports for adults only.

Table IV.9:
Percent of Single-Parent Leavers with Health Insurance for Adults by Coverage Type: Survey Data

State/Study	Exit Cohort	Timing of Survey Post Exit	Type of Coverage at Time of Interview (%)
			Medicaid	Employer1	Other	Uninsured
Arizona2	1Q98	12 - 18 months	38	15	5	41
District of Columbia2,3	4Q98	~ 12 months	54	19	4	22
Georgia	Jan 1999- June 2000	~ 6 months	66	n.a	10 4	24
Illinois2	3Q97 - 4Q98	6 - 8 months	47	21 5	n.a	36
Iowa2,6	2Q99	8 - 12 months	48	14	8	37
Massachusetts2,3	Dec 1998 - Mar 1999	~ 10 months	81	13	n.a	10
Missouri3	4Q98	26 - 34 months	33	25	9	32
South Carolina3,7	Oct 1998 - Mar 1999	12 months	85	10 5	1	10
Washington8	4Q97	6 - 8 months	53	13	12	26
Bay Area	4Q98	6 - 12 months	53	n.a	23 9	24
1Employer includes own employer coverage for survey respondents. Spouse employer coverage, where reported separately (Missouri, Iowa, and Washington) is included in other. 2Calculated using public use data. 3Results are for all cases; not just single-parent cases. 4Includes all non-Medicaid coverage. 5Includes all private coverage. 6Respondents' own health insurance. 7Responses are for leavers who have not returned to welfare and other household members. Figures reflect at least one household member has coverage or all household members are uninsured. 8Multiple responses are allowed. 9Includes private/government. Of the children covered by private/government, a vast majority are covered by private insurance. Source: See Appendix B for a complete listing of the leavers studies referenced.

The share of adults without health insurance varies substantially across studies. The rates range from 10 percent in Massachusetts to 41 percent in Arizona. South Carolina reports that in 10 percent of leaver families that have not returned to welfare, all members are uninsured. This range reflects, in part, differences in Medicaid coverage for adults as well as, to a lesser extent, differences in private coverage. The lower rate of adult uninsurance in Massachusetts is a result of the higher rate of adult Medicaid coverage compared with other studies. Arizona has one of the lowest rates of adult Medicaid coverage, and the highest uninsured rate. However, private/employer coverage plays a significant role in Missouri which reports the lowest rate of adult Medicaid coverage among the grantees (33 percent), but has the highest rate of private (employer and other) coverage at 34 percent.

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D. Other Sources of Public Support

There are a number of other sources of public support that can provide crucial assistance to families that have exited welfare. These include housing assistance through subsidies or public housing, Supplemental Security Income (SSI) program and Social Security program income for persons with disabilities or survivors of beneficiaries. Other programs include reduced price or free school lunches, the Women, Infant, and Children's (WIC) nutritional supplement program, fuel/energy assistance, and unemployment compensation. In addition, many working leavers are eligible for the federal and/or state Earned Income Tax Credits (EITC) that supplement incomes of low-income workers. A few studies ask about receipt of these benefits in their surveys, some asking about receipt at the time of the survey and some about receipt at any point since exit. ²⁵

There is a wide variation in the percent of leavers receiving housing assistance in the eleven studies reporting this information (Table IV.10). Rates of receipt of housing assistance at the time of the survey range from 18 percent in Arizona to 60 percent in Georgia. Receipt of housing assistance at any point since exit ranges from 14 percent of welfare leavers in Illinois to 53 percent in Massachusetts.

Table IV.10:
Percent of Single-Parent Leavers Receiving Other Publicly Funded Sources of Income: Survey Data

State/Study	Exit Cohort	Timing of Survey Post Exit	Housing	SSI	Social Security	School Lunch	WIC	Fuel/ Energy	Unem. Comp.	EITC
Results for time of survey
Arizona1	1Q98	12 - 18 months	18	12	n.a	27	25	n.a	n.a	52
District of Columbia1,2,3	4Q98	~ 12 months	27	6/64	7	n.a	12/354	3	3	n.a
Georgia	Jan 1999-June 2000	~ 6 months	60	n.a	n.a	87	n.a	n.a	n.a	n.a
Missouri2	4Q98	26 - 34 months	26	12	n.a	n.a	23	n.a	2	n.a
South Carolina2	Oct98-Mar99	12 months	24	10	8	48	26	n.a	n.a	n.a
Bay Area	4Q98	6 - 12 months	24	n.a	n.a	n.a	n.a	n.a	n.a	32
Results for time since exit
District of Columbia1,2	4Q98	~ 12 months	31	7/84	8	n.a	16/464	9	5	50
Illinois2	3Q97-4Q98	6 - 8 months	14	12	6	40	20	13	4	41
Iowa1	2Q99	8 - 12 months	23	7	7	46 5	32	n.a	n.a	65
Massachusetts1,2	Dec98-Mar99	~ 12 months	53 6	20 7	n.a	71	27	27	9	42
Washington1	4Q97	6 - 8 months	17	4 3	4	52	n.a	16	4	65
Cuyahoga County	3Q98	14 - 21 months	28	5	n.a	n.a	n.a	n.a	n.a	n.a
1Calculated from public use data. 2Results are for all cases; not just single-parent cases. 3Month prior to survey. 4Adults/children. 5Breakfast or lunch. 6At time of survey. 7Includes SSI, Social Security, and SSDI. Source: See Appendix BB for a complete listing of the leavers studies referenced.

The variation in SSI receipt is lower, with between 4 and 12 percent of former recipients receiving this form of cash assistance in the nine studies reporting this benefit. Massachusetts reports a higher percentage (20 percent), but this includes Social Security and Social Security Disability Insurance (SSDI) receipt. For those studies reporting Social Security receipt separately, the combined SSI and Social Security percentages range from 8 percent (Washington) to 18 percent (Illinois and South Carolina). Since this income is generally for persons with a disability that prevents them from working, some leavers who are not working may be relying on this income rather than cash assistance from the TANF program.

Receipt of nutritional assistance programs such as reduced price or free school lunch and WIC are much more common, which likely reflects higher income thresholds for eligibility and easier eligibility processes, as well as widespread coverage among low-income children. Receipt of reduced-price or free school lunch varies from 27 percent in Arizona to 87 percent in Georgia. The percent of former recipient families receiving WIC generally ranges from one-quarter to one-third.

Four studies report fuel/energy assistance and five report unemployment compensation receipt. Fuel/energy assistance use ranges from 9 percent in DC to 27 percent in Massachusetts. This higher percentage for Massachusetts likely results from its harsher winters and therefore greater need for fuel assistance. Unemployment compensation use is very low, from 2 percent to 9 percent. These low rates may reflect the fact that many leavers do not have sufficiently high earnings or quarters of employment to be eligible for unemployment insurance.

A final source of public support is the federal EITC. Working families with relatively low earnings are eligible to receive this credit from the federal government.²⁶ Seven studies report how many leavers received this credit. Results range from 32 percent in the Bay Area to 65 percent in Washington and Iowa (these percentages are for all leavers, not just working leavers). Arizona and Illinois also report that a higher percentage of leavers had heard of the EITC, 66 percent and 76 percent, respectively. Illinois probes further and finds that although three-quarters of leavers have heard of the EITC, only 47 percent say they know what it is, a percentage not much higher than those receiving the credit.

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E. Program Participation by Subgroup

Individual reports find differences in results when comparing across subgroups such as employed and not employed or sanctioned and not sanctioned. Two types of subgroup comparisons for program participation were included in enough reports to be discussed here — employment status and race/ethnicity.

Examining receipt of government assistance by employment status provides information on the extent to which those who are employed are combining work with some form of public assistance. Generally, one would expect that those who are working are less likely to be receiving government benefits. It is also interesting to examine whether working leavers’ benefit receipt declines over time, which would be consistent with increasing wages and more stable employment. All the figures described in this section with the exception of South Carolina are calculated from the public use data files for these studies. This allows the report to present program participation by employment status when it is not reported in the published studies.

Program participation by employment status is examined both in administrative data and survey data. Public-use data files including administrative data on food stamps and Medicaid have been provided by two states, Arizona and Iowa. For both of these studies we compare those who have worked at some point since exit and those who have never worked since exit (Table IV.11). Across both these states and programs, 44 to 63 percent of leavers who have worked since exit receive food stamps or Medicaid in any given quarter after exit. A higher percentage, almost three-quarters, receive food stamps or Medicaid at some point during the year after exit. These higher figures indicate that among working leavers there is some cycling on and off non-TANF benefit programs. Because we are examining the group who worked at any point since exit (not necessarily continually), this benefit receipt could be connected to movement on and off TANF.

Table IV.11:
Percent of Single-Parent Leavers Receiving Government Benefits by Employment Status: Administrative Data

Program	State/Study	Exit Cohort	Quarter Relative to Exit (%)				Receipt Any Time in Year After Exit
			Q1	Q2	Q3	Q4
Food Stamps
	Arizona1	1Q98
	Worked Since Exit		55	49	48	44	71
	Never Worked Since Exit		44	39	39	37	57
	Iowa1	2Q99
	Worked Since Exit		53	47	44	60	70
	Never Worked Since Exit		45	39	37	48	58
Medicaid
	Arizona1	1Q98
	Worked Since Exit		63	58	52	48	76
	Never Worked Since Exit		51	45	44	39	63
	Iowa1	2Q99
	Worked Since Exit		57	52	51	49	72
	Never Worked Since Exit		48	41	43	40	58
1Quarterly data calculated from public use files. Source: See Appendix B for a complete listing of the leavers studies referenced.

The administrative data show that those who have never worked since exit are less likely to receive food stamps or Medicaid than those who have worked since exit. This is true in all quarters for Arizona and Iowa for both the food stamp and Medicaid programs. One possible explanation for this difference is that those who have never worked since exit are a heterogeneous group including leavers who have a working spouse or partner and may not qualify for benefits, as well as leavers who have few sources of income. Another possible explanation is that some leavers who do not show up as having earnings or food stamps in administrative databases have moved out of state or may have misspelled last names or missing social security numbers which hamper linkages to both earnings and food stamps databases. In fact, survey data discussed below show different results.

The administrative data can be used to examine the trend in participation over the four quarters for these subgroups. For those who worked at some point since exit and those who never worked since exit, both studies show a gradual decline in benefit receipt over the first three quarters. In Iowa, however, food stamp participation turns up sharply in the fourth post-exit quarter.

Another way of considering program participation by employment status is to examine current benefit receipt among those who are currently working or currently not working. Some of the studies with survey data allow us this comparison to be made. Six of the studies we information by employment status on receipt of food stamps, Medicaid, and SSI (Table IV.12). Program participation for food stamps and Medicaid is almost always higher for those not currently employed compared to those currently employed. The only exception is Massachusetts, where 80 percent of those not currently employed have Medicaid compared with 83 percent of those currently employed. While many of the differences are modest, in the District of Columbia the difference in benefit receipt by current employment status is quite large. Figure IV.6 illustrates the differences in food stamp receipt between leavers who are currently employed and not currently employed.

Table IV.12:
Percent of Single-Parent Leavers Receiving Government Benefits at Time of the Survey by Employment Status: Survey Data¹

Program	State/Study	Exit Cohort	Timing of Survey Post Exit	Currently Employed	Not Currently Employed	Never Worked Since Exit
Food Stamps	Arizona	1Q98	12-18 months	30	38	40
	District of Columbia2	4Q98	~ 12 months	26	69	59
	Iowa3,4	2Q99	8 - 12 months	36	41	49
	Massachusetts2	Dec.1998-Mar.1999	~10 months	33	36	55
	South Carolina2	Oct.1998-Mar.1999	12 months	49	72	n.a.
	Washington4	Oct-98	6-8 months	44	50	56
Medicaid	Arizona	1Q98	12-18 months	27	29	36
	District of Columbia2	4Q98	~ 12 months	41	72	75
	Iowa2,3	2Q99	8 - 12 months	37	46	52
	Massachusetts2	Dec.1998-Mar.1999	~10 months	83	80	92
	South Carolina2	Oct.1998-Mar.1999	12 months	82	83	n.a.
	Washington	Oct-98	6-8 months	52	56	57
SSI	Arizona	1Q98	12-18 months	11	10	18
	District of Columbia2	4Q98	~ 12 months	4	2	16
	Iowa2,3	2Q99	8 - 12 months	3	4	17
	Massachusetts2,5	Dec.1998-Mar.1999	~10 months	17	19	27
	South Carolina2,6	Oct.1998-Mar.1999	12 months	6	15	n.a.
	Washington	Oct-98	6-8 months	3	3	8
1All figures except South Carolina calculated from public use data files. 2Results are for all cases; not just single-parent cases. 3Month prior to survey. 4Figures are for time since exit from welfare. 5Also includes SSDI and Social Security. 6Includes adult or child in household receiving. Source: See Appendix B for a complete listing of the leavers studies referenced.

Figure IV.6:
Food Stamp Receipt of Welfare Leavers by Employment Status

^{Notes: See table IV.12 for more information.}

Table IV.12 also shows results for those who have never worked since exit. Leavers who never worked since exit are more likely to receive food stamps and Medicaid than currently employed leavers. In several studies these differences are quite large. In addition, in almost all of the studies, those who have never worked since exit are more likely to receive benefits than those who are not currently employed. This suggests that those who have never worked since exit are more dependent on government benefits than leavers who have worked at some point since exit. These survey results might differ from the administrative results because they measure receipt in a specific month, versus receipt at any time over a quarter. If there is a great deal of movement on and off benefit programs, as is likely more true for those working at any point since exit than those never working since exit, receipt at some point during a quarter will be higher than receipt in a given month²⁷

Finally, examination of SSI receipt by employment status shows that a relatively high percentage of those who have never worked since exit are receiving this form of cash assistance. The percentages range from 8 percent in Washington to 27 percent in Massachusetts (which includes SSDI and Social Security benefits). That these numbers are relatively high for those who have never worked is not surprising since SSI requires that recipients have a disability that prevents work. However, the majority of former recipients that have not worked since exit are not receiving disability benefits.

Five studies report some information on the participation of leavers in TANF, food stamps, or Medicaid in the year after exit by race and ethnicity (Table IV.13). For the most part, the share of black leavers receiving these forms of government assistance in the year after exit is higher than the share of white and other racial/ethnic group leavers.

Table IV.13:
Program Participation of Single-Parent Welfare Leavers by Race/Ethnicity: Administrative Data Findings

	Race/Ethnicity Group
	Black	White	Hispanic	Other1
Returns to TANF in Year After Exit (%)
Arizona2	33	21	30	40
Florida	32	22	22	16
Georgia	23	13	n.a.	10
Missouri3,4	32	27	n.a.	n.a.
South Carolina5	8	6	n.a.	n.a.
Receipt of Food Stamps in Year After Exit (%)
Arizona2	70	62	71	69
Florida	73	63	55	50
Missouri3,4	72	69	n.a.	n.a.
Adult Covered by Medicaid in Year After Exit (%)
Arizona2	75	68	77	70
Florida	78	69	70	63
Missouri3,4	37	44	n.a.	n.a.
1Other includes Asain/Pacific Islander, Native American, and other groups unless otherwise specified. 2"Other" category represents Native American. A small percent of caseload (less than 1%) is other race/ethnicity groups not included in this table. 3Category "black" refers to nonwhite and includes Hispanic, Native American and other leavers who comprise less than 2 percent of Missouri's leavers. 4Results are for all cases; not just single-parent cases. 5Results are from survey data.

In all five studies, the percentage of black leavers who return to TANF at some point in the year after exit is higher than the percentage of white leavers who return to TANF. The difference ranges from 2 percentage points in South Carolina (8 percent of black leavers compared with 6 percent of white leavers) to 12 percentage points in

Arizona (33 percent of black leavers compared with 21 percent of white leavers). The two studies reporting results for Hispanic leavers, Arizona and Florida, show mixed results. In Arizona, returns to welfare among Hispanic leavers (30 percent) are closer to those of black leavers than to those of white leavers. Returns for Native American leavers are even higher, at 40 percent. However, the percentage of Hispanic leavers returning to TANF in Florida (22 percent) is the same as for white leavers. The “other” category in Florida and Georgia show very low returns to TANF, 16 and 10 percent respectively, but these groups are very small percentages of the entire group of leavers in each study.

Leaver subgroups with higher returns to TANF tend to have higher participation in food stamps and Medicaid. The percentage of black leavers receiving food stamps and the percentage covered by Medicaid in the year after exit are for the most part higher than the percentage of white leavers receiving these benefits. The differences in receipt between these two groups ranges from 3 to 10 percentage points. The exception is in Missouri, where fewer nonwhite leavers have Medicaid coverage than white leavers. The pattern for Hispanic leavers follows the pattern of returns to TANF: in Florida, fewer Hispanic leavers receive these benefits than blacks, and in Arizona, more Hispanic leavers receive these benefits than blacks.

It is not surprising that receipt of food stamps and Medicaid is generally higher for racial and ethnic leaver groups that have higher rates of return to TANF. Receipt of these benefits is likely easier for those who are currently receiving TANF than for former recipients. However, it is somewhat surprising that black leavers have a higher rate of return to TANF than white leavers in light of results described in an earlier chapter showing black leavers tend to have higher employment and earnings than white leavers.²⁸ This may reflect differences in the reason for leaving across groups. If black recipients are more likely to leave for employment than white recipients and employment leads to less permanent transitions than other reasons (such as marriage) then employment rates and returns to TANF could be higher for black leavers. We do not have evidence on the differences across race and ethnic groups in the reasons for leaving TANF.

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F. Chapter Summary

Receiving non-TANF government assistance can help families in their transition from welfare to work. Despite the availability of these supports, about a quarter to a third of families who left welfare returned to TANF at some point in the first year after exit. About half of leaver families receive food stamps in the first quarter after exit and two-thirds receive this benefit at some point in the year after exit. About 60 percent of families have an adult enrolled in Medicaid in the first quarter after exit. Medicaid coverage of children is generally higher, ranging from 78 to 90 percent at some point in the year after exit. Participation in both of these programs is generally lower for continuous leaver families. Several studies also report on additional sources of government assistance, such as housing assistance, disability benefits, reduced-price lunches, WIC, fuel/energy assistance, unemployment compensation, and the Earned Income Tax Credit.

Program participation also varies by work status and race/ethnicity. In general, workers are less likely to receive non-TANF government assistance than non-workers, and black leavers are generally more likely to return to TANF and to participate in food stamps and Medicaid than white leavers.

Endnotes

¹⁸Some studies report quarterly information (receipt at some point within a three-month period) and some present monthly information (receipt in a particular month). Studies reporting quarterly information will report a higher percentage than if they reported a monthly number. For example, the New York study shows that 17 percent of original exiters were receiving TANF in the twelfth month after leaving, but 19 percent received at some point in the fourth quarter after leaving. To increase comparability, we have included calculations of quarterly data from public use data files where possible. All tables in this chapter indicate whether numbers reported are monthly or quarterly.
¹⁹Recall that most of these studies require that a family remain off welfare for at least two months to be considered a leaver. This common leaver definition may contribute to the similar, low return rates across some sites in the first quarter after exit.
²⁰Arizona and Missouri also have less then 5 year benefit time limits but allow the child's portion of the grant to continue. These families would not be included as leavers under the definition used in Arizona and no families had reached the time limit in Missouri at the time of the study.
²¹Food stamp receipt in the Bay Area study is the combination of non-TANF food stamp receipt and the percentage of families who have returned to TANF. These numbers are likely lower in part because they are monthly reports, not quarterly.
²²Iowa shows a large increase in food stamps receipt from the third to fourth quarter, of 42 percent to 56 percent. As was the case with the large declines in fourth quarter employment data, it is unclear why such a large increase is shown here. We see no large increase for returns to TANF or, as we shall see, Medicaid participation in the fourth quarter.
²³A number of states also have programs that extend public coverage to children at higher income levels through the State Children's Health Insurance Program (SCHIP). While this coverage sometimes goes by names other than Medicaid, we are including it under Medicaid here.
²⁴The health insurance results for children are discussed later in the child well-being section of this report.
²⁵District of Columbia reports results for both time of the survey and since exit.
²⁶As of 2000, six study areas had state EITCs: District of Columbia, Illinois, Iowa, Massachusetts, New York, and Wisconsin.
²⁷Also, as discussed on the previous page, some of the administrative results for those coded as non-working non-recipients of food stamps may be due to difficulties in tracing certain individuals in administrative databases.
²⁸Similar findings are reported and discussed in Lower-Basch (2000).

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