The first phase of this project developed baseline knowledge about current state formal diversion programs and activities. In the second phase, we will conduct two additional analyses, case studies in five local communities and a follow-up survey to states with lump sum payment and/or mandatory applicant job search programs to gather more detailed information on how criteria for Medicaid eligibility are developed and defined. The second-phase research will build on the information gathered for the first phase of this study and will address these four major goals: 1) describe and examine the actual implementation of diversion programs and identify potential consequences of diversion for low-income families, particularly with respect to entry into the job market and access to Medicaid; 2) describe state policies regarding Medicaid eligibility for applicants diverted through lump sum payments and mandatory applicant job search, 3) examine whether and how the potential changes in Medicaid enrollment rates associated with diversion efforts might affect traditional health care safety net providers, and 4) examine potential strategies for monitoring changes in Medicaid enrollment rates as well as the effects of these changes over time.
Case studies will be conducted in five states for the purpose of determining exactly what has been happening with respect to the implementation of diversion programs and activities in these states. In selecting the state case study sites, we will consider the following characteristics of the states' diversion programs: 1) the range and types of state diversion programs/activities, 2) the diversion programs/activities that are most common, 3) the diversion programs/ activities that appear to present greater or fewer barriers to providing support services and maintaining links to Medicaid, 4) the programs/activities that are likely to be the most and least successful in promoting work, and 5) the length of time since implementation.
Collection of data during site visits will involve semi-structured interviews with welfare administrators, welfare benefits field staff, families participating in diversion, community-based welfare rights groups, safety net providers, and community-based providers; focus groups with families participating in diversion; field observation; and review of selected case records. Review of the availability and quality of state administrative databases will be conducted prior to or subsequent to the site visits. The site visits will be designed to develop a broad understanding of how diversion activities are implemented on a day to day basis and the impact they have on potential TANF recipients and service providers.
Formal Diversion Programs and Medicaid Eligibility Study
Given the complex policy and implementation issues associated with assessing the effects of formal diversion programs, i.e., lump sum payment and mandatory applicant job search, on Medicaid eligibility, as well as the general lack of knowledge about the effects of diversion activities on Medicaid, we will also include a more in-depth examination of how states have addressed issues of Medicaid eligibility in designing and implementing their lump sum payment and mandatory applicant job search programs. Project staff will conduct telephone interviews with all 31 states that have implemented either one or both of these diversion programs to understand more specifically what decisions about Medicaid eligibility criteria have been made and how Medicaid linkages are being addressed for diverted TANF applicants. There will be a particular emphasis on examining state officials' knowledge about their options to affect Medicaid eligibility post-PRWORA. Project staff also will have an opportunity to explore Medicaid issues in more detail in the case studies planned during the next phase of the project. This research is essential to consider fully the impact of diversion programs on Medicaid eligibility.
Formal efforts to divert potential TANF recipients from receiving ongoing assistance represent one of many approaches states have implemented to shift to a more work-oriented, transitional system. These programs are clearly in their infancy but have the potential to affect large numbers of families. Thus, it is essential to begin to build a knowledge base that can provide a foundation for additional evaluation and monitoring of these program and activities.