As shown in Figure 1, mandatory welfare-to-work programs can affect nontargeted outcomes (box D) through effects on the targeted outcomes (box C). For example, an increase in employment, if the increase is in jobs that do not provide health benefits, could affect the proportion of people with health care coverage. Program implementation features (box B) can also affect nontargeted outcomes (box D). For example, interactions between welfare recipients and case managers that stress the importance of quality child care, or networks among welfare recipients that develop through job search clubs or other program activities and end up providing child care provider "tips," can, in turn, change the child care environments for welfare recipients' children. This section briefly summarizes program effects on the nontargeted outcomes for which data are available in the NEWWS Evaluation. Again, the effects on nontargeted outcomes are measured by comparing outcomes for the program and control groups, and differences in impacts for the client survey and COS samples are highlighted.
- Some programs led to a reduction in health insurance coverage for both children and parents.
In total, four programs Riverside LFA, Portland, Columbus Integrated, and Oklahoma City decreased health care coverage levels (as reported by parents) as of the end of the follow-up period.(18) (See Table 3, which shows these effects for several different samples for which child impacts are discussed later in this document.) Portland program impacts were not statistically significant, but were just above the 10 percent level used as the standard throughout the NEWWS Evaluation analyses. For the client survey sample, the other seven programs had no impacts on health care coverage rates for children or parents. COS sample members in the Grand Rapids and Riverside LFA programs also reported a decrease in coverage, for focal children as well as any other children. (See Box 3 for a discussion of the dynamics that may have led to health insurance coverage reductions.)
How Welfare-to-Work Programs Can Lead to a Reduction in Health Insurance Coverage
At study entry, almost all NEWWS Evaluation sample members and their dependent children had health coverage because they were receiving welfare and were automatically covered under Medicaid. (In Oklahoma City, where applicants for assistance whose eligibility was not yet determined were included in the sample, initial coverage rates were lower.) Over time, coverage rates declined for both program and control group members, as some people left welfare and did not replace their Medicaid coverage with coverage from employers or other sources. By the end of the two-year follow-up period, between 81 percent (Columbus) and 88 percent (Detroit) of control group members reported having health care coverage for themselves and their children. (This range covers all sites except Oklahoma City, where the rate was 68 percent.)
Three programs Riverside LFA, Portland, and Columbus Integrated that increased employment and decreased welfare receipt as of the end of the two-year follow-up also decreased health care coverage levels (as reported by parents). (No program increased health insurance coverage.) Reductions in coverage ranged from 4 to 7 percentage points for sample members and their children, and from 3 to 6 percentage points for children only. Although many program group members who left welfare (and automatic Medicaid coverage) found a job that provided health insurance, received transitional Medicaid benefits, or obtained alternative sources of coverage, others were not able to replace the coverage they had under Medicaid. Some of these individuals never received transitional Medicaid, and others had exhausted or had not restarted their benefits as of the end of the two-year follow-up period.
Program group members in Oklahoma City reported even larger decreases in coverage: 11 percentage points for adults and children and 9 percentage points for children only. This program decreased welfare receipt and appears to have increased short-term employment that did not provide any health insurance.
- The programs differed in their messages and practices concerning child care.
All 11 programs offered child care assistance to welfare recipients who needed this service while they were participating in program activities or while they were employed.(19) In the Atlanta LFA and HCD, Oklahoma City, Portland, and Detroit programs child care assistance was emphasized either by site staff or by the welfare department's organizational structure. In both Atlanta programs case managers actively promoted the availability of child care reimbursement as a benefit of program participation. In Oklahoma City state-wide emphasis on access to child care made assistance to clients readily available while they were in the program and after they left welfare for work. Oklahoma City had no set caps on the amount of child care assistance that clients could receive. Atlanta and Oklahoma City, unlike the other programs, reimbursed only for care given by licensed providers. In Portland case managers did not push specific types or locations of providers, but they did emphasize the necessity for individuals to make arrangements and assisted those who were unable to make arrangements on their own. In Detroit case managers placed a priority on making child care payments, and made referrals to licensed providers in the area on request, but the choice of provider (including choosing licensed or unlicensed care) was left to the parent.
Both the Grand Rapids and Columbus programs would reimburse expenses from child care in licensed as well as unlicensed care, but expected parents to make their own arrangements. Referrals to licensed providers in the area could be made at the parents' request.
Child care providers were not difficult to come by in any site except Riverside, where case managers encouraged the use of low-cost, more informal arrangements, both to contain program costs and because case managers believed that parents would be more able to afford such arrangements after program or other government supports expired.
The authorization of transitional child care benefits for those who left welfare for work was easiest in the Detroit, Portland, Columbus, and Oklahoma City programs. Few individuals who went to work in the other six programs received these benefits.(20)
- Most programs increased the use of paid child care during employment.
Between 15 and 32 percent of control group members (depending on the site) in all 11 programs used paid child care while employed at some point during the two-year follow-up period. Nine programs all four of the employment-focused programs and five of the seven education-focused programs produced impacts on paid child care, with the impacts in two programs (Portland and Detroit) above 10 percentage points in magnitude. (See Table 3.) Relatively few control group members (less than 15 percent in any site) used transitional child care benefits. Five programs increased the use of such benefits, but these impacts were sizable only in the Atlanta LFA and Portland programs, where the increases in the receipt of these benefits were 7 and 11 percentage points, respectively. Among COS sample members, only the two Riverside programs increased child care during employment for the focal child (measured during the month prior to the client survey interview), and this care tended to be informal and to occur during nonstandard hours (evenings or weekends). Thus, in no site were COS focal children more likely than their control group counterparts to be in formal child care during their mother's employment. (See Box 4 for a discussion of how child care use and employment might have interacted.)
- The programs had little, if any, effect on fertility or family structure or living arrangements. Any effects found were small and not clustered among certain programs. This was true for the client survey sample as well as for the COS sample.
Across all 11 programs, only Columbus Traditional had any effect on fertility; this program resulted in a 3 percentage point decrease in the proportion of sample members who had a baby since study entry. (See Table 3.) Only two programs had impacts on marital status: in Portland a 5 percentage point increase in the proportion of sample members living as an unmarried couple (not shown in Table 3), and in Riverside LFA a 3 percentage point reduction in the proportion of sample members married and living with a spouse. Similarly, only two programs had impacts, small in size, on family household composition. Impacts on housing status were not extensive either, although five programs did produce impacts (not shown in Table 3). The largest of these was a 5 percentage point increase in the proportion of program group members in the Columbus Traditional program who lived with family or friends and paid rent. For COS sample members, none of the programs had an impact on fertility or marital status, and only Riverside's LFA program had an impact on families' living arrangements, with fewer fathers living with their biological focal child.
Most Programs Increased the Use of Child Care During Employment Independent of Their Effects on Increasing Employment
As noted, nine programs produced increases in the use of paid child care while employed, ranging from 4 to 13 percentage points. Increases in employment do not entirely explain program impacts on child care use and on paid care while employed, since in many programs impacts on child care use were maintained even when only those who worked during the follow-up period are considered (a nonexperimental comparison). A likely explanation is that employed program group members required or preferred more stable child care arrangements than employed control group members, either because of the different characteristics of their jobs or because they more frequently heard messages from case workers regarding the importance of child care. (Keep in mind, as noted earlier, that practices related to child care assistance access to and allowable payments for child care were the same for control and program group members within each site.) For example, case managers in the Atlanta LFA program (as well as in the Atlanta HCD program) encouraged people to use child care and emphasized it as a reason to participate in the program, in part by strongly emphasizing the availability of reimbursement for child care costs. For the client survey sample, the LFA program did not increase employment levels but did increase child care use while employed by 4 percentage points and raised use of paid child care by nearly 6 percentage points. Similarly, case managers in Detroit placed a priority on arranging child care, and the increase in the use of paid child care (13 percentage points) exceeded the program's employment gains.
- The few effects on mothers' psychological functioning and stress or on parenting can be considered small. These particular nontargeted outcomes were examined only for the COS sample.
Measures specific to the COS component of the two-year client survey were used to assess mothers' psychological well-being and parenting. Psychological well-being was assessed in three areas: time stress, locus of control or self-efficacy, and depression. Increases in mothers' feelings of time stress were found in both Atlanta programs and in the Riverside HCD program. There were no impacts on mothers' feelings of control over their own lives. Only the Grand Rapids LFA program had an impact an unfavorable one on mothers' depressive symptoms. Parenting was assessed on such dimensions as maternal warmth, maternal aggravation, and maternal cognitive stimulation. Impacts were found on two of the parenting measures for the Atlanta HCD program (both favorable), on four of the measures for the Atlanta LFA program (all favorable), and on one measure for the Grand Rapids LFA program (unfavorable). No impacts on parenting were found for the other programs. (The impacts discussed in this paragraph are not shown in a table.)