Final Synthesis Report of Findings from ASPE "Leavers" Grants. 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


Exit Cohort Quarter Relative to Exit Receipt Any Time in Year After Exit
Q-1 Q1 Q2 Q3 Q4



1Q98 96 60 54 49 45 72

District of Columbia2,3

4Q98 98 44 49 49 50 58


2Q97 n.a 55 52 48 45 74


3Q97 - 4Q98 93 57 52 47 40 69


2Q99 n.a 54 49 49 46 68


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


4Q97 93 53 49 46 43 n.a


2Q98-4Q98 96 80 79 78 76 87


3Q98 n.a 60 55 50 46 70

Bay Area4,7

4Q98 n.a 74 70 66 n.a n.a



2Q97 n.a 62 58 54 51 78


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


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

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


Exit Cohort Quarter Relative to Exit (%) Receipt Any Time in Year After Exit
Q1 Q2 Q3 Q4



All Leavers

  60 54 49 45 72

Continuous Leavers

  55 44 34 28 61

District of Columbia1,2


All Leavers

  44 49 49 50 58

Continuous Leavers

  38 39 37 37 46



All Leavers

  55 52 48 45 74

Continuous Leavers

  49 41 35 39 69


3Q97 - 4Q98  

All Leavers

  57 52 47 40 69

Continuous Leavers

  50 53 55 56 n.a.



All Leavers

  54 49 49 46 68

Continuous Leavers

  49 37 33 30 55



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



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

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


Exit Cohort Timing of Survey Post Exit Type of Coverage at Time of Interview (%)
Medicaid Employer1 Other Uninsured


1Q98 12 - 18 months 38 15 5 41

District of Columbia2,3

4Q98 ~ 12 months 54 19 4 22


Jan 1999- June 2000 ~ 6 months 66 n.a 10 4 24


3Q97 - 4Q98 6 - 8 months 47 21 5 n.a 36


2Q99 8 - 12 months 48 14 8 37


Dec 1998 - Mar 1999 ~ 10 months 81 13 n.a 10


4Q98 26 - 34 months 33 25 9 32

South Carolina3,7

Oct 1998 - Mar 1999 12 months 85 10 5 1 10


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.