How Effective Are Different Welfare-to-Work Approaches? Five-Year Adult and Child Impacts for Eleven Programs. Conclusions


A potential effect of the NEWWS programs was the loss of health coverage for participants as they moved from welfare to work. Many low-wage workers either are not offered or do not accept employer-provided insurance, making it difficult to replace their lost Medicaid with private coverage. It is encouraging that the programs did not lead to a loss in coverage for the adults or their children.

As expected, levels of health care coverage decreased for both program and control group members over time, though a large majority of respondents and their children were still insured at the end of the five-year follow-up. Since the evaluation started, states have continued to address the issue of coverage for low-income families by creating or expanding public programs. These additional benefits were not a program component and were available to members of both research groups. The findings presented in this chapter indicate that the sites were generally successful in continuing to provide coverage for families who left welfare. Nonetheless, 20 to 30 percent of adults were not covered, suggesting that states should continue in their efforts to reach the uninsured. Because access to health care has been expanding, the findings presented here on the effects of the programs might have been different had the evaluation taken place in more recent years.


1.  Mullahy and Wolfe, 2000.

2.  Guyer and Mann, 1999.

3.  Kaplan, 1997.

4.  Families USA Foundation, 1999.

5.  Quint and Widom, 2001.

6.  Farber and Levy, 2000.

7.  In Riverside, about 16 percent of control group respondents (and one-third of those employed) combined work and welfare at the end of year 5, compared with less than 10 percent of control group members in the other three sites.

8.  The OHP provides publicly financed health care coverage to residents of the state of Oregon who do not qualify for Medicaid but whose income is below the poverty level.

9.  See Holahan and Brennan, 2000.

10.  About 8 percent of respondents were excluded from this analysis either because none of their children was 18 or under at interview or because they reported having no children.

11.  In very few families  between 3 and 7 percent of control group families  were only some (but not all) of the children in the family covered.

12.  In 1998 the State of California increased Transitional Medicaid coverage for up to two years. This change would have affected only the sample members in Riverside who entered the program near the end of the random assignment period.

13.  Recipients who find jobs and stop communicating with caseworkers might lose transitional coverage, since caseworkers might close their cases.

14.  For more detailed information about health care coverage at the end of year 2, see Freedman et al., 2000a, Chapter 8.