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


  • The majority of control group respondents, ranging from 72 percent in Atlanta to 81 percent in Portland, had health coverage at the end of year 5. Most control group members had coverage through public sources, such as Medicaid or other public programs, rather than employer-provided or other private sources. Children in the control group were somewhat more likely to have coverage than adults, owing to the greater number of public health programs available to low-income children. Coverage rates for children ranged from 80 percent in Portland to 85 percent in Atlanta.
  • Employment did not guarantee coverage: About 20 to 30 percent of individuals in the control groups who were working did not have health coverage. Among those who were working and did have coverage, between 40 and 60 percent obtained it from their employers.
  • Between 20 and 30 percent of adults in the control groups did not have health care coverage at the end of year 5. This indicates that many of those who left welfare for work were not able to replace Medicaid with private coverage once their transitional benefits expired. Control group respondents without coverage were just as likely as those with coverage to have been working at the end of the five-year follow-up, but they were much less likely to have been offered coverage through their jobs.
  • None of the programs had a statistically significant impact on coverage for adults or children. There is some evidence that because the programs increased employment, they may have led to a shift from public to private coverage. In all seven programs, program group respondents were more likely than those in the control group to have private health care coverage at the end of year 5 and less likely (in six of seven programs) to have publicly funded coverage, although these differences were not statistically significant.
  • Not all families eligible for Transitional Medicaid received it. Only about 60 to 75 percent of control group members who left welfare for work received Transitional Medicaid during the five-year follow-up period. Most of the programs increased the use of Transitional Medicaid, although only the impacts in Riverside LFA and HCD were statistically significant. The effect in these two programs is due to the fact that they increased the number of individuals who were eligible (those who left welfare for work) and slightly increased use among those who were eligible.