How Effective Are Different Welfare-to-Work Approaches? Five-Year Adult and Child Impacts for Eleven Programs. Transitional Medicaid Use During the Five-Year Follow-Up

12/01/2001

For many welfare recipients, the potential loss of health coverage can create a disincentive to leave welfare and go to work. Transitional Medicaid reduces this disincentive by allowing working individuals to continue coverage, for themselves and their children, for up to one year after leaving welfare.(12) Receipt of this benefit is not automatic, however, and eligible recipients must request it and receive caseworker approval.(13) Data on the receipt of Transitional Medicaid are available from the survey: Respondents were asked whether they had ever received this benefit during the five-year follow-up period.

Table 8.4 shows the percentage of respondents who were eligible for and used Transitional Medicaid. The upper panel shows the percentage of program and control group members who worked and were off welfare at some point during the follow-up period and indicates the number of respondents who would have been eligible to receive Transitional Medicaid. Between 56 and 68 percent of control group members worked and left welfare during the follow-up period in Atlanta, Grand Rapids, and Portland. A much smaller percentage of controls (40 percent) were eligible for Transitional Medicaid in Riverside, probably because fewer in this site worked and when they did many were still eligible for welfare. Both programs in Riverside produced a significant increase in the percentage working and off welfare.

 

Table 8.4
Impacts on Transitional Medicaid Benefits

Site and Program

Sample Size Program Group (%) Control Group (%) Difference (Impact) Percentage Change (%)

Ever employed and off welfare during follow-up

Atlanta Labor Force Attachment 1,071 59.7 56.2 3.5 6.2
Atlanta Human Capital Development 1,146 59.6 56.2 3.3 5.9
Grand Rapids Labor Force Attachment 1,097 71.3 67.7 3.6 5.4
Grand Rapids Human Capital Development 1,109 67.9 67.7 0.3 0.4
Riverside Labor Force Attachment 1,219 46.9 39.6 7.2*** 18.3
Lacked high school diploma or basic skills 657 37.7 28.3 9.4*** 33.3
Riverside Human Capital Development 778 36.6 28.3 8.2** 29.1
Portland 504 67.8 66.8 1.0 1.6

Ever covered by Transitional Medicaid during follow-up

Atlanta Labor Force Attachment 1,071 42.0 38.1 3.8 10.1
Atlanta Human Capital Development 1,146 42.7 38.1 4.6 12.1
Grand Rapids Labor Force Attachment 1,097 53.5 50.8 2.7 5.3
Grand Rapids Human Capital Development 1,109 50.2 50.8 -0.6 -1.2
Riverside Labor Force Attachment 1,219 32.3 25.8 6.5** 25.3
Lacked high school diploma or basic skills 657 25.6 17.9 7.7** 42.8
Riverside Human Capital Development 778 26.2 17.9 8.2** 45.9
Portland 504 55.5 50.8 4.6 9.1

For those ever off welfare and employed,ever covered by Transitional Medicaid

Atlanta Labor Force Attachment   70.3 67.8 2.5 3.6
Atlanta Human Capital Development   71.7 67.8 4.0 5.8
Grand Rapids Labor Force Attachment   75.0 75.1 -0.1 -0.1
Grand Rapids Human Capital Development   73.9 75.1 -1.2 -1.6
Riverside Labor Force Attachment   68.8 65.0 3.9 6.0
Lacked high school diploma or basic skills   67.9 63.3 4.6 7.2
Riverside Human Capital Development   71.6 63.3 8.2 13.0
Portland   81.8 76.2 5.7 7.4

SOURCE:  MDRC calculations from the Five-Year Client Survey.
NOTES:  See Appendix A.2

The middle panel of Table 8.4 shows that not all who were eligible received Transitional Medicaid. This can be seen more easily in the lower panel, which shows receipt of Transitional Medicaid by those who were eligible (this is a nonexperimental comparison). Data for the control groups show that about 65 to 76 percent of eligible respondents received this benefit. In Atlanta, for example, 56 percent of control group members were eligible for Transitional Medicaid and 38 percent received it, meaning that only 68 percent of eligible respondents received it. Data from the two-year survey (not shown) indicate that the use of this benefit increased over time, probably as more families became eligible. At the two-year point, between 10 and 25 percent of control group members reported having used Transitional Medicaid compared with a much higher percentage at the end of year 5.

The programs generally increased Transitional Medicaid use  although only Riverside LFA and Riverside HCD produced statistically significant increases  because they increased the percentage who were eligible to receive it, but also because they increased its use among those eligible. The similarity of the impacts on the number of respondents who were employed and off welfare and on the number who used Transitional Medicaid suggests that most of those individuals who were induced by the program to work and leave welfare did, in fact, receive Transitional Medicaid at some point. This is also reflected in the nonexperimental numbers in the lower panel of Table 8.4. Of program group members who were eligible in Portland, for example, 82 percent received the benefit compared with only 76 percent of control group members. This finding is consistent with one of the hypotheses raised earlier that more involvement by caseworkers would lead to greater use of available benefits.