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.
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|
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|
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|
SOURCE: MDRC calculations from the Five-Year Client Survey.
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.