Initial Synthesis Report of the Findings from ASPE's "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. (18) Like food stamps, families receiving TANF are generally eligible for this benefit. This is borne out in the high rates of receipt, above 92 percent, in the three studies reporting Medicaid coverage in the quarter prior to exiting TANF (table V.5). Most families exiting welfare through employment are eligible for Transitional Medical Assistance and most children in low-income families are eligible for Medicaid.


Table V.5:
Percent of Leavers Receiving Medicaid:
Administrative Data
State Exit Cohort Quarter Relative to Exit (%) Ever Received Within
Year After Exit
Q-1 Q0 Q1 Q2 Q3 Q4
Arizona1,2 1Q98 96 55 50 45 42 37 72
District of Columbia2,3 4Q98 n.a. 98 42 47 47 48 n.a.
Florida2 2Q97 n.a. 100 55 52 48 45 74
Illinois2 3Q97-4Q98 93 42 57 52 47 40 69
Missouri3 4Q96 n.a. n.a. 41 39 34 31 n.a.
New York 1Q97 n.a. n.a. n.a. n.a. n.a. 354 n.a.
Washington3,5 4Q97 93 99 53 49 46 43 n.a.
Wisconsin July 1995-June 1996 n.a. n.a. 76 69 66 63 82
Cuyahoga Co. 3Q96 n.a. n.a. 41 42 40 38 n.a.
San Mateo Co.2 1997 n.a. 100 26 26 22 22 47
Florida2 2Q97 n.a. 100 62 58 54 51 78
Missouri3 4Q96 n.a. n.a. 81 86 97 87 n.a.
New York 1Q97 n.a. n.a. n.a. n.a. n.a. 344 n.a.
San Mateo Co.2 1997 n.a. 100 28 28 25 24 50
1 Only head of household enrollment considered.
2 Studies report data monthly, not quarterly.
3 Studies report results for all cases.
4 In New York, four quarters after exit, 45% of cases have any member with Medicaid.
5 All individuals are included, adults in two-parent households are counted separately.
Source: See Appendix B for a complete listing of the leavers studies referenced.

In the studies reporting Medicaid administrative data, however, we see relatively low rates of Medicaid coverage for both adults and children in the first months after exiting TANF. For adults, whom we expect to have lower Medicaid coverage than children, the results range from 26.4 percent in San Mateo County to 75.9 percent in Wisconsin. Five out of nine study areas reporting coverage in the first quarter (or third month) after leaving show less than half of adult leavers with Medicaid coverage.(19) Only four studies report separate administrative data numbers for children. The coverage rates here vary quite a bit, with 61.6 percent coverage in Florida the third month after exit and 27.6 percent coverage in San Mateo County at the same point. However, in both of these areas, coverage for children is higher than for adults. New York is the only study reporting higher Medicaid coverage for adults than children (35 percent versus 34 percent) although the ranking reverses when considering single and two-parent families together.

Over time, the rate of Medicaid coverage declines for both adults and children in all study areas except the District of Columbia. As with food stamp receipt, the decline would likely be greater if we separated out those leavers who are receiving Medicaid after returning to TANF. The four studies reporting Medicaid use by continuous leavers show this more dramatic decline (not shown in table). Rates of Medicaid coverage one year after exiting TANF are substantially lower for continuous leavers than for all leavers in DC, Florida, Illinois, and Washington.(20) This is not unexpected since after six months, transitional Medicaid benefits are income-tested.

Also similar to food stamp receipt, the percentage of leavers who received Medicaid 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, 68.8 percent of adults and 77.8 percent of children had received Medicaid at some point over the year, but only 40.0 percent and 50.8 percent of adults and children respectively were receiving benefits in the twelfth month after exit. This signifies a fair amount of turnover in Medicaid receipt.

In the area of health insurance coverage, survey data can add a great deal to our knowledge. It allows us to ascertain coverage by private sources as well as public and to discover the percentage of persons with no coverage at all. Five studies report survey data for insurance coverage of adults and children at the time of the survey (table V.6). The percentages for Medicaid are reported in the first column. This information roughly corresponds to the administrative findings where similar time periods are available, although survey reports of Medicaid tend to be higher than administrative reports.


Table V.6:
Percent of Leavers with Health Insurance by Coverage Type:
Survey Data
State Exit Cohort Timing of Survey
Post Exit
Type of Coverage at Survey
Medicaid Employer1 Other Uninsured
Arizona2 1Q98 12-18 months 39 15 5 40
District of Columbia 4Q98 ~12 months 54 19 4 22
Illinois Dec. 1998 6-8 months 473 214 n.a. 36
Missouri 4Q98 26-34 months 33 25 9 32
Washington2,5 Oct. 1998 6-8 months 53 13 12 26
Arizona2 1Q98 12-18 months 51 12 8 26
District of Columbia 4Q98 ~12 months 60 12 11 16
Illinois Dec. 1998 6-8 months 533 234 n.a. 29
Missouri 4Q98 26-34 months 68 20 3 8
Washington2 Oct. 1998 6-8 months 67 9 10 13
1 Employer for adults includes own employer coverage for survey respondents. Spouse employer coverage, where reported separately (Missouri and Washington) is included in other.  For children, employer includes all employer coverage.
2 Single-parent cases
3 Illinois is the only area reporting Medicaid coverage since exit as well as at the time of survey.  Results since exit are 58.0% for adults and 62.0% for children.
4 Includes all private coverage.
5 Multiple responses allowed.
Source: See Appendix B for a complete listing of the leavers studies referenced.

The rates of uninsured among adults and children vary substantially across survey areas. For adults, the range is from 22.4 percent in the District of Columbia to 40.0 percent in Arizona. The range is due in part to the range in Medicaid coverage for adults across the states as well as, to a lesser extent, differences in private coverage. The lower rate of adult uninsurance in DC is a result of the somewhat higher rate of adult Medicaid coverage compared with other areas. Missouri has the lowest reported adult Medicaid coverage, 33 percent, but also has the highest rate of private (employer and other) coverage at 34 percent.

The rate of uninsurance within study area is always lower for children than adults, largely due to greater eligibility for Medicaid, but it still varies across area. For children, the range is from 8.0 percent in Missouri to 28.9 percent in Illinois. The low rate of uninsurance for children in Missouri is directly related to the high rate of Medicaid coverage, 68 percent, the highest of any of the areas. Employer-sponsored or other coverage for children is similar across study areas.