Monitoring Outcomes for Former Welfare Recipients: A Review of 11 Survey Instruments. Knowledge of Medicaid and Food Stamp Eligibility

08/11/1999

The final outcome measure included in this analysis concerns the former recipient’s knowledge of her potential eligibility for Medicaid and food stamps.  Preliminary findings from administrative data and state­funded surveys of leavers suggest that relative low percentages of leavers — in some cases less than 50 percent — are receiving Medicaid or food stamps.  This is a puzzling finding, given that many families who leave TANF are expected to be eligible for these programs, because of their relatively low­paying jobs and low family income.  Furthermore, all families leaving because of employment should qualify for transitional Medicaid assistance during the first six months after an exit.  In order to better understand, and eventually, address issues of non­participation among this seemingly eligible population, many leavers’ surveys include questions about clients’ knowledge of their entitlement to benefits.

As shown in Table VI, seven instruments include questions that probe for respondents’ knowledge of their eligibility for Medicaid, their children’ eligibility for Medicaid, and their family’s eligibility for food stamps.  Of the seven questions about Medicaid, five ask, “Did you know that... (you may be eligible, your children may be eligible, working adults are eligible, children are eligible)?”  The Georgia instrument asks a somewhat broader question, “Once you leave TANF, do Medicaid benefits end?”  The Illinois survey asks about the client’s perception of her specific eligibility, “Did you think you would be eligible to get a Medicaid card...?”  In addition to asking about knowledge of eligibility rules, two surveys ask whether the former recipient received information from the welfare office about Medicaid.

Table VI:  Knowledge of Medicaid and Food Stamp Eligibility

Questions
Did you know that you [adults who work] could/may continue to be eligible to get Medicaid after leaving TANF?  YOUR CHILDREN...   C
X
X
C
X C C X           5
Once you leave TANF, do Medicaid benefits end?*             X         1
Did you think you would be eligible to get a Medicaid card after you left cash assistance?  Children? X
C
                    1
Did caseworker tell you/did you receive info from welfare office letting you know about Medicaid eligibility for you (your children) X
C
    C               2
Have you ever heard of the Children's Health Initiative Program?         C             1
Did you know that you can/ may/might continue to get food stamps after leaving TANF?   X X     X           3
Did you think you would be eligible for food stamps after you left cash assistance? X                     1
Did caseworker tell you/did you receive info from welfare office about food stamps? X     X               2
Total Number of Questions 6 3 3 3 2 2 1 0 0 0 0  

X = Question asked of adult;  C = Question asked about children in household.

*  An additional survey not included in this review, an IRP survey of families applying from and/or diverted from cash assistance in Milwaukee asks a somewhat similar question, “Can someone receive Medicaid without participating in W-2?” The question is repeated with “food stamps” substituting for “Medicaid.”

 

Similar questions are asked about food stamp eligibility and information at welfare offices, although these questions are not as common as the questions about Medicaid eligibility.  Though not included in this analysis, many surveys also include questions about recipients’ knowledge of eligibility for child care subsidies.  (See Appendix V for a complete listing of the questions on knowledge of Medicaid and food stamps).

With regard to the questions about Medicaid eligibility, it seems to me that the question, “did you know that people like you are eligible for Medicaid...” is a “loaded” question, and thus not as meaningful as a more neutral question about eligibility rules, like the example in the Georgia survey.  If someone were to ask me if I knew that the Federal government (my employer) provided a particular brand of health insurance or a particular kind of life insurance, I would likely answer yes, not wanting to admit that I do not recall the details of the ½" thick pile of papers on benefit options that I plowed through on my first day of employment.  However, if one were to ask me more neutrally, does the Federal government offer X to its employees, I might be more likely to respond honestly that I do not know.  Perhaps researchers might want to consider the potential merit of rewording questions about Medicaid eligibility, to bring them more in line with the more neutral wording of the Georgia example.(15)