WtW enrollees had more difficulty maintaining health insurance coverage for themselves than for their children. Exhibit V.12 shows near-universal coverage (93 percent or more) by public or private health insurance for the children of WtW enrollees two years after program entry in all but the Ft. Worth (84 percent) and St. Lucie County (89 percent) sites. The coverage rates for children were essentially unchanged from the previous year, as illustrated in the top panel of Exhibit V.14. For the enrollees themselves, the median coverage rate across the study sites was just 75 percent. The enrollee coverage rate was lowest in Milwaukee, where very low rates of TANF receipt (4 percent, as shown in Exhibit V.2) by the noncustodial parent enrollees reduced the likelihood they would be covered by Medicaid (Exhibit V.12). In six sites, the percentage of enrollees covered by health insurance fell during the second year following program entry by between 4 points (Philadelphia) and 12 points (West Virginia), as shown in the bottom panel of Exhibit V.14.
Loss of Medicaid coverage following exit from TANF appears to have been a factor behind the reductions in health insurance coverage for WtW enrollees. In five of the six sites where enrollee health insurance coverage rates fell the second year after program entry, rates of receipt of TANF also fell. A comparison of the bottom panel of Exhibit V.14 with Appendix Exhibit B.12 reveals that rates of health insurance coverage and TANF receipt both fell significantly in Boston, Chicago, Ft. Worth, Philadelphia, and West Virginia. St. Lucie County was the only site where the health insurance coverage rate for WtW enrollees fell but there was no significant reduction in the rate of TANF receipt. Thus, it appears that exit from TANF exposed enrollees in about half of the study sites to a greater risk that they, but not their children, would be without health insurance coverage.(67)