Preliminary Findings from Grants to States and Localities to Study Welfare Reform Outcomes, with an Emphasis on TANF Applicants and Diversion (1999)
While the majority of ASPE-funded studies of TANF applicants and divertees are still in the data collection or analysis stage, some preliminary findings are available. The grantees that have either released reports or gathered preliminary data include: Florida, Illinois, South Carolina, Texas, Wisconsin, and the two consortia of counties in the Bay Area of California. A more complete picture of the circumstances of families who have applied for TANF will emerge throughout the coming months, as more findings from these studies become available. However, a few themes have emerged. First, based on data that have been reported to date, divertees and TANF applicants appear to be worse off, on average, than individuals and families leaving TANF. Fewer applicants are employed in the months following application, and applicants are more likely to rely on government assistance such as food stamps, Medicaid, and TANF. While these findings are preliminary, they are not surprising, as one would expect that individuals who are applying for TANF would have more economic difficulties than those who are leaving cash welfare. Second, the "applicant" population is harder to locate than the leavers population. While the typical ASPE-funded leavers study achieved response rates of 70 to 75 percent, most of the surveys of TANF applicants and divertees have been able to obtain responses from only about 55 to 60 percent of the sample. Finally, it will be even more difficult to make cross-state comparisons across these studies than among studies of TANF leavers. In both sets of studies, grantees had significant discretion over their research questions and construction of their surveys. However, while studies of TANF leavers used a common definition of leaver (as those who left TANF and remained off the rolls for at least two months), the definitions of "applicant" or "diverted" populations vary considerably by grantee, making comparisons across the studies more difficult.
Devolution and Urban Change (2000)
The Project on Devolution and Urban Change being conducted by the Manpower Demonstration Research Corporation (MDRC), is an on-going, multi-disciplinary, longitudinal study that examines the implementation and effects of welfare reform in four large urban areas — Cleveland, OH; Philadelphia, PA; Los Angeles, CA; and Miami, FL. The project brings together data from many sources: longitudinal administrative data for families dating back to 1992, survey data, an implementation study, neighborhood indicators, an institutional study focusing on local service providers, and an ethnographic study of families. This multi-component approach allows researchers, in the absence of experimental data, to capture effects that might be missed using only one approach, and to improve understanding of the strengths and weaknesses of each approach. The project is co-funded by numerous foundations, DHHS and USDA. Two reports have been released this year. A project description and links to all publications from the Urban Change project are available at: <http://www.mdrc.org/WelfareReform/UrbanChange.htm>.
Post-TANF Food Stamp and Medicaid Benefits: Factors that Aid or Impede Their Receipt (January 2001). This paper focuses on practices in welfare offices in the four cities to understand reasons for the decline in Food Stamp and Medicaid participation that occurred nationally between Fiscal Years 1996 and 1999. The study, which was conducted in early 2000, found that:
- Welfare staff did not routinely inform recipients early on that, when they became employed, they were likely to be eligible for transitional Medicaid and possibly food stamps as well.
- Many welfare recipients left welfare for work without informing the welfare agency; they would simply fail to attend their next eligibility redetermination appointments at which point their cash assistance, food stamps and Medicaid benefits would be terminated.
- On those occasions when a welfare recipient did let her worker know that she had found a job, the agency worker was likely to take necessary steps to ensure her continued receipt of Medicaid and (if eligible) food stamps.
Since this study was conducted, both the Centers for Medicare and Medicaid Services (CMS)/ DHHS (formerly the Health Care Financing Administration) and USDA have taken steps to address these problems by improving information and removing some of the administrative hurdles for working families.
Social Service Organizations and Welfare Reform (February 2001). This report examines the knowledge, views, experiences, and expectations about welfare reform among staff in community-based organizations in urban neighborhoods with large concentrations of welfare recipients. The agencies included churches, small grassroots organizations, and larger established organizations. They provided various services including education and employment preparation, basic needs, child care, school and youth services, and health care.
- The majority of agencies had very sketchy information about welfare reform and lacked knowledge about specifics of welfare policies. Agencies tended to express either mixed (62 percent) or negative (27 percent) views of welfare reform. These views were quite consistent across sites and types of agencies.
- Changes in the demand for education and training services have been the biggest effect of welfare reform. Whether demand increased or decreased depended partly on state and local welfare policies and how they were implemented, e.g., a greater emphasis on job search over education and training. Many agencies are planning to change their services/curriculum to accommodate the new needs arising from welfare reform.
- Most basic needs organizations did not report increases in demand for food or emergency services due to welfare reform. Nor have they seen increases in private donations. However several of Cleveland's basic needs agencies reported notable increases and they believe these are tied to a rise in TANF sanctions.
- There was some evidence of an increase in need for child care, but the child care agencies were already operating at capacity so enrollment levels did not change. Some expected to expand service hours to accommodate working parents.
Welfare Reform and the Health and Economic Status of Immigrants and the Organizations that Serve Them (1998, 1999, and 2000)
The Kaiser Family Foundation released a research report in April entitled Caring for Immigrants: Health Care Safety Nets in Los Angeles, New York, Miami and Houston, which documents the results of a study conducted by the Urban Institute and sponsored jointly by the Kaiser Family Foundation and various federal agencies - including DHHS, the U. S. Department of Agriculture and the Immigration and Naturalization Service of the Department of Justice. Several reports already have been issued under this project. A final report is expected by the Fall of 2001. Kaiser publications on immigrant health policy can be found at <http://www.kff.org/content/2001/2241>.
Major findings include:
- Low-income immigrants' access to health care services has become more tenuous since welfare reform was enacted. Some health care providers believe that Medicaid participation has begun to climb more recently. Data from the March 2000 Current Population Survey indicate that nationally the noncitizen Medicaid participation rate increased slightly between 1998 and 1999, although the participation level remained lower than in 1995.
- In each site, health care safety net providers (e.g., public hospitals and health clinics) reported that they were losing Medicaid patients and revenue while the number of uninsured patients was rising. Reasons beyond immigrant eligibility changes were identified (e.g., broader reductions in Medicaid caseloads, new requirements under Medicaid managed care, and general competition in the health care marketplace).
- Immigrants appear to have shifted increasingly to obtaining care from health safety net providers that offer free or reduced-price care. Immigrants also have delayed or avoided medical care and turned to alternative, sometimes underground, health care providers for services.
- Although the responses in each site varied, the state and/or local governments and health providers assumed additional responsibilities and costs in response to federal restrictions.
- Language difficulties faced by immigrants with limited English capabilities were viewed as a major barrier to obtaining medical care and a serious threat to medical care quality.