Barriers to TANF Enrollment Associated with Higher Uninsurance Rates

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Policies that deter enrollment in Temporary Assistance to Needy Families (TANF) may contribute to declines in Medicaid enrollment and to increased uninsurance, according to a study published in the American Journal of Public Health.

The study examined the welfare policies and insurance enrollment rates of all 50 states. Data sources included national surveys conducted by the National Governors' Association and the Center on Budget and Policy Priorities, Health Care Financing Administration (HCFA) 2082 reports, and Census Bureau Current Population Surveys.

Findings showed that TANF enrollment declined in states that reduced the entire family's cash grant for noncompliance with work requirements, that did not offer child care for families enrolled in TANF, and/or that required individuals to document their job search efforts before applying for TANF.

The authors note that this research should be considered preliminary rather than definitive because it is subject to several limitations, including the omission of economic variables and the lack of qualitative information on state policies. Nonetheless, they assert that this study contributes to the literature demonstrating that increases in uninsurance have followed the 1996 implementation of welfare reform and that "policies which deter TANF enrollment may contribute to these changes."

Chavkin W, Romero D, Wise PH. State welfare reform policies and declines in health insurance. American Journal of Public Health. 2000. 90(6):900-908.

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MCH Alert. 2001. Arlington, VA: National Center for Education in Maternal and Child Health. http://www.ncemch.org/alert.