Uninsurance and Welfare Reform in Rural America

Research center:
Lead researcher:
Project completed:
January 2006
Former recipients of welfare are likely to face significant difficulties obtaining health insurance in rural areas, perhaps even greater than in urban areas, primarily because jobs in rural areas are less likely to offer health insurance but also because difficulties with the Medicaid program might be exacerbated in rural areas. The loss of health insurance coverage for mothers who leave welfare could impose a significant risk factor on their families, especially if the mother or children have health conditions or disabilities. Women who have made the transition to work but have lost their health insurance coverage because the job does not offer insurance coverage may return to Temporary Assistance for Needy Families (TANF) coverage, knowing that TANF will provide Medicaid coverage.

This project researched the following hypotheses:

  • Transitions off of welfare are often not accompanied by the acquisition of private health insurance or the continuation of Medicaid coverage.
  • Transitions off of welfare, accompanied by health insurance coverage, will lead to improved health status, and improved access to health care, for former welfare recipients.
  • Transitions off of welfare, not accompanied by health insurance coverage, will lead to declines in health status, and declines in access to health care, for former welfare recipients.

This project proceeded in two phases. In the first phase, project staff used widely-accepted databases to examine the recent history of uninsurance rates in the U.S., focusing on the low-income population that could be eligible for welfare. In the second phase, the focus was on how welfare reform has impacted the health insurance coverage of welfare recipients and other low-income persons over the period of time when welfare reform was phased in.