Gaps and Transitions in Health Care Access: Welfare Reform and America's Uninsured Poor Children

Deborah Graefe, Pennsylvania State University
Pamela Farley Short, Pennsylvania State University
Tokunba Oluwole, Pennsylvania State University

As millions of poor mothers moved from welfare to work in accordance with the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), two-thirds of poor and near-poor children went a month or more without health insurance coverage between 1996 and 1999. Despite most state's provision of Transitional Medical Assistance (TMA) and implementation of the State Children's Health Insurance Program (SCHIP) in 1997, poor children experienced considerable instability in health insurance coverage. This paper used data from the 1996 Panel of the Survey of Income and Program Participation (SIPP) in a longitudinal research design to document poor children’s transitions from publicly provided insurance coverage over the 4 years following welfare reform. Only 18% of children with family incomes below the poverty line remained on Medicaid/SCHIP continuously. Discrete-time event history analysis was used to determine children’s retention of Medicaid in connection with families’ loss of cash assistance.