Access to adequate health insurance is a key concern of families with
children at all income levels. Since 1965, mothers and children on wel
fare have had health care coverage through the Medicaid program, which
has provided a health care safety net for welfare recipients. Althoug
h most Americans are insured through their employers, families who lea
ve welfare for employment often find themselves in jobs that do not of
fer health care coverage, adding to the ranks of the uninsured. This a
rticle examines the extent to which poor children and their mothers ha
ve private insurance, Medicaid, or no health insurance at all. It docu
ments how recent expansions of Medicaid eligibility to low-income chil
dren who do not receive welfare have improved the insurance status of
children, though these changes have not helped the mothers who leave w
elfare for work. Citing evidence that health insurance options influen
ce the welfare and employment decisions of women whose families face h
ealth problems, the article suggests that implementing welfare reform
at a time when rates of private insurance coverage are declining will
be challenging and may expose some families to health risks.