State welfare reform policies and declines in health insurance

Objectives. This study sought to determine whether there is a relationship between state policies on Temporary Assistance to Needy Families (TANF), de clines in both TANF and Medicaid caseloads, and the rise in the number of u ninsured. Methods. Extant data sources of state TANF policies, TANF and Medicaid part icipation, and uninsurance rates were analyzed with the state as the unit o f analysis. The independent variables included state TANF policies that dir ectly address receipt of benefits or relate to health; dependent variables included changes in state TANF enrollment, Medicaid enrollment, and health insurance status since the enactment of the law. Results. In the bivariate analysis, declines in Medicaid were associated wi th sanction for work noncompliance, lack of a child care guarantee, and str ategies to deter TANF enrollment; this last factor was also associated with increased uninsurance. In the multivariate analysis, lack of a child care guarantee and deterrent strategies predicted TANF declines; deterrent strat egies predicted Medicaid decline and uninsurance increases. Conclusions. This analysis suggests that policies deterring TANF enrollment may contribute to declines in Medicaid and increased uninsurance. To maint ain health insurance for the poor, policymakers should consider revising po licies that deter TANF enrollment.