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Answer
Frequently overlooked in the welfare reform debate is
the fact that when families move from welfare to work
they often remain in poverty. The jobs parents get are
generally low-wage and lack important benefits, such as
paid sick days and health insurance. Many of those who
go to work quickly lose their jobs – about half are no
longer working within a year. Research suggests that
higher incomes and benefits are key factors in job retention
for former welfare recipients.
Promoting access to government benefits that support work
can increase income and improve the chances that families
will succeed in employment. Anticipating this, the Personal
Responsibility and Work Opportunity Reconciliation Act
of 1996 included provisions designed to ensure that when
families left welfare two key benefits, Food Stamps and
Medicaid, would continue.
In practice, however, the transition off welfare has often
meant an end to these benefits as well (see “Who Participates?”
at right). Participation in both Food Stamps and Medicaid
declined in the last several years by far more than can
be attributed to either the economy or reduced eligibility.
Food Stamp participation fell by 34 percent between 1994
and 1999. The number of people insured by Medicaid decreased
in 1996 for the first time in nearly a decade, while the
proportion of uninsured people nationally increased.
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How
the Transition Should Work. |
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Transitional Medicaid
benefits are available to families who lose eligibility
for Medicaid due to increased earnings or income from
child support. The family must have received Medicaid
in three of the preceding six months, and the transitional
benefits last for six to twelve months. (Some states provide
longer periods of Transitional Medicaid under federal
waivers.) When families leave welfare, states must provide
Transitional Medicaid without requiring a reapplication.
The first six months of Transitional Medicaid are available
to all families, regardless of income. During the second
six-month period, families remain eligible provided their
income (minus child care expenses) is below 185 percent
of the federal poverty level. If a family loses eligibility,
the state must determine whether any household member
is eligible under another Medicaid eligibility category.
Food Stamp benefits work somewhat differently. Food Stamps
are available to all families who meet program eligibility
criteria, generally those with incomes up to 130 percent
of poverty and whose assets total $2,000 or less. When
a family leaves welfare for work, the state is required
to reevaluate its continued eligibility for Food Stamps
and, if found to remain eligible, continue benefits at
the appropriate amount. In addition, a new option – the
Transitional Benefit Alternative – allows states to provide
transitional Food Stamps for up to three months to families
leaving welfare for work.[2]
During the transitional period, families receive
at least the level of benefits they received while on
TANF, and states are not liable for quality control errors
should the household’s income change.
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Why
Many Families Do Not Receive These Benefits |
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The most common
reasons why families who leave welfare do not continue
to receive Food Stamps and Medicaid are related to lack
of awareness and administrative failure. Many recipients
mistakenly believe that when they leave TANF they are
no longer eligible for Food Stamps or Medicaid. When they
leave welfare, their Food Stamp and Medicaid cases are
often closed along with their TANF case even though they
remain eligible. State agencies may not take sufficient
steps to continue benefits - despite federal rules that
require a separate eligibility determination - and families
may not understand what they need to do to ensure that
the benefits continue.
Other factors regularly cited by families leaving welfare
(and other low-income working families) are burdensome
recertification and reporting requirements that make it
difficult to access benefits and often force potential
recipients to take time off from work to do so. In addition,
some families may be reluctant to participate because
of the stigma associated with receipt of the benefits
and a desire to distance themselves from the welfare agency.
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How
Participation Can Be Increased |
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States and localities
can take a number of steps to ensure that eligible families
receive Transitional Medicaid and Food Stamps. |
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Market transitional
benefits early and often.
Welfare recipients should be made aware that if they leave
welfare for work they can continue to receive Food Stamps
and Medicaid and that time limits and other TANF policies
do not apply to these benefits. Marketing transitional
benefits serves the dual purpose of encouraging welfare
recipients to work and making work pay. It is especially
important that recipients be made to understand the steps
they need to take in order to ensure that they receive
the benefits. However, this information often gets lost
in the scores of policies and requirements described to
clients. To ensure that the message gets across, present
the information regularly and repeatedly, particularly
in the context of welfare-to-work services. |
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Check eligibility
before closing a TANF case.
Before a TANF case is closed, determine whether household
members may be eligible for Food Stamps and Medicaid.
TANF closing notices should make clear whether or not
Medicaid and Food Stamps are affected, and what families
must do to continue these benefits. Federal rules stipulate
that states may not terminate Medicaid unless all avenues
to eligibility have been explored and exhausted. Food
stamp rules require that states recompute eligibility
from case information where possible, inform families
losing TANF of any information they may need to continue
their Food Stamp eligibility, and give them sufficient
time to submit the information. |
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Make sure closing
codes are appropriate and trigger transitional benefits.
For some common reasons that TANF cases are closed, families
are likely still eligible for Food Stamps and Medicaid.
To the extent that systems are automated, benefits should
be extended automatically when appropriate. Triggering
the benefits, however, generally requires that certain
closing codes be entered, and not all closings involving
employment or increased earnings are identified as such.
Individuals who believe they are no longer eligible for
cash assistance may simply fail to attend a recertification
appointment, resulting in the assignment of a closing
code that may not trigger transitional benefits. Welfare
agencies should contact families to confirm the reason
for leaving and enter an appropriate closing code. |
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Review closed
TANF cases.
State agencies should regularly review closed TANF cases
for which Medicaid and Food Stamp benefits were not continued
to determine whether or not appropriate action was taken
to determine ongoing eligibility. Families identified
as eligible for either benefit should be contacted by
the agency, and their case should be reopened. States
should use this review process not only to identify individual
cases that are eligible for benefits, but also to discover
and address any recurring problems. |
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Stagger the timing
of recertifications for TANF and other benefits.
Welfare recipients who find jobs often fail to appear
at recertification appointments because they believe they
are no longer eligible for TANF. Similarly, if a review
coincides with a TANF time limit, recipients may not feel
compelled to attend. If that same appointment covers recertification
for Food Stamps and Medicaid, failure to report can lead
to termination of those benefits as well. Putting Food
Stamps (a new option for states) and Medicaid on a different
recertification schedule ensures that recipients who miss
a TANF appointment would not automatically lose these
other benefits. |
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Simplify the
process of obtaining transitional benefits.
Making the administrative procedures for establishing
eligibility for Transitional Medicaid and Food Stamps
simpler can make it easier for eligible families to access
benefits. States can shorten forms, minimize the number
of appointments required, and allow families to report
information by phone, fax, or mail. Often, information
already in case files may be sufficient to complete the
paperwork to continue Food Stamps and Medicaid; caseworkers
should ask only for changes or missing information. Agencies
can also extend evening and weekend hours (beyond the
limited non-traditional hours usually offered) and station
staff at various community locations. These alternatives
should be well publicized and coordinated with public
transit routes and schedules |
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Make providing
these benefits a program priority.
Line staff - who may have high caseloads and multiple
job tasks - should receive a clear and consistent message
about their role in providing transitional benefits. The
message should be communicated through staff training,
written guidance, supervisory review, and performance
evaluations. Staff should receive regular training regarding
eligibility rules, administrative procedures, and how
to explain and market the benefits to families |
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Take advantage
of federal options that promote participation.
Federal rules offer several opportunities for states to
extend eligibility for Medicaid and Food Stamps. New regulations
allow states to provide up to three months of Transitional
Food Stamps, supporting families in the transition to
work and giving both families and welfare agencies time
to determine ongoing eligibility. States also have an
option to grant continuous Medicaid eligibility to children
under age 19 for up to 12 months, even if there is a change
in family income or circumstances. This option helps to
ensure that children maintain coverage, especially if
there are delays in establishing Transitional Medicaid.
Improving Access to Benefits for the Working Poorm.
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Improving
Access to Benefits for the Working Poor |
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Transitional benefits
are only a partial answer to helping low-income families
make ends meet, and participation in both programs - especially
Food Stamps - has historically been low among the working
poor (see "Who's In, Who's Out?" at right. As
fewer low-income families receive welfare, it becomes
increasingly important for states and localities to improve
access to these benefits for families who may never have
received welfare or for whom transitional benefits have
ended. Increasing participation among the working poor
will require: |
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Outreach and
education
Outreach efforts are needed to ensure that low-income
families know they may be eligible for Food Stamps and
Medicaid, even if they do not receive TANF. These may
include public campaigns using a variety of media (such
as radio, television, and bus ads) and targeted dissemination
at community locations (such as neighborhood supermarkets,
churches, and child care facilities) that are frequented
by the working poor. Marketing should positively promote
the programs as supports for working families and challenge
the stigma that is often associated with receiving these
benefits. Federal funding is available to support outreach
efforts for both programs. |
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Facilitating
applications
Low-income families should conveniently be able to
access Medicaid and Food Stamps independent of TANF. Separate
Medicaid and Food Stamp applications should be available
in addition to joint TANF applications. Eligibility workers
can be stationed in places that serve low-income families,
such as community health centers and Head Start programs.
The application process can be simplified by reducing
the number of appointments required, shortening forms,
allowing application by mail, phone, or fax, and speeding
up the processing of applications. Expanded evening and
weekend hours would allow individuals to apply without
taking time off of work. Federal rules require that families
be able to apply for and receive these benefits without
delay. In particular, any policies designed to divert
families from TANF or delay TANF receipt should not affect
the processing of Medicaid and Food Stamp applications. |
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Reducing reporting
requirements
States should adopt the maximum certification periods
the law allows and minimize the extent to which families
must report and document each change in hours or earnings.
Medicaid recertification can take place as infrequently
as every 12 months. New Food Stamp rules allow semi-annual
reporting. (Families would report modest changes in earnings
only every six months and reapply only once a year). |
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Expanding eligibility
Federal regulations provide states with several opportunities
to expand coverage. States have considerable discretion
to expand Medicaid eligibility for low-income families
by revising the way in which they count income and resources.
They can realize this flexibility by modifying state Medicaid
plans, without federal waiver approval. States can ease
Food Stamp vehicle rules to conform to any program funded
through TANF or state Maintenance-of-Effort (MOE) funds,
or they confer categorical eligibility through a TANF-
or MOE-funded service. States can also use Children's
Health Insurance Program (CHIP) coverage to extend insurance
to children not covered by Medicaid, and they can use
TANF, MOE, or other state funds to support Food Stamp
expansions.
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More
information on this topic |
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Notes |
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1. |
Polit,
London, and Martinez, 2001. |
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2. |
Although
TBA was included in final regulations published by USDA
in November 2000, TBA and several other provisions will
not take effect until final regulations are published
in a future notice in the Federal Register. |
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^ Back to top |
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No. 6, October 2001
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Amy Brown
is Director of Planning at Community Food Resource Center,
a non-profit direct service and advocacy organization.
In CFRC's Food Force project, teams equipped with laptop
computers travel to more than 400 community-based sites
to provide Food Stamp information and application assistance
to more than 30,000 households each year.
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Who Participates? Receipt of Medicaid and Food Stamps in the Urban Change
Study
In a survey of families in MDRC's Urban Change study,
one-third of working former welfare recipients had no
health insurance, and nearly a third said that someone
in the family needed a doctor but could not afford one.
The families were even less likely to get Food Stamps.
Sixty-eight percent of working former recipients no longer
received Food Stamps, though based on their income, most
seemed to be eligible for benefits.[1]
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Who's In, Who's Out? Transitional Benefits and Common Reasons for Welfare
Exit
Employment or Increased Earnings
When welfare recipients find jobs, many simply fail
to attend their next TANF appointment or ask that their
case be closed. A closing code for reasons other than
employment may not trigger transitional benefits.
Time Limits
As more families reach welfare time limits, this will
be an increasing reason for TANF case closings. However,
despite federal requirements that make clear that Food
Stamps and Medicaid are not time limited, families may
mistakenly believe that they are no longer eligible
for these benefits, as well.
Sanctions
Medicaid and Food Stamps may be terminated in some –
but not all – situations in which a TANF case is closed
for failure to comply with program requirements. In
addition, in most cases Food Stamp and Medicaid sanctions
may apply only to the person violating the requirement;
children or other household members generally continue
to remain eligible.
Voluntary Case Closures
Some families may opt to close a TANF case to preserve
their months of welfare eligibility. But recipients of
Medicaid and Food Stamps are required to submit separate
confirmation of their desire to end those benefits as
well.
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QFF#6
Answer 
