Planning for and securing health insurance in the context of welfare reform

Previous research indicates that 25% to 50% of former Temporary Assistance to Needy Families (TANF) recipients and approximately 15% to 30% of their children become uninsured after the expiration of the one-year transitional Medicaid coverage they receive when leaving welfare. Using data from 90 face-to-face interviews, this paper explores the expectations, plans, and coping strategies of TANF leavers in Oregon who are in the middle of this year of transitional coverage. The paper examines (1) the information available to these individuals, (2) their planning and expectations about securing health insurance, and (3) their perceptions of opportunities for obtaining jobs that provide insurance. The paper shows that while TANF leavers often assume their Medicaid coverage will continue after the transitional year, many lack complete information about this. Many respondents have no active plans for securing health insurance. Even those who do have sufficient information to plan for the end of the transitional year may find themselves having to make stark choices (e.g., sacrificing income in order to keep coverage). Policy recommendations are presented.