PEDIATRICS Vol. 106 No. 6 December 2000, p. e83

ELECTRONIC ARTICLE:
Welfare Reform Consequences for Children: The Wisconsin Experience

Received Apr 10, 1999; accepted Jun 27, 2000.

From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.

Background.  The Temporary Assistance to Needy Families, enacted under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, is a reality for many working families. As public policies are enacted, unintended consequences for infants/children must be minimized. Child advocates in Wisconsin, leading this nation in reforming Aid to Families with Dependent Children (AFDC), are concerned about supporting eligible infants/children as safety-net programs are unlinked.

Objective.  This study reviews the enrollment status of 4 linked programs over time in Wisconsin, from January 1995 to August 1998. Eligible infants/children in programs, such as Medicaid/AFDC, Medicaid/Healthy Start, and Food Stamps, were analyzed and compared with enrollment in Special Supplemental Nutrition Program for Women, Infants/children (WIC), a nonlinked program.

Design.  A cross-sectional analysis of monthly enrollment for infants/children was subdivided into 3 periods: prewelfare reform or AFDC (January 1, 1995 to December 31, 1995), the welfare reform pilot or Pay For Performance (January 1, 1996 to August 31, 1997), and welfare reform better known as Wisconsin Works (W-2), (September 1, 1998 to August 31, 1998), periods 1, 2, and 3, respectively.

Participants.  Infants/children in Wisconsin from birth to 18 years of age enrolled in W-2 and/or other safety-net programs were monitored: AFDC or W-2, WIC, Food Stamps, Medicaid/AFDC, and Medicaid/Healthy Start.

Results.  The average number of infants/children removed from AFDC and Medicaid/AFDC during periods l and 2 were 1210 increasing to 3128 per month, respectively, almost tripling the rates of decline during the pilot period (see Fig 2). By the end of this study, >100 000 (111 198) infants/children were removed from AFDC/W-2 enrollment and 51 559 fewer infants/children benefited from Medicaid. This rate of decline slowed during period 3, averaging 687 per month, while W-2 enrollment continued to decline significantly at a rate of 2692 per month. In contrast, Medicaid/Healthy Start enrollment, targeted to infants/children <6 years of age, increased significantly over all periods by +332, +1327, and +266, respectively. Food Stamps enrollment also declined throughout all 3 consecutive periods, 603, 2462, and 1450, respectively. However, enrollment in the WIC program did not decline significantly to the same degree as other certification-linked programs with AFDC or W-2, as indicated by the consecutive slopes of 60, 111, and 183, respectively.

HEIGHT= SRC="/content/vol106/issue6/images/small/pe1204586002.gif"> View larger version (K): [in this window] [in a new window]   Fig. 2.   The following periods represent changes in public policies and the enrollment of Wisconsin children is compared for: Period 1, which indicates Aid to Families with Dependent Children; Period 2, which indicates a welfare reform pilot period known as Pay for Performance; and Period 3, which indicates the initiation of Temporary Assistance to Needy Families or Wisconsin Works. Monthly and quarterly enrollment data of children under the age of 18 were analyzed using linear regression analysis for Medicaid/AFDC, Medicaid/Healthy Start, Food Stamps, AFDC/W-2, and WIC. Slopes of lines for each safety net program indicate the average increase or decline in enrollment per month during each consecutive period.

Conclusion.  Wisconsin infants/children were rapidly removed from welfare rolls in unprecedented numbers during the periods January 1995 and August 1998. Comparisons of periods before W-2 implementation and 1 year after implementation support the fact that certification-linked programs, such as Medicaid and Food Stamps, were sufficiently aligned to AFDC/W-2 to significantly impact infants/children enrollment. Historically, WIC certification in Wisconsin has not been linked to AFDC, and infants/children traditionally eligible for Medicaid and Food Stamps are also eligible for WIC. Yet, contrary to the AFDC-linked safety-net programs, declines in WIC enrollment were not statistically significant during all study periods. Statewide and local interventions within Wisconsin, such as outreach activities, targeted to Medicaid/Healthy Start and more recently Title XXI (State Children Health Insurance Program), slowed the reductions of Medicaid enrollment for Wisconsin infants/children. These findings support that altering safety-net programs can result in unintended consequences if not carefully transitioned as demonstrated in Wisconsin welfare reform.  Key words:  welfare reform, Medicaid, Wisconsin, children, working families.

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