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California’s unprecedented reduction on welfare caseload has potentially serious consequences for health-insurance coverage. Although all welfare recipients are automatically covered by Medi-Cal (the state version of Medicaid), only some former recipients are eligible. This research examines health insurance coverage among families who have left welfare, using data on approximately 3,000 current and former welfare recipients from the California Health and Social Services Survey. The authors found that a substantial proportion of people in former welfare families are uninsured — 30 percent of female family caretakers; 23 percent of children; and 43 percent of partners and spouses of female caretakers. Hispanics are most likely to be uninsured. Many of these uninsured individuals many be eligible for, but not participating in, Medi-Cal or Healthy Families, California’s State Children’s Health Insurance Program. Medi-Cal coverage declines as time away from welfare increases. However, this trend is countered by changes in employee-sponsored insurance coverage, which is higher among those off welfare longer. Of former welfare recipients who had some form of employment in the month prior to being interviewed, slightly more than half were offered insurance. Complementary strategies to improve the likelihood that such insurance is offered would improve health insurance outcomes.

Originally published in: Medi-Cal Policy Institute, Oakland, Calif., 2002, pp. 1-31.

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