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National Perspective | HEALTH CARE

For Some, Welfare Reform Leaves Safety Net Tenuous


WASHINGTON — Seven months pregnant, jobless and uninsured, Nicole Prado went to a government office in Billings, Mont., hoping to get federal and state health benefits. Instead, "the caseworker told me there was a six-month waiting list and she said: 'Why sign up if you have to wait six months?' "

Prado was one of a dozen or so people in Montana who were part of a test of barriers to poor people who seek federally subsidized services--health insurance, food stamps and child care--to which they are entitled.

The National Campaign for Jobs and Income Support, which ran the test, reported in a study released Friday that many of the poor encountered what Prado did: a culture of discouragement in benefits offices.

That finding puts a human face on trends that poverty researchers have been struggling to bring to public attention. That their reports have received little notice signifies what they regard as a lack of willingness by states and the federal government, even in a time of economic plenty, to focus on a core principle of welfare reform: that to be productive workers, the poor need help with such costly services as health care and child care.

"When the governors and Congress struck the grand bargain of welfare reform, the governors said, 'Give us the money and we'll make sure people get the support they need,' " said Deepak Bhargava, executive director of the National Campaign for Jobs and Income Support. "They've broken that promise, and some states seem to be violating federal protections."

The organization is a coalition of grass-roots groups in 38 states. The study was conducted in Oregon, Washington, Montana, Idaho, South Carolina and Arkansas.

The 1996 welfare law, according to Bhargava and other advocates of the poor, not only ended automatic cash payments to impoverished families with children but also started a far more general unraveling of the safety net for low-income Americans.

Although most former welfare recipients remain eligible for other support programs, in many states they are not being told of their eligibility, are being knocked off the rolls arbitrarily or are being discouraged when they do apply.

Prado, for example, was wrongly denied Medicaid benefits. Despite what she was told, there is no waiting list for the program. Anyone who is poor enough to qualify is immediately eligible.

The National Governors' Assn. said that ending welfare turned out to be a far more complex task than was understood at the time and that many states were trying hard to get people back on Medicaid rolls. Medicaid, the health insurance program for the poor and disabled, is jointly funded by the federal government and the states.

Federal officials said that many states now are taking the initiative to find people who are eligible for poverty programs. In 1998, many states put in place the State Children's Health Insurance Program, which provides federal and state dollars for health care for children of the working poor.

The outreach efforts for that program, which has enrolled 2 million children, has had a spillover effect, bringing in poor families who are ultimately enrolled in other programs, said Cindy Mann, director of Medicaid's Family and Children's Health Programs Group.

When welfare reform began, Mann said, caseworkers and their clients did not get the message that "when they couldn't apply for cash assistance, there was still health insurance for them." As a result, roughly 1 million adults and 1.2 million children dropped from the Medicaid rolls from 1995 to 1998, according to researchers at the nonpartisan Urban Institute. In California, the rolls dropped by about 250,000 from 1995 to 1998.

As of the end of 1999, most states had shown little interest in remedying these problems. They had used just 23% of the $500 million Congress set aside to help them redesign computer systems, retrain caseworkers and reach out to eligible residents.

California has spent just 8% of the funds available to it. In Montana, where Prado lives, the state has spent just 1% of the available funds. For Prado, the result of not having health insurance is $3,600 in medical bills for baby delivery and postpartum care. Working for $6 an hour at a job in a rubber factory, she feels as if she may never catch up.

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