While 26% of former California welfare recipients are obtaining health insurance coverage through employer-sponsored plans, more than one in four of them and more than one in five of their children still have no health insurance, according to Beyond Medi-Cal: Health Insurance Coverage Among Former Welfare Recipients, a study commissioned by the California HealthCare Foundation (CHCF). The study results come from analysis of survey data of some 3,000 current and former welfare recipients in six California counties: Alameda, Butte, Fresno, Los Angeles, Sacramento, and San Diego. These counties are home to about half of the state's welfare recipients.

The study is the first-ever analysis of the role private health insurance plays in providing health care coverage to former California welfare recipients. It reveals that as time away from welfare increases, so does the proportion of individuals who are covered by private insurance. Conversely, coverage by Medi-Cal, California's version of Medicaid, declines with increased time away from welfare.

"We asked RAND to conduct this study so policymakers and business leaders could better understand the role employer-sponsored plans play in the health care coverage of former welfare recipients, as well as to discover what factors influence whether they are covered by private health insurance," said Chris Perrone, acting director of CHCF's Medi-Cal Policy Institute.

According to the study, conducted by RAND researchers Carole Roan Gresenz and Jacob Alex Klerman, 72% of former welfare recipients had some form of employment in the 30 days prior to the survey. Among those who worked, slightly more than half were offered insurance. Approximately two-thirds of those offered insurance accepted the offer.

"For a variety of reasons, not everyone offered employer-sponsored insurance accepts," said lead researcher Gresenz. "Some individuals have Medi-Cal coverage, others find the employer-sponsored plans too expensive."

Altogether, 26% of former welfare recipients in California report being covered by an employer-sponsored health insurance plan, and another 41% retain Medi-Cal as their primary source of coverage. However, 30 percent of former welfare recipients have no health insurance, results show.

"Health insurance is also an important factor in determining where individuals obtain care," said Perrone. "Coverage has significant implications for access to health care services. We found that those who are uninsured are 50% more likely than those covered by Medi-Cal to receive care in a hospital emergency room, outpatient department or clinic, rather than a private doctor's office. As budget-strapped counties struggle to pay for indigent care, these findings emphasize the importance of state and local efforts to improve Medi-Cal retention among those without the option of employer-sponsored coverage."

Other key findings include:

• 23% of children in families who left welfare were covered by an employer-sponsored health plan as their primary source of health insurance.
• Former welfare recipients who are working full-time are more than 1.5 times as likely to be offered health insurance from their employer than those only working 20 to 35 hours per week. (Full-time workers are also twice as likely to participate in employer-sponsored plans when offered.)
• Former recipients with 12 or more months distance from welfare are twice as likely to have employer sponsored insurance coverage compared to those who have been off welfare less than 6 months.
• Employer-sponsored coverage among former welfare recipients varies by race: Among those who have been off welfare for more than one year, whites have the highest rate of employer-sponsored insurance (47%), compared to 18% among African Americans, 28% among Hispanics, and 36% among other minorities. Medi-Cal coverage:
• 50% of children in families who leave welfare retain Medi-Cal as their primary source of coverage.
• Within six months of leaving welfare, 55% of former welfare recipients are covered by Medi-Cal, compared to 39% of those with 12 or more months off welfare.
• Medi-Cal coverage also varies by race: Among those who have been off welfare for 12 or more months, 33% of Hispanics, 45% of African Americans, 26% of whites, and 48% of other minorities retain Medi-Cal as their primary source of coverage. Uninsured:
• 23% of children in families who leave welfare are without health insurance.
• Because they are more likely to be covered by employer-sponsored health insurance, welfare recipients 12 or more months off welfare are less likely to be uninsured compared to those less than one year off welfare.
• The percentage of former welfare recipients who lack health insurance coverage varies by race: Among those 12 or more months off welfare, Hispanics are most likely to be uninsured (38%), compared to 20% of African Americans, and 25% of whites. "Medi-Cal isn't the only health insurance option for former welfare recipients -- but many of those who still need this option may not be taking advantage of it," said Gresenz. "The study results suggest that over 90% of former welfare recipients who are uninsured may be eligible for Healthy Families or Medi-Cal."

  According to the report, published this week, the welfare caseload in California peaked at 2.7 million in 1995. As of September 2001, fewer than 1.2 million Californians were receiving welfare.

  The study uses data from the California Household and Social Services Survey (CHSSS), which was conducted between August 2000 and March 2001 as part of RAND's Statewide CalWORKs Evaluation. Most respondents were female caretakers living in one- or two-parent households.

  Beyond Medi-Cal: Health Insurance Coverage Among Former Welfare Recipients is available for download through the link below.