State welfare reform policies and maternal and child health services: a national study.
OBJECTIVE
Welfare reform (Personal Responsibility and Work Opportunity Reconciliation Act of 1996) resulted in dramatic policy changes, including health-related requirements and the administrative separation of cash assistance from Medicaid. We were interested in determining if changes in welfare and health policies had had an impact on state MCH services and programs.


METHODS
We conducted a survey in fall 1999 of state MCH Title V directors. Trained interviewers administered the telephone survey over a 3-month period. MCH directors from all 50 states, Washington, DC, and Puerto Rico participated (n = 52; response rate = 100%).


RESULTS
Among the most noteworthy findings is that similar proportions of respondents reported that welfare policy changes had either helped (46%) or hindered (42%) the agency's work, with most of the positive impact attributed to increased funding. MCH data linkages with welfare and other social programs were low. Despite welfare reform's emphasis on work, limited services and exemptions were available for mothers with CSHCN. Almost no efforts have been undertaken to specifically address the needs of substance abusers in the context of new welfare policies.


CONCLUSIONS
Few MCH agencies have developed programs to address the special needs of women receiving TANF who either have health problems themselves or have children with health problems. Recommendations including increased MCH and family planning funding and improved coordination between TANF and MCH to facilitate linkages and services are put forth in light of reauthorization of PRWORA.
Romero
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D
Center for Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York 10032, USA. drr6@columbia.edu
Chavkin
W
W
Wise
P H
PH
Hess
C A
CA
VanLandeghem
K
K
D000293:Adolescent; D016497:Adolescent Health Services / Q000191:economics; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D018166:Health Care Reform / Q000191:economics* / Q000331:legislation & jurisprudence*; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007223:Infant; D007229:Infant Welfare / Q000191:economics* / Q000331:legislation & jurisprudence*; D007231:Infant, Newborn; D007407:Interviews as Topic; D008429:Maternal Welfare / Q000191:economics* / Q000331:legislation & jurisprudence*; D012946:Social Welfare / Q000191:economics* / Q000331:legislation & jurisprudence*; D014481:United States; D016387:Women's Health