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Stigma and other determinants of participation in TANF and Medicaid

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Author Info

  • Jennifer Stuber

    (Division of Health and Science Policy, The New York Academy of Medicine)

  • Karl Kronebusch

    (Division of Health Policy and Administration, Yale University)

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    Abstract

    We developed a conceptual framework to examine the association between stigma, enrollment barriers (e.g., difficult application), knowledge, state policy, and participation in the Temporary Assistance to Needy Families (TANF) and adult Medicaid programs. Survey data from 901 community health center patients, who were potential and actual participants in these programs, indicated that while images of the Medicaid program and its recipients were generally positive, stigma associated with welfare stereotypes reduced both TANF and Medicaid enrollment. Expectations of poor treatment when applying for Medicaid, enrollment barriers, and misinformation about program rules were also associated with reduced Medicaid enrollment. States that enacted strict welfare reform policies were potentially decreasing TANF participation, while states with more simplified and generous programs were potentially increasing Medicaid participation. The results suggest that the image of the adult Medicaid program remains tied to perceptions about welfare and provides guidance to policymakers about how to improve participation rates. © 2004 by the Association for Public Policy Analysis and Management.

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    File URL: http://hdl.handle.net/10.1002/pam.20024
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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Journal of Policy Analysis and Management.

    Volume (Year): 23 (2004)
    Issue (Month): 3 ()
    Pages: 509-530

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    Handle: RePEc:wly:jpamgt:v:23:y:2004:i:3:p:509-530

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    Web page: http://www3.interscience.wiley.com/journal/34787/home

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    1. Barr, Nicholas A & Hall, Robert E, 1981. "The Probability of Dependence on Public Assistance," Economica, London School of Economics and Political Science, vol. 48(190), pages 109-23, May.
    2. Moffitt, Robert, 1983. "An Economic Model of Welfare Stigma," American Economic Review, American Economic Association, vol. 73(5), pages 1023-35, December.
    3. Rebecca M. Blank, 1989. "The Effect of Medical Need and Medicaid on AFDC Participation," Journal of Human Resources, University of Wisconsin Press, vol. 24(1), pages 54-87.
    4. Nichols, Albert L & Zeckhauser, Richard J, 1982. "Targeting Transfers through Restrictions on Recipients," American Economic Review, American Economic Association, vol. 72(2), pages 372-77, May.
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    Cited by:
    1. Wu, Chi-Fang & Eamon, Mary Keegan, 2010. "Need for and barriers to accessing public benefits among low-income families with children," Children and Youth Services Review, Elsevier, vol. 32(1), pages 58-66, January.
    2. Hauge, Janice A. & Jamison, Mark A. & Todd Jewell, R., 2008. "Discounting telephone service: An examination of participation in the Lifeline Assistance Program using panel data," Information Economics and Policy, Elsevier, vol. 20(2), pages 135-149, June.
    3. Gundersen, Craig & Jolliffe, Dean & Tiehen, Laura, 2009. "The challenge of program evaluation: When increasing program participation decreases the relative well-being of participants," Food Policy, Elsevier, vol. 34(4), pages 367-376, August.
    4. Ewoudou, Jacques & Tsimpo, Clarence & Wodon, Quentin, 2009. "Stigma and the take-up of social programs," Policy Research Working Paper Series 4962, The World Bank.

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