Asthma, children and welfare reform

1
Asthma, children and welfare reform

• March 13, 2003
• Deborah Schlick and Rahel Tekle, Ramsey County
  Human Services

2
Welfare reform and serious health problems

• Of 8,000 families on MFIP in Ramsey County, at
  least 2200 have a severely disabled family member
• One national study found that 41 of working
  mothers who had been on welfare had at least one
  child with a chronic health condition
• J. Heymann et al, Work Family Issues and Low
  Income Families, Summer 2002

3

• Some national studies indicate that asthma rates
  are higher in children on welfare than in the
  general population

4

• 20-25 of families on welfare include a someone
  with a disability
• About 45 of all these disabilities are
  respiratory diseases, in particular asthma
• Expensive Children in Poor Families, Meyers, et.
  Al, Public Policy Institute of California
  Lukemeyer et al, 2000.

5

• 14 of working mothers who had received welfare
  for more than 2 years had a child with asthma
• vs. 7 of mothers who had never been on welfare
• Jody Heyman et al, Work Family Issues and Low
  Income Families, 2002

6

• Of the 187 children living at home in a study of
  very low income working families in 3 cities
• 23 have diagnosed asthma
• Keeping Jobs and Raising Families in Low Income
  America, Across the Boundaries Project, Radcliffe
  Public Policy Center and 9 to 5, 2002

7
How welfare reform impacts asthma in children

• Parents leaving welfare are likely to be in low
  paying jobs without benefits, like health
  insurance or sick leave
• Parents on welfare tend to use informal and
  changing child care arrangements

8

• Mothers who had been on welfare were
• more likely to be caring for at least 1 child
  with a chronic condition (37 vs. 21)
• yet were less likely to have sick leave (36 vs.
  20)
• SJ Heyman, American Journal of Public Health,
  v.89,49

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How asthma in children can impact welfare reform

• Parents with children with asthma are more likely
  to miss work and therefore lose jobs
• Parents are more likely to have difficulty
  finding child care they can be comfortable with

10

• Some basic information about children on MFIP in
  Ramsey County

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Ages of children Receiving Cash Assistance in
Ramsey County as of October, 2002 n22041
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Children Receiving Cash Assistance in Ramsey
County by Race as of October 2002
n22041
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Where in Ramsey County do Children on MFIP Live?
As of October 2002 n 22138
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Three groups of families on MFIP

• Families who use welfare for a short period of
  time (3 years or less) and move, usually into low
  wage jobs
• Families who reach time limits (set at five years
  by federal and state policy)
• Families where only the child is on MFIP, because
  the parent is disabled or no longer has custody

15
Percent of Children, 0 - 47 MFIP Months Used as
of October, 2002 in Ramsey County by Race
n17,124
16

• What we have learned about families who reach the
  time limits on welfare

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• Parents who stay on welfare a long time are very
  likely to have multiple and complex challenges --
  including mental illness, active domestic
  violence, learning impairments, and major health
  problems

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Reasons people can stay on MFIP longer than 5
years

• Significant illness -- for the parent or a family
  member
• Hard to employ diagnosis -- low IQ, learning
  disabilities, domestic violence, serious mental
  illness
• Working 25-30 hours a week but not earning enough
  to get off

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• Of the 900 Ramsey County families who reached
  time limits by December 2002,
• 778 received extensions

20
Reasons MFIP has been extended for parents as of
December 2002
21
More than 5000 children are in families reaching
or nearing time limits in Ramsey County
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• For almost 2000 families only the children are on
  MFIP
• in more than 1300 of these families the parent is
  disabled

23
Ramsey MFIP Children in MA HMOs as of Fall,
2002
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The implications of this information

• Welfare reform cannot succeed if it does not
  address realities often not tied to training and
  work experience such as whether a childs
  chronic health problem needs to be addressed if
  her mother can sustain employment

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The implications of this information

• To reach some of the children most at risk for
  poor asthma outcomes the health care system is
  going to have engage in non-medical strategies to
  improve childrens health