Welfare Reform: Former TANF Recipients with Impairments Less	 
Likely to Be Employed and More Likely to Receive Federal Supports
(06-DEC-02, GAO-03-210).					 
                                                                 
Debates surrounding the reauthorization of welfare reform	 
legislation have involved some discussion regarding outcomes for 
TANF recipients with physical or mental impairments. To inform	 
this discussion, GAO was asked to report on (1) whether 	 
recipients with impairments were as likely to exit TANF as their 
counterparts without impairments and (2) the sources of income	 
reported by leavers with and without impairments. To obtain this 
information, GAO analyzed self- reported data for the most recent
years available from the Census Bureau's Survey of Income and	 
Program Participation (SIPP)--a national survey of households	 
that includes questions about TANF status and functional	 
impairments.							 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-03-210 					        
    ACCNO:   A05648						        
  TITLE:     Welfare Reform: Former TANF Recipients with Impairments  
Less Likely to Be Employed and More Likely to Receive Federal	 
Supports							 
     DATE:   12/06/2002 
  SUBJECT:   Block grants					 
	     Comparative analysis				 
	     Persons with disabilities				 
	     Program graduation 				 
	     Welfare benefits					 
	     Welfare recipients 				 
	     Aid to Families with Dependent Children		 
	     Program						 
                                                                 
	     Census Bureau Survey of Income and 		 
	     Program Participation				 
                                                                 
	     Disability Insurance Program			 
	     HHS Temporary Assistance for Needy 		 
	     Families Block Grant				 
                                                                 
	     Supplemental Security Income Program		 

******************************************************************
** This file contains an ASCII representation of the text of a  **
** GAO Product.                                                 **
**                                                              **
** No attempt has been made to display graphic images, although **
** figure captions are reproduced.  Tables are included, but    **
** may not resemble those in the printed version.               **
**                                                              **
** Please see the PDF (Portable Document Format) file, when     **
** available, for a complete electronic file of the printed     **
** document's contents.                                         **
**                                                              **
******************************************************************
GAO-03-210

Report to Congressional Requesters

United States General Accounting Office

GAO

December 2002 WELFARE REFORM Former TANF Recipients with Impairments Less
Likely to Be Employed and More Likely to Receive Federal Supports

GAO- 03- 210

Recipients of Temporary Assistance for Needy Families (TANF) who had
impairments were found to be half as likely to exit TANF as recipients
without impairments, and recipients caring for children with impairments
were found to be less than half as likely to exit TANF as recipients not
caring for children with impairments, after controlling for demographic
differences such as age, race, and marital status. Although impairments
affect exits, other factors, including family support and personal
motivation, as well as local TANF policies, may also affect whether
recipients exit TANF.

After leaving TANF, people with impairments were one- third as likely as
people without impairments to be employed, according to a statistical
model that controlled for demographic differences, and they were more
likely to receive federal supports. Forty percent of leavers with
impairments

receiving cash assistance from Supplemental Security Income (SSI), a
federal program designed to assist low- income individuals who are aged,
blind, or disabled. Leavers with impairments were also more likely to
receive non cash support in the form of Food Stamps and Medicaid than
their counterparts without impairments.

These findings underscore the challenge states face in ensuring that
recipients with impairments and those caring for children with impairments
receive the supports they need to meet the work- focused goals and
requirements of TANF.

Employment and Receipt of SSI among Leavers with and without Impairments,
July 1997 through July 1999

82% Employed (no SSI)

18%

Not employed (no SSI) Not employed (no SSI)



Employed (no SSI)

6%

Both employed and receiving SSI a

Receiving SSI (not employed)



Leavers with impairments Leavers without impairments

27%  33% 34% 73%

Source: GAO's analysis of SIPP data on disability.

a Employment and receipt of SSI are not necessarily concurrent. WELFARE
REFORM

Former TANF Recipients with Impairments Less Likely to Be Employed and
More Likely to Receive Federal Supports

www. gao. gov/ cgi- bin/ getrpt? GAO- 03- 210. To view the full report,
including the scope and methodology, click on the link above. For more
information, contact Cynthia M. Fagnoni at (202) 512- 7215 or fagnonic@
gao. gov. Highlights of GAO- 03- 210, a report to the

Ranking Minority Member, Subcommittee on Human Resources, Committee on
Ways and Means, House of Representatives and another representative

December 2002

Debates surrounding the reauthorization of welfare reform legislation have
involved some discussion regarding outcomes for TANF recipients with
physical or mental impairments. To inform this discussion, GAO was asked
to report on (1) whether recipients with impairments were as likely to
exit TANF as their counterparts without impairments and (2) the sources of
income reported by leavers with and without impairments. To obtain this
information, GAO analyzed selfreported reported data for the most recent
years available from the Census Bureau*s Survey of Income and Program
Participation (SIPP) *- a national survey of households that includes
questions about TANF status and functional impairments.

Page i GAO- 03- 210 Welfare Reform Letter 1

Results in Brief 2 Background 3 Impairments Were Relatively Common Among
TANF Recipients 8 Recipients with Impairments Were Less Likely to Exit
TANF Than

Recipients without Impairments 10 After Leaving TANF, People with
Impairments Were Less Likely to

Be Employed and Were More Likely to Receive Federal Supports Than Were
People without Impairments 14 Concluding Observations 19 Agency Comments
20

Appendix I Scope and Methodology 22 Data Source: Census Bureau*s SIPP Data
22 Logistic Regression Analyses 23

Appendix II Comments from the Department of Health and Human Services 28

Appendix III GAO Contacts and Staff Acknowledgments 30 GAO Contacts 30
Staff Acknowledgments 30

Bibliography 31

Related GAO Products 32

Tables

Table 1: Results of Logistic Regression Model of TANF Exits 25 Table 2:
Results of Logistic Regression Model of Post- TANF

Employment 26 Contents

Page ii GAO- 03- 210 Welfare Reform Figures

Figure 1: Prevalence of Impairments among TANF Recipients and Non- TANF
Population, July 1997 through July 1999 9 Figure 2: Demographic
Differences between Adult TANF

Recipients with and without Impairments 10 Figure 3: Employment and
Receipt of SSI among Leavers with and

without Impairments, July 1997 through July 1999 16 Figure 4: Proportion
of Leavers with and without Impairments

Reporting Receipt of Income from Personal Earnings, Household Earnings, or
SSI in First Month after Leaving TANF 18 Figure 5: Proportion of Leavers
Receiving Food Stamps and

Medicaid, July 1997 through July 1999 19

Abbreviations

ADA Americans with Disabilities Act of 1990 AFDC Aid to Families with
Dependent Children DI Disability Insurance HHS Department of Health and
Human Services MDRC Manpower Demonstration Research Corporation MOE
maintenance of effort PRWORA Personal Responsibility and Work Opportunity

Reconciliation Act of 1996 SIPP Survey of Income and Program Participation
SSA Social Security Administration SSI Supplemental Security Income TANF
Temporary Assistance for Needy Families

Page 1 GAO- 03- 210 Welfare Reform

December 6, 2002 The Honorable Benjamin L. Cardin Ranking Minority Member
Subcommittee on Human Resources Committee on Ways and Means House of
Representatives

The Honorable Pete Stark House of Representatives

With the enactment of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (PRWORA), the Congress made sweeping changes to
federal welfare policy for needy families. PRWORA created the Temporary
Assistance for Needy Families (TANF) block grant to states, which
emphasizes work and responsibility over dependence on government benefits.
Under TANF, states are to impose work requirements on most adults
receiving TANF cash assistance and place a lifetime limit of 60 months on
the receipt of federal cash assistance. Some policymakers have expressed
concerns about the ability of TANF recipients with physical or mental
impairments to comply with program requirements, which has contributed to
a heightened interest in what happens to people with impairments after
they exit TANF. Although the TANF block grant program was due to expire on
September 30, 2002, the Congress provided for an extension of the program
until January 11, 2003. By that time, the Congress must either reauthorize
the program or provide for an additional extension. As of September 30,
2002, the House of Representatives had passed reauthorization legislation
and the Senate Committee on Finance had passed a reauthorization bill,
although the full Senate had not yet voted on this bill.

To provide you with information on how people with impairments are faring
in the current welfare environment and what issues may need attention as
welfare reform evolves, you asked us to determine (1) how prevalent
impairments are among TANF recipients; (2) whether recipients with
impairments are as likely to exit TANF as recipients without impairments;
and (3) what sources of income people with impairments have after leaving
TANF, compared with people without impairments.

To address all three questions, we analyzed self- reported data for the
most recent years available from the Census Bureau*s Survey of Income and

United States General Accounting Office Washington, DC 20548

Page 2 GAO- 03- 210 Welfare Reform

Program Participation (SIPP)* a survey of households nationwide that asks
respondents questions about their TANF status and functional impairments
and uses categories of impairments comparable to those covered by the
Americans with Disabilities Act of 1990 (ADA). 1 Because these data are
self- reported, they may not accurately reflect the size of the population
with impairments. We used a cross section of responses given between July
1997 and July 1999 and relied on a definition of impairments developed by
Census that includes both severe and nonsevere physical and mental
impairments. Our analyses included both descriptive statistics and
multivariate analyses. We used appropriate techniques to weight the data
to make population estimates. The sampling error for these estimates
varied but did not exceed plus or minus 8 percentage points. For more
information, see appendix I. We also reviewed findings of other studies to
supplement the SIPP data. We conducted our work from March to October 2002
in accordance with generally accepted government auditing standards.

Impairments were relatively common among TANF recipients, with 44 percent
reporting having at least one impairment, caring for a child with at least
one impairment, or both, compared with only 15 percent of the non- TANF
population. The term impairments encompasses both mental and physical
conditions. For instance, impairments could be physical conditions that
hinder movement or require a cane or other mobility device, cognitive
impairments, or mental conditions such as chronic depression. Adult
recipients who had impairments were more likely to be over age 35 and
white than adult recipients without impairments.

Recipients with impairments were less likely to exit TANF than recipients
without impairments. Specifically, controlling for certain demographic
characteristics, such as age, race, and marital status, adult recipients
with impairments were half as likely to exit TANF as were adult recipients
without impairments. Likewise, recipients caring for children with
impairments were less than half as likely to exit TANF as all other
recipients. Although impairments affect exits, other factors, such as
family support, personal motivation, and local TANF policies, may also
affect whether recipients exit TANF. For example, in a previous study, we
found

1 The ADA defines persons with disabilities as those who have a physical
or mental impairment that substantially limits one or more major life
activities, such as walking, hearing, etc.; those who have a record of
such impairment; or those who are regarded as having such an impairment.
Results in Brief

Page 3 GAO- 03- 210 Welfare Reform

that local TANF agencies sometimes exempted recipients with impairments
from requirements to participate in work or work- related activities.
While in some cases this may be appropriate because of the level of
severity of an impairment, in other cases it may mean that recipients may
not get the encouragement or opportunity to acquire work skills that could
help them exit TANF.

After leaving TANF, people with impairments were less likely to be
employed and more likely to receive federal supports than were people
without impairments. Controlling for demographic characteristics and other
factors, we found that leavers with impairments were one- third as likely
to be employed as leavers without impairments. Although they were less
likely to be employed, many leavers with impairments (40 percent) received
income support from Supplemental Security Income (SSI), a federal program
providing cash assistance to low- income individuals who are aged, blind,
or disabled. Among those who did have earnings from employment or other
sources, the amount of these earnings was similar for leavers with and
without impairments and averaged around $1,000 per month. Leavers with
impairments were more likely than leavers without impairments to report
having no income* from personal earnings, household earnings, or SSI
benefits* in their first month after exiting TANF. Specifically, 36
percent of leavers with impairments reported having no income from these
sources compared with 23 percent of leavers without impairments. However,
leavers with impairments also were more likely to receive non- cash
supports from Food Stamps (77 percent versus 62 percent) and Medicaid (89
percent versus 71 percent) than their counterparts without impairments.

In commenting on a draft of this report, the Department of Health and
Human Services (HHS) noted our analysis, while possibly the best available
approach, does not provide information on the extent to which outcomes
differ for recipients with different types or severity of impairments, nor
does it provide information on how local employment services may affect
these outcomes. We acknowledge that while our analysis provides important
descriptive information on outcomes for TANF recipients with impairments
as a whole, much remains unknown about how best to help people with
different types of impairments to become self- sufficient.

PRWORA built upon and expanded state- level welfare reforms to transform
federal welfare policy for needy families with children. PRWORA replaced
the individual entitlement to benefits under the Background

Page 4 GAO- 03- 210 Welfare Reform

61- year- old Aid to Families with Dependent Children (AFDC) program with
the TANF block grant, which provides family assistance grants to the
states, and emphasizes the transitional nature of assistance and the
importance of reducing welfare dependence through employment, among other
goals. HHS administers the TANF block grant program, which provided grants
to states totaling up to $16.5 billion each year through September 2002.
To receive its grant, each state must also spend at least a specified
amount of its own funds, referred to as state maintenance of effort (MOE)
funds.

While states have had flexibility to design programs that meet their own
goals and needs, they also have been required to implement federal work
requirements and time limits designed to promote employment among those
able to work. First, TANF established stronger work requirements for those
receiving aid than did the AFDC program. Specifically, to avoid financial
penalties, states had to meet federal participation rate requirements,
under which states were to ensure that an increasing percentage of adult
recipients were participating in federally defined activities each year
through fiscal year 2002. Second, states have been required to reduce the
cash assistance benefit of an adult who did not participate as required by
the state, referred to as a sanction, and could opt to terminate cash aid
for the entire family. Third, states also have had to enforce a 60- month
limit (or less at state option) on the length of time a family may receive
federal TANF assistance.

However, the law also provided states considerable flexibility in how they
implemented work requirements and time limits, and some states and
localities have used this flexibility to exempt recipients with
disabilities from these requirements. For example, in our 2002 report on
states* implementation of work requirements and time limits, 2 we noted
that states have generally faced greatly reduced federal participation
rate requirements. This resulted from the law*s *caseload reduction
credit* which adjusted downward the federally required rate if a state*s
caseload declined, which is exactly what occurred in most states* dramatic
caseload declines from 1996 through at least mid- 2001. In fiscal year
2000, these caseload reduction credits reduced required rates from 40
percent

2 U. S. General Accounting Office, Welfare Reform: With TANF Flexibility,
States Vary in How They Implement Work Requirements and Time Limits, GAO-
02- 770 (Washington D. C.: July 5, 2002). State Flexibility on TANF

Work Requirements and Time Limits

Page 5 GAO- 03- 210 Welfare Reform

(the required rate) to 0 in 31 states. These lower participation rate
requirements gave states more flexibility in exempting TANF recipients
considered hard to employ from meeting work requirements. We found that
while almost all states met or exceeded their adjusted required rate in
that year, the federal participation rates that states actually achieved
before adjustment ranged from about 6 percent to more than 70 percent.

Regarding time limits, we found that states generally excluded from time
limits families with a parent or caretaker with a disability or caring for
a family member with a disability. States could do this by using the 20-
percent federal time limit extension established in the law or by using
state maintenance of effort funds, as also allowed by the law. 3 Our work
also showed that most families had not yet reached their federal or
stateimposed cash assistance time limit as of fall 2001.

While recipients with impairments may sometimes be exempted from work
requirements and time limits, they may be at risk of having their benefits
reduced or terminated through sanctions. A study in four urban areas
conducted by the Manpower Demonstration Research Corporation (MDRC) found
that recipients with a greater number of health problems were more likely
to be sanctioned for noncompliance with program requirements than their
healthier counterparts. 4 Over 50 percent of former recipients with at
least one health problem left welfare due to sanctions compared with 39
percent of recipients without health problems. Our earlier report on
sanctions under the TANF program found that families who left welfare due
to sanctions relied on support from family and friends after TANF payments
stopped, rather than on income from employment, to a greater extent than
families who left the program for other reasons. 5

TANF often serves, as did AFDC, as a temporary stopping point for
lowincome individuals with physical or mental impairments that may be

3 A state may exempt up to 20 percent of its average monthly caseload for
hardship or having been subjected to domestic violence. 4 Denise F. Polit,
Andrew S. London, and John M. Martinez, The Health of Poor Urban Women:
Findings from the Project on Devolution and Urban Change, (New York:
Manpower Demonstration Research Corporation, 2001).

5 U. S. General Accounting Office, Welfare Reform: State Sanction Policies
and Number of Families Affected, GAO/ HEHS- 00- 44 (Washington, D. C.:
Mar. 31, 2000). The Relationship between

TANF and SSI

Page 6 GAO- 03- 210 Welfare Reform

considered severe enough to make them eligible for the federal SSI
program. SSI, administered by the Social Security Administration (SSA),
provides cash assistance to low- income individuals who are aged or who
are unable to work because of a severe long- term impairment and who do
not have sufficient work history to qualify for SSA*s Disability Insurance
(DI) program. 6 To qualify for SSI, an applicant*s impairment must be of
such severity that the person is not only unable to do the kind of work
that he or she engaged in previously, but is also unable to do any other
kind of substantial gainful activity that exists in the national economy.
7 In most states, SSI eligibility also entitles individuals to Medicaid
benefits. As distinct from TANF, SSI for adults has federally established
eligibility requirements and benefit levels and a nationwide disability
determination process. 8

Some individuals who apply for TANF may have impairments severe enough to
make them eligible to receive SSI. Even before welfare reform, states had
been actively identifying and referring potential SSI- eligible welfare
recipients to SSI. In these cases, individuals may be on TANF while they
are waiting for their SSI eligibility to be determined. 9 In recent years,
receiving an initial disability determination took an average of about 4
months from the date of SSI application. For claims that are denied and
appealed, it may take over a year to reach a final decision. Generally,
except for more temporary conditions, TANF recipients who have impairments
but are not eligible for SSI or DI may be expected to work, as their
impairments have been deemed not severe enough to preclude substantial
employment.

Title I of the ADA prohibits discrimination against such persons who have
impairments but who are nonetheless able to perform the essential

6 Cash assistance and services for persons with disabilities who have
worked long enough and recently enough are also available from the DI
program. Other programs, which may be available, include private
disability insurance or pensions and state workers* compensation programs.

7 Work activity is generally considered substantial and gainful if the
person*s earnings exceed a particular level established by statute and
regulations. 8 Some states provide supplemental payments to the federal
benefit level.

9 Federal rules for TANF and SSI do not explicitly prohibit individuals
from receiving cash assistance from both TANF and SSI simultaneously.
However, in effect, states* income eligibility rules for TANF generally
preclude individuals from doing so.

Page 7 GAO- 03- 210 Welfare Reform

functions of the job they seek or hold. 10 Under Title II of the ADA, no
qualified individual with a disability shall be excluded from
participation or be denied the benefits of the services, programs, or
activities of a public entity, or be subject to discrimination by such
entity. TANF, as a federal program, is subject to this requirement. 11

Identifying and measuring impairments or disabilities is a complex
undertaking, and no single survey instrument has been accepted or
generally agreed upon as the preferred method for identifying impairments
within a population. Census believes the extensive set of disability
questions contained in the SIPP make it a preferred source to examine most
impairment- related issues. 12 Nevertheless, SIPP data should be
interpreted with care. For instance, the SIPP relies on self- reports of
impairments and, therefore, may not accurately reflect the size of the
general or TANF population with impairments. This can result in the
overreporting or underreporting of impairments. For example, although some
impairments, such as the inability to walk, missing or impaired limbs, or
severely impaired vision, are easy to identify, many impairments are not.
Individuals may not report less obvious impairments because of certain
stigmas surrounding them or because they may not know of their existence.
Some examples of these impairments include learning disabilities,
depression, and mental illness. Other surveys use different approaches to
measure impairments. The National Household Survey of Drug Abuse and the
University of Michigan*s Women*s Employment Survey, for example, use
nonclinical in- depth diagnostic questioning to identify certain
psychiatric disorders that may be overlooked by other survey techniques.
13

10 The ADA was enacted, in part, to remove barriers to employment and
receipt of public services for people with disabilities by prohibiting
discrimination. In the area of employment, the ADA requires employers to
make reasonable accommodations to persons with disabilities (e. g., by
providing a magnified computer screen for a vision- impaired person),
unless such accommodations would impose undue hardship on employers.

11 On January 19, 2001, HHS*s Office of Civil Rights issued *Summary of
Policy Guidance Prohibition Against Discrimination on the Basis of
Disability in the Administration of TANF* to all entities involved in the
administration and operation of TANF programs.

12 The SIPP data reported do not include impairments related to substance
abuse. 13 Rukmalie Jayakody, Sheldon Danziger, and Harold Pollack,
*Welfare Reform, Substance Use, and Mental Health,* Journal of Health
Politics, Policy and Law (Aug. 2000). Identifying and Measuring

Impairments

Page 8 GAO- 03- 210 Welfare Reform

Physical and mental impairments were reported to be relatively common
among TANF recipients and, to a lesser degree, their children, compared
with their prevalence among the non- TANF population. 14 National survey
data from the SIPP show that a total of 44 percent of TANF recipients
reported in both 1997 and 1999 that they either had one or more physical
or mental impairments as defined by Census or that they were caring for a
child with such impairments. 15 Specifically, in 29 percent of the TANF
cases, only the adult recipient was reported to have impairments; in 7
percent of the cases, only the child was reported to have impairments; and
in 8 percent of the cases both the adult and child were reported to have
impairments. 16 The prevalence of impairments among TANF recipients is
greater than among the U. S. non- TANF population, among whom a total of
15 percent of individuals reported that they or their children had
impairments. (See fig. 1.) Appendix I lists the specific criteria
developed by Census that individuals must meet to be considered impaired
as applied in the SIPP. We considered individuals to be impaired if they
met the Census criteria in both 1997 and 1999.

14 *TANF recipients* are defined as those SIPP respondents who reported
receiving TANF in any month during the period of July 1997 through July
1999. 15 In an earlier study (GAO- 02- 37), we reported that SIPP data
showed that in 1999, a total of 44 percent of TANF adults aged 18 to 64
reported having one or more physical or mental impairments as defined by
Census. This figure differs from our current finding that SIPP data show a
total of 44 percent of TANF adults either had impairments themselves or
were caring for a child with impairments in both 1997 and 1999. The fact
that both numbers are *44 percent* is purely coincidental.

16 These data capture individuals who reported functional or other
activity limitations generally covered by the ADA. Impairments Were

Relatively Common Among TANF Recipients

Page 9 GAO- 03- 210 Welfare Reform

Figure 1: Prevalence of Impairments among TANF Recipients and Non- TANF
Population, July 1997 through July 1999

As shown in figure 2, SIPP data show some demographic differences between
TANF recipients aged 18 to 62 who have impairments and those who do not
have impairments. Two- thirds of adult recipients with impairments were
over 35 years old, while fewer than a quarter of adult recipients without
impairments were older than 35. Age differences between individuals with
and without impairments exist not only among TANF recipients, but among
the non- TANF population as well. Among the non- TANF population with
impairments, 81 percent were aged 36 to 62 compared with 54 percent of
those without impairments. Figure 2 also shows that TANF recipients with
and without impairments differed by race. Forty- three percent of adult
recipients with impairments were white compared with 28 percent of adult
recipients without impairments. Among the non- TANF population, roughly
equal percentages of people with and without impairments were white.
Finally, as shown in figure 2, we found that SIPP data indicated no
significant differences between recipients with and without impairments in
the percentage who were married or the

Neither adult nor child has impairments

29% 

Only adult has impairments

8%

Both adult and child have impairments

7%

Only child has impairments

 

Neither adult nor child has impairments

11% 

Only adult has impairments

1%

Both adult and child have impairments

3%

Only child has impairments 

TANF recipients Non- TANF population

85%  56% 

Source: GAO's analysis of SIPP data on disability.

Page 10 GAO- 03- 210 Welfare Reform

percentage who had no more than a high school education. Regardless of
impairment status, about one- quarter of adult recipients were married and
two- thirds to three- quarters had no more than a high school education.

Figure 2: Demographic Differences between Adult TANF Recipients with and
without Impairments

a Differences between recipients with and without impairments are
statistically significant.

Impairments, whether they affected either adults or children, were
associated with a decreased likelihood that a family would exit TANF. In
particular, adult recipients with impairments were half as likely to exit
TANF as adult recipients without impairments, after controlling for
demographic differences, such as age, race, and marital status. Recipients
caring for children with impairments were less than half as likely to exit
TANF as others, after controlling for demographic differences. Different
types of impairments or impairments of differing severity could have
different effects on TANF exits, although we were not able to measure
these effects. Furthermore, factors other than impairments may also affect
whether recipients exit TANF. Recipients with

Impairments Were Less Likely to Exit TANF Than Recipients without
Impairments

Percentage of recipients with characteristic 0 10

20 30

40 50

60 70

80 Age 36- 62 a Married White a High School

diploma or less

All recipients With impairments Without impairments 67

28 43

33 26 23 25 39

23 33

69 77

72 Source: GAO's analysis of SIPP data on disability.

Page 11 GAO- 03- 210 Welfare Reform

Using a statistical model to control for basic demographic factors
(gender, race, age, marital status, and education) and state- level
differences, 17 we found that adult recipients with impairments were half
as likely to exit TANF as recipients without impairments. That is, an
individual with an impairment who received TANF at some point between July
1997 and July 1999 was less likely than an individual without an
impairment to have exited TANF by July 1999, all else being equal. For
example, among whites, those with impairments were less likely to exit
TANF than were whites without impairments. Likewise, among nonwhites,
those with impairments were less likely to exit TANF than were nonwhites
without impairments. If demographic factors are not taken into account,
approximately equal proportions (about 3 out of 4) of recipients with and
without impairments exited TANF. 18

Among those recipients who did exit TANF, a number of them returned to the
TANF rolls at some point. SIPP data show that among individuals who
received TANF and subsequently exited TANF between July 1997 and July
1999, about 1 in 4 had returned to TANF before the end of that period.
This was true both of individuals with impairments and those without
impairments. Other studies of TANF leavers that have included various time
periods, populations, and methodologies have found similar results. 19 For
example, a recent study using data from the National Survey of America*s
Families found that 21.9 percent of families leaving welfare in 1997
returned within 2 years. They also found that almost half of those who
returned originally left welfare to work and that return rates were higher
for former recipients with little education, limited work experience, and
poor health. 20

17 A variable is included in the model to control for any differences
among states, although the model does not evaluate the specific effects of
different state policies. See appendix I for model results.

18 This helps to explain why the proportion of the caseload that had
impairments did not increase between 1997 and 1999, as we found in our
October 2001 report, even though one might expect the proportion of
recipients with impairments to increase if recipients with impairments
were less likely to exit TANF than those without impairments.

19 See U. S. General Accounting Office, Welfare Reform: Progress In
Meeting Work- Focused TANF Goals, GAO- 01- 522T (Washington, D. C.: Mar.
15, 2001). 20 Pamela Loprest. Who Returns to Welfare? Policy Brief B- 49
(Washington, D. C.: The Urban Institute, Sept. 2002). Adult Recipients
with

Impairments Were Half as Likely to Exit TANF as Adult Recipients without
Impairments

Page 12 GAO- 03- 210 Welfare Reform

After using a statistical model to control for demographic factors, we
found that recipients caring for children with impairments were less than
half as likely to exit TANF as their counterparts not caring for children
with impairments. 21 A variety of complicating factors related to their
children*s impairments may contribute to the decreased likelihood that
this population of TANF recipients will pursue and maintain employment.
For instance, parents of children with impairments may face demands on
their time related to their children*s impairments in the form of special
therapies, the administering of medications, regular medical appointments,
and hospitalizations. Furthermore, the chronic and unpredictable nature of
many impairments, such as severe asthma and seizures, may cause parents to
be absent from work frequently and with little or no advance notice to
their employers. This may be particularly problematic for TANF leavers,
many of whom enter into low- or unskilled entry- level jobs that offer
limited flexibility and benefits, such as vacation time, sick leave, and
health insurance.

Finding child care and maintaining adequate health insurance coverage can
be particularly challenging for parents caring for children with
impairments. Children with impairments may need child care providers with
the specialized training and equipment to accommodate their needs. In
earlier work, we found that child care providers for children with special
needs are sometimes in limited supply, especially in low- income
neighborhoods. 22 In addition to the difficulty in obtaining child care,
families may be less likely to leave TANF if they are concerned about
losing health care coverage. While the Congress established provisions to
ensure that adults and children would continue to be eligible for Medicaid
after leaving TANF, in our 1999 report we found some evidence to suggest
that the reforms of 1996 initially contributed to confusion on the part of
both beneficiaries and caseworkers about the criteria for maintaining
Medicaid coverage after TANF benefits have been discontinued. Increased
awareness of the need to ensure continued Medicaid enrollment for families
exiting welfare has given rise to outreach efforts designed to promote
awareness and maximize enrollment among eligible families.

21 See appendix I for model results. 22 See U. S. General Accounting
Office, Child Care: States Increased Spending on LowIncome Families, GAO-
01- 293 (Washington, D. C.: Feb. 2, 2001); and Welfare Reform: States*
Efforts to Expand Child Care Programs, GAO/ HEHS- 98- 27 (Washington, D.
C.: Jan. 13, 1998). Recipients Caring for

Children with Impairments Were Less Than Half as Likely to Exit TANF as
Others

Page 13 GAO- 03- 210 Welfare Reform

Although recipients with impairments were less likely to exit TANF than
recipients without impairments, SIPP data did not provide reliable data on
several other factors that may also affect whether recipients exit TANF.
For example, there were insufficient data to differentiate among
individuals based on the severity, type, or number of their impairments.
However, it is possible that these factors might affect whether
individuals exit TANF, as evidenced in a study of SIPP data from the early
1990*s that suggested that respondents with more severe disabilities were
less likely to exit welfare than respondents with less severe limitations.
23 Furthermore, intangible factors such as family support and personal
motivation might also lead to very different experiences with TANF for
otherwise similar individuals. In our 1997 survey of individuals receiving
Social Security Disability Insurance, encouragement from family and
friends and high self- motivation were identified to be among a range of
factors that enabled these individuals with impairments to return to work.
24

In addition, local TANF policies, which are not measured by the SIPP
questionnaire, may affect whether recipients with impairments exit TANF.
For example, local TANF policies regarding screening, assessment, and work
requirements may affect whether recipients with impairments receive
assistance that could help them move toward employment. In a national
survey of county TANF agencies conducted for our October 2001 report,
almost all the counties reported that they screened and assessed TANF
recipients for impairments, but many used methods that may not accurately
identify all impairments. 25 In some cases, this may not be a problem
because recipients may find jobs and leave welfare without special
assistance. In other cases, recipients may need assistance targeted

23 Gregory Acs and Pamela Loprest, Do Disabilities Inhibit Exits from
AFDC?

(Washington, D. C.: The Urban Institute, Aug. 1994). 24 U. S. General
Accounting Office, Social Security Disability Insurance: Multiple Factors
Affect Beneficiaries* Ability to Return to Work, GAO/ HEHS- 98- 39
(Washington, D. C.: Jan. 12, 1998).

25 U. S. General Accounting Office, Welfare Reform: More Coordinated
Federal Effort Could Help States and Localities Move TANF Recipients With
Impairments Toward Employment, GAO- 02- 37 (Washington, D. C.: Oct. 31,
2001). The terms screening and assessment are often loosely applied and
can have different meanings in various treatment and service communities.
We defined screening as *any means of gaining information about an
individual that can be used to detect warning signs that suggest that some
form of impairment might exist.* If there is an indication that an
impairment may exist, the next step is to perform an assessment. We
defined assessment as *a comprehensive examination of an individual that
is used to identify the specific impairment( s) he or she has.* Factors
Other Than

Impairments May Also Affect Whether Recipients Exit TANF

Page 14 GAO- 03- 210 Welfare Reform

to their special needs to help them take steps toward employment or to
transition to SSI.

We also found that many counties reported exempting from state work
requirements TANF recipients who had impairments or were caring for a
child with an impairment. While exemptions from work requirements may be
appropriate in some cases, in other cases it may mean recipients may not
be getting the help, direction, or encouragement they need to take steps
toward employment and increase their chances of exiting TANF. Exemptions
from work requirements could also leave them more at risk of reaching a
time limit without getting the assistance they need to find employment or
alternative means of support such as SSI. Our previous work and other
research makes clear that recipients exit TANF for a variety of reasons*
increased income, time limits, sanctions, and voluntary exits* and that
the reason that a family exits TANF could have an effect on the family*s
outcomes or circumstances. However, SIPP data did not provide reliable
data on the reasons families exited TANF. 26

TANF leavers with impairments were less likely to be employed and more
likely to receive federal supports than were leavers without impairments.
Although we found, after controlling for certain factors, that leavers
with impairments were less likely to be employed than leavers without
impairments, many of the leavers with impairments received income from
SSI. Leavers with impairments also were more likely to receive Food Stamps
and Medicaid.

26 The survey did ask respondents about their reasons for exiting TANF,
but 81 percent did not answer the question. After Leaving TANF,

People with Impairments Were Less Likely to Be Employed and Were More
Likely to Receive Federal Supports Than Were People without Impairments

Page 15 GAO- 03- 210 Welfare Reform

Leavers with impairments were one- third as likely to be employed as
leavers without impairments, after controlling for basic demographic
factors, state- level differences, and receipt of SSI. 27 In other words,
for those not receiving SSI, leavers with impairments were one- third as
likely to be employed as leavers without impairments, all else being
equal. Leavers caring for children with impairments were equally likely to
be employed as others, after controlling for demographics and other
factors.

In addition to estimating the probability of employment, we determined the
actual percentages of adults who reported being employed at some point
after leaving TANF between July 1997 and July 1999. Thirty- nine percent
of adult leavers with impairments were employed at some point after
leaving TANF, including 6 percent who also received SSI at some point
after leaving TANF. 28 (See fig. 3.) In contrast, 82 percent of leavers
without impairments reported being employed at least at some point after
leaving TANF between July 1997 and July 1999. In addition to the 6 percent
of adult leavers with impairments who reported both employment and receipt
of SSI, 34 percent reported receipt of SSI but not employment, indicating
that a number of TANF recipients had impairments severe enough to qualify
them for SSI and presumably also severe enough to limit their ability to
sustain regular employment. Figure 3 shows that the proportion of leavers
with impairments who reported either employment or SSI receipt, or both,
is about the same as the proportion of leavers without impairments who
reported employment. 29

The fact that many recipients with impairments seem to have impairments
severe enough to qualify them for SSI suggests that many recipients are
relying on TANF while awaiting determination of their eligibility for SSI.
Again, it may take over a year from the time that an individual applies
for SSI to the time that a final eligibility decision is made. During this
time, individuals on TANF may or may not be exempted from work
requirements.

27 The model analyzed employment status for the period spanning July 1997
through July 1999 and controlled for gender, race, age, marital status,
education, and receipt of SSI. A variable was included in the model to
control for any differences among states, although the model did not
evaluate the specific effects of different state policies. See appendix I
for model results.

28 Employment and receipt of SSI were not necessarily concurrent. 29 There
is no statistically significant difference between the proportions of
leavers with impairments and without impairments who are neither employed
nor receiving SSI. Leavers with Impairments

Were Less Likely to Be Employed, but Many Received SSI

Page 16 GAO- 03- 210 Welfare Reform

Figure 3: Employment and Receipt of SSI among Leavers with and without
Impairments, July 1997 through July 1999

Notes: For comparison, among the non- TANF populations, 52 percent of
people with impairments were employed, while 93 percent of people without
impairments were employed during the same time period.

*Employed* and *Receiving SSI* include people who reported being employed
or receiving SSI, respectively, in any month after leaving TANF and before
the end of July 1999. *Not employed* and *no SSI* include people who
reported not being employed or not receiving SSI, respectively, the entire
time after leaving TANF and before the end of July 1999. a Employment and
receipt of SSI were not necessarily concurrent.

Leavers with impairments were not only less likely than those without
impairments to be employed at any time after leaving TANF, but not
surprisingly, they were also less likely to report having personal
earnings from employment or other sources in any single month. In each of
the first 6 months after exiting TANF, about 20 percent of leavers with
impairments reported having personal earnings, compared with about 60
percent of leavers without impairments. For those who did report personal
earnings, though, the average amount of earnings for members of both
groups was essentially equal, at about $1,000 per month. 30 About 35
percent of leavers in both groups also reported household earnings.
Regardless of their impairment status, their household earnings amounted
on average to about $2,000 per month in addition to any personal earnings
they may have had.

30 Estimates are based on small numbers of respondents, so differences too
subtle to measure could exist.

82% Employed (no SSI)

18%

Not employed (no SSI) Not employed (no SSI)



Employed (no SSI)

6%

Both employed and receiving SSI a

Receiving SSI (not employed)



Leavers with impairments Leavers without impairments

27%  33% 34% 73%

Source: GAO's analysis of SIPP data on disability.

Page 17 GAO- 03- 210 Welfare Reform

Leavers with impairments were more likely than those without impairments
to report having no income* from personal or household earnings or SSI* in
any single month, although they may have received Food Stamps or Medicaid.
31 In their first month after leaving TANF, 36 percent of leavers with
impairments reported having no personal or household earnings, or SSI,
compared with 23 percent of leavers without impairments. (See fig. 4.)
These proportions remained relatively constant in each of the first 6
months after leaving TANF. Over the course of the entire 24- month
observation period, 10 percent of all individuals who left during that
period reported never having income from personal or household earnings or
SSI at any point after leaving TANF. This means that 90 percent of leavers
had income from at least one of these sources at some point after leaving
TANF. There were insufficient data to examine whether there were any
differences between people with and without impairments on this measure.

31 There were insufficient data to determine how many recipients who
reported no income also did not receive Food Stamps or Medicaid.

Page 18 GAO- 03- 210 Welfare Reform

Figure 4: Proportion of Leavers with and without Impairments Reporting
Receipt of Income from Personal Earnings, Household Earnings, or SSI in
First Month after Leaving TANF

a Differences between recipients with and without impairments are
statistically significant.

A greater proportion of leavers with impairments reported receiving Food
Stamps and Medicaid than did leavers without impairments. Specifically, 77
percent of leavers with impairments received Food Stamps compared with 62
percent of leavers without impairments. Similarly, 89 percent of leavers
with impairments reported receiving Medicaid in contrast to 71 percent of
leavers without impairments. (See fig. 5.) Leavers with Impairments

Were More Likely to Receive Food Stamps and Medicaid

Percentage of leavers 0 10

20 30

40 50

60 70

80 90

100

Reported at least one of these sources of income Reported none of these
sources of income

64 77

23 36

Leavers with impairmentsa Leavers without

impairmentsa

Source: GAO's analysis of SIPP data on disability.

Page 19 GAO- 03- 210 Welfare Reform

Figure 5: Proportion of Leavers Receiving Food Stamps and Medicaid, July
1997 through July 1999

a Differences between leavers with and without impairments are
statistically significant.

The 1996 welfare reform legislation enacted by the Congress clearly
emphasizes the importance of welfare recipients taking steps toward
employment and self- support. At the same time, the legislation provides
states some flexibility to design programs that meet the needs of families
affected by serious physical and mental impairments who may need special
attention to facilitate the transition to work or to SSI. As states move
beyond the first 5 years of the TANF program, a key challenge will be to
ensure that recipients with impairments and those caring for children with
impairments receive the supports they need to meet the work- focused goals
and requirements of TANF.

Our findings underscore the magnitude and complexity of this challenge.
Our findings that both adult recipients with impairments and recipients
caring for children with impairments are less likely to exit TANF, and
that adult leavers with impairments are less likely to be employed,
suggest that in the early years of welfare reform at least, these families
were not as Concluding

Observations

Percent 0 10

20 30

40 50

60 70

80 90

100 Received Food Stamps a Received

Medicaid a

77 62

89 71

Leavers with impairments Leavers without impairments Source: GAO's
analysis of SIPP data on disability.

Page 20 GAO- 03- 210 Welfare Reform

successful as those without impairments at leaving welfare through work.
Our finding that 40 percent of families with impairments who did leave
welfare received SSI after leaving TANF shows that SSI is an important
source of support for many of these families. This finding raises the
difficult question of how best to use their time on TANF while awaiting
SSI eligibility determination, such as what work expectations to have for
these recipients. These findings also raise the more general question for
policymakers about how best to promote work and personal responsibility*
through work requirements and time limits* while at the same time taking
into consideration the particular needs of recipients with impairments and
those caring for children with impairments. While our analysis provides
descriptive information on outcomes for TANF recipients with impairments,
much remains unknown about how best to help people with different types of
impairments become self- sufficient.

In commenting on a draft of this report, HHS said that the topic of TANF
recipients with impairments is an important one. HHS also noted that our
analysis, while possibly the best available approach, has limited
application in providing information on the extent to which different
types of impairments, impairments of varying severity, or local employment
services may affect outcomes for individuals with impairments. We
acknowledge that our analysis focuses on describing outcomes rather than
identifying explanations for these outcomes, in part because information
is not readily available to look at the more complex picture of each
individual*s needs and the particular services received. However, our
analysis provides important information on what is happening in the early
years of welfare reform with regard to recipients with impairments as a
whole. We added language to our concluding observations to state that much
remains unknown about how best to help people with different types of
impairments to become self- sufficient. HHS also noted that an analysis
that excluded recipients who moved onto SSI would be useful. We added
language to the report to clarify that our finding that recipients with
impairments are one- third as likely to be employed as recipients without
impairments refers to recipients who did not receive SSI. HHS*s written
comments are included in appendix II. HHS and two welfare experts also
provided technical comments, which we have incorporated where appropriate.

We are sending copies of this report to the Secretary of Health and Human
Services, relevant congressional committees, and other interested parties.
Agency Comments

Page 21 GAO- 03- 210 Welfare Reform

We will also make copies available to others upon request. In addition,
the report is available at no charge on GAO*s Web site at http:// www.
gao. gov.

If you have any questions about this report, please contact me at (202)
512- 7215 or Gale Harris at (202) 512- 7235. Other contacts and
acknowledgments are listed in appendix III.

Cynthia M. Fagnoni Managing Director, Education, Workforce

and Income Security

Appendix I: Scope and Methodology Page 22 GAO- 03- 210 Welfare Reform

To describe the role of physical and mental impairments in the lives of
families leaving Temporary Assistance for Needy Families (TANF), we
developed estimates of the number of TANF recipients with impairments and
investigated the differences between TANF recipients and leavers with and
without impairments, using a 2- year cross section of data from the Census
Bureau*s Survey of Income and Program Participation (SIPP). The SIPP is a
national household survey conducted by the U. S. Census Bureau in which
panels of individuals representative of the nation, including those
receiving TANF, are interviewed over a period of 2 years or more. At 4-
month intervals, panel participants are asked a set of *core* questions
involving such subjects as their labor force activity, welfare program
participation, and demographic characteristics. Periodically, the survey
also asks a detailed set of questions called *topical modules* on a
variety of topics not covered in the core section, such as disabilities.
For our purposes, we selected panels starting in 1996 and sampled TANF and
non- TANF adults between the ages of 18 and 62. Data from the topical
modules on disability that we analyzed were from interviews conducted from
August 1997 to November 1997, and August 1999 to November 1999, in which
respondents were asked about their status in recent months, including July
of that year. We included respondents who were in the sample in both July
1997 and July 1999 and analyzed their responses during this time period.

During these interviews, panel members were asked an extensive set of
questions about their physical or mental impairments, including questions
on a range of functional or other activity limitations. To be identified
as having a disability or impairment in the SIPP, individuals must meet
specific disability criteria developed by the U. S. Census Bureau. 1 That
is, they must meet any of the following criteria:

1. Had difficulty performing one or more functional activities, including
seeing, hearing, speaking, lifting, and carrying, using stairs, and
walking.

2. Had difficulty with one or more activities of daily living, such as
getting around inside the home, getting in or out of a bed or chair,
bathing, dressing, and eating.

1 Children were identified as having an impairment or not based on the
questions in the SIPP disability module related to children*s
disabilities. These questions differed somewhat from the questions related
to adults* disabilities. Appendix I: Scope and Methodology

Data Source: Census Bureau*s SIPP Data

Appendix I: Scope and Methodology Page 23 GAO- 03- 210 Welfare Reform

3. Had difficulty with one or more instrumental activities of daily
living, including going outside the home, keeping track of money or bills,
preparing meals, doing light housework, and using the telephone.

4. Had one or more specific conditions, including a learning disability,
mental retardation or another developmental disability, Alzheimer*s
disease, or some other type of mental or emotional condition.

5. Had an other mental or emotional condition that seriously interfered
with everyday activities, including frequently depressed or anxious,
trouble getting along with others, trouble concentrating, or trouble
coping with day- to- day stress.

6. Had a condition that limited the ability to work, including around the
house.

7. Had a condition that made it difficult to work at a job or business. 8.
Received federal benefits based on inability to work. 9. Used a
wheelchair, a cane, crutches, or a walker. For our purposes, we considered
individuals to have impairments if their survey responses indicated they
had impairments at both times that the disability topical module was
administered (i. e., in both 1997 and 1999). We considered individuals to
not have impairments if their survey responses indicated they did not have
impairments at both times that the disability topical module was
administered. Individuals whose impairment status differed between the
first and second modules were excluded from the analyses. (We excluded
12.5 percent of respondents for this reason). We used appropriate
techniques to weight the data to make population estimates for 1999 as
well as to take into account the complex sampling design when estimating
variances. Because the estimates we reported from the SIPP were based on
samples, they are subject to sampling error, which varied but did not
exceed plus or minus 8 percentage points at the 95- percent confidence
interval. Therefore, the chances are 95 out of 100 that the actual
population percentages are within no more than plus or minus 8 percentage
points of our estimates.

In addition to descriptive statistics, we used logistic regression models
to examine the effects of recipients* having impairments, and of
recipients* caring for children with impairments on the likelihood of
leaving TANF and of being employed after leaving TANF, after controlling
for age, Logistic Regression

Analyses

Appendix I: Scope and Methodology Page 24 GAO- 03- 210 Welfare Reform

gender, marital status, race, and educational attainment. 2 Recognizing
that TANF policies may vary across states, we controlled for state in the
models as well. The models of post- TANF employment also controlled for
receipt of Supplemental Security Income (SSI). 3

The results from the models we used are odds ratios that estimate, in
table 1, the relative likelihood of leaving TANF for each factor and, in
table 2, the effect of each factor on the likelihood of being employed
after leaving TANF. If there were no significant differences between two
groups, their odds would be equal, and the ratio of their odds would be
1.00. The more the odds ratio differs from 1.00 in either direction, the
larger the effect it represents.

The odds ratios in each table were computed in relation to a defined
reference group. In table 1 an odds ratio that is greater than 1.00
indicates a greater likelihood of leaving TANF than the reference group
while a ratio under 1.00 indicates a lesser likelihood of leaving than the
reference group. In table 2 an odds ratio that is greater than 1.00
indicates a greater likelihood of being employed after leaving TANF than
the reference group while a ratio under 1.00 indicates a lesser likelihood
of being employed after leaving TANF than the reference group. Both tables
also show the 95- percent confidence intervals around the odds ratios. If
these intervals contain 1. 00, the difference is not statistically
significant.

2 The purpose of our model is only to examine the effects of recipients or
their children having impairments on the likelihood of leaving TANF and of
being employed after leaving TANF. We are not attempting to explain TANF
exits or post- TANF employment generally.

3 In developing our model, we examined the effects of all of the
reasonable variables available to us in the SIPP. In addition to those
included in the final model, we tested the effect of the number of
children in a household and found that this variable had no significant
effect on the results.

Appendix I: Scope and Methodology Page 25 GAO- 03- 210 Welfare Reform

Table 1: Results of Logistic Regression Model of TANF Exits Model of
adults with impairments Model of adults caring for children with
impairments Variable Odds ratio 95- percent

confidence interval Odds ratio 95- percent confidence interval

Have a disability?

Disabled 0. 49 a (0.29- 0.85) b b Not disabled 1.00

(reference group) b b

Have a child with a disability?

Child with disability

b b 0.44 a (0.28- 0.69) No child with disability

b b 1.00 (reference group)

Age

18- 35 as of 7/ 97 0.85 (0.53- 1.35) 1. 09 (0.72- 1.65) 36- 62 as of 7/ 97
1.00

(reference group) 1.00

(reference group)

Gender

Male 2.21 (0.88- 5.59) 1. 89 (0.76- 4.68) Female 1.00

(reference group) 1.00

(reference group)

Marital status

Currently married 1.24 (0.78- 1.99) 1. 40 (0.86- 2.28) Not currently
married 1.00

(reference group) 1.00

(reference group)

Minority status

Minority 0. 40 a (0.23- 0.70) 0. 44 a (0.27- 0.73) White 1. 00

(reference group) 1.00

(reference group)

Education

More than high school 1.01 (0.59- 1.71) 1. 06 (0.63- 1.81) High school or
less 1.00

(reference group) 1.00

(reference group) Note: The models also included a set of dummy variables
to allow for effects of unmeasured state characteristics. We have omitted
the coefficients associated with the dummy variables to simplify
presentation. a Odds ratio is statistically significant at p<= 0.05.

b Not applicable. Source: GAO*s analysis of SIPP data on disability.

Appendix I: Scope and Methodology Page 26 GAO- 03- 210 Welfare Reform

Table 2: Results of Logistic Regression Model of Post- TANF Employment
Model of adults with impairments Model of adults caring for children with
impairments Variable Odds ratio 95- percent

confidence interval Odds ratio 95- percent confidence interval

Have a disability?

Disabled 0. 28 a (0.13- 0.60) b b Not disabled 1.00

(reference group) b b

Have a child with a disability?

Child with disability

b b 0.72 (0.33- 1.58) No child with disability

b b 1.00 (reference group)

Age

18- 35 as of 7/ 97 1.45 (0. 72- 2.92) 2. 27 (1.37- 3.73) 36- 62 as of 7/
97 1.00

(reference group)

Gender

Male 4.90 a (1.45- 16. 51) 1.41 (0.68- 2.95) Female 1.00

(reference group) 1.00

(reference group)

Marital status

Currently married 0.31 a (0.16- 0.60) 0. 51 a (0.30- 0.86) Not currently
married 1.00

(reference group) 1.00

(reference group)

Minority status

Minority 0. 70 (0.33- 1.50) 1. 00 (0.58- 1.73) White 1. 00

(reference group) 1.00

(reference group)

Education

More than high school 1.93 (0.89- 4.18) 2. 26 (1.29- 3.95) High school or
less 1.00

(reference group) 1.00

(reference group)

Receipt of SSI

Not receiving SSI 28.18 a (5.66- 150.37) b b Receiving SSI 1.00

(reference group) b b

Note: The models also included a set of dummy variables to allow for
effects of unmeasured state characteristics. We have omitted the
coefficients associated with the dummy variables to simplify presentation.
a Odds ratio is statistically significant at p<= 0.05.

b Not applicable. Source: GAO*s analysis of SIPP data on disability.

Appendix I: Scope and Methodology Page 27 GAO- 03- 210 Welfare Reform TANF
recipient: Respondents who reported receiving TANF in any

month during the period (July 1997 through July 1999).

TANF leaver: Respondents who reported receiving TANF in some month during
the period and subsequently not receiving TANF at some point for at least
2 consecutive months.

Non* TANF population: Respondents who did not receive TANF benefits in any
month during the time period.

Employed (leavers): Respondents who reported employment in any month after
leaving TANF during the time period.

Age: Categorized as 18- 35 and 36- 62 and defined as the respondent*s
reported age in July 1997.

Education: Categorized as either having more than a high school education
or not. For models of TANF exits, education is defined as the reported
level of education in July 1997; for models predicting employment among
leavers, education is defined as the reported level of education in the
month the respondent reported leaving TANF.

Marital status: Categorized as either married or not. For models of TANF
exits, marital status is defined as reported status in July 1997; for
models predicting employment among leavers, marital status is defined as
reported status in the month the respondent reported leaving TANF.

Received Food Stamps/ Medicaid (leavers): Respondents who reported
receiving Food Stamps/ Medicaid in any month after leaving TANF during the
time period.

Received SSI (leavers): Respondents who reported receiving SSI in any
month after leaving TANF during the time period. Definitions of Other

Variables

Appendix II: Comments from the Department of Health and Human Services
Page 28 GAO- 03- 210 Welfare Reform

Appendix II: Comments from the Department of Health and Human Services

Appendix II: Comments from the Department of Health and Human Services
Page 29 GAO- 03- 210 Welfare Reform

Appendix III: GAO Contacts and Staff Acknowledgments

Page 30 GAO- 03- 210 Welfare Reform

Sigurd Nilsen (202) 512- 7003 Gale Harris (202) 512- 7235 Heather McCallum
(202) 512- 2890

In addition to those named above, Tiffany Boiman, Wendy Ahmed, and Grant
Mallie made important contributions to this report. Appendix III: GAO
Contacts and Staff

Acknowledgments GAO Contacts Staff Acknowledgments

Bibliography Page 31 GAO- 03- 210 Welfare Reform

Acs, Gregory, and Pamela Loprest. *Do Disabilities Inhibit Exits from
AFDC?* Washington, D. C.: The Urban Institute, 1994.

Brandon, Peter D., and Dennis P. Hogan. *The Effects of Children with
Disabilities on Mothers* Exit from Welfare.* Paper presented at the Joint
Center for Poverty Research, Research Conference. Washington, D. C.:
February 2002.

Collier- Bolkus, Winifred. *The Impact of the Welfare Reform Law on
Families with Disabled Children That Need Child Care.* Ph. D. diss.,
Widener University, 2000.

Danziger, S. K., and others. "Barriers to the Employment of Welfare
Recipients." In Prosperity for All? The Economic Boom and African
Americans. Eds. R. Cherry and W. Rodgers. New York: Russell Sage
Foundation Press, 2000.

Lee, Sunhwa, Melissa Sills and Gi- Taik Oh. *Disabilities Among Children
and Mothers in Low Income Families.* Washington, D. C.: Institute for
Women*s Policy Research, June 20, 2002.

Meyers, Marcia K., Anna Lukemeyer and Timothy Smeeding. *Work, Welfare and
the Burden of Disability: Caring for Special Needs of Children in Poor
Families.* Syracuse University: Center for Policy Research, Maxwell School
of Citizenship and Public Affairs. 1996.

Polit, Denise F., Andrew S. London, and John M. Martinez. *The Health of
Poor Urban Women: Findings from the Project on Devolution and Urban
Change.* New York, NY: Manpower Demonstration Research Corporation. 2001.

Smith, Lauren A., MD et al. *Employment Barriers Among Welfare Recipients
and Applicants with Chronically Ill Children.* American Journal of Public
Health, 92, no. 9 (September 2002): 1453- 1457.

Wise, Paul H., MD et al. *Chronic Illness Among Poor Children Enrolled in
the Temporary Assistance for Needy Families Program.* American Journal of
Public Health, 92, no. 9 (September 2002): 1458- 1461.

Wood, Pamela R., MD et. al. *Relationships Between Welfare Status, Health
Insurance Status, and Health and Medical Care Among Children with Asthma.*
American Journal of Public Health, 92, no. 9 (September 2002): 1446- 1452.
Bibliography

Related GAO Products Page 32 GAO- 03- 210 Welfare Reform

Welfare Reform: Tribes Are Using TANF Flexibility to Establish Their Own
Programs. GAO- 02- 695T. Washington, D. C.: May 10, 2002.

Welfare Reform: Federal Oversight of State and Local Contracting Can Be
Strengthened. GAO- 02- 661. Washington, D. C.: June 11, 2002.

Welfare Reform: States Are Using TANF Flexibility to Adapt Work
Requirements and Time Limits to Meet State and Local Needs.

GAO- 02- 501T. Washington, D. C.: March 7, 2002.

Welfare Reform: More Coordinated Federal Efforts Could Help States and
Localities Move TANF Recipients with Impairments Toward Employment. GAO-
02- 37. Washington, D. C.: October 31, 2001.

Welfare Reform: Moving Hard- to- Employ Recipients Into the Workforce.

GAO- 01- 368 Washington, D. C.: March 15, 2001.

Welfare Reform: Work- Site- Based Activities Can Play an Important Role in
TANF Programs. GAO/ HEHS- 00- 122. Washington, D. C.: July 28, 2000.

Welfare Reform: Means- Tested Programs: Determining Financial Eligibility
is Cumbersome and Can Be Simplified. GAO- 02- 58. Washington, D. C.:
November 2, 2001.

Welfare Reform: Improving State Automated Systems Requires Coordinated
Federal Effort. GAO/ HEHS- 00- 48. Washington, D. C.: April 27, 2000.

Welfare Reform: State Sanction Policies and Number of Families Affected.
GAO/ HEHS- 00- 44 Washington, D. C.: March 31, 2000.

Welfare Reform: Assessing the Effectiveness of Various Welfare- to- Work
Approaches. GAO/ HEHS- 99- 179. Washington, D. C.: September 7, 1999.

Welfare Reform: Information on Former Recipients* Status.

GAO/ HEHS- 99- 48. Washington, D. C.: April 28, 1999.

Welfare Reform: States* Experiencs in Providing Employment Assistance to
TANF Clients. GAO/ HEHS- 99- 22. Washington, D. C.: February 26, 1999.

Welfare Reform: Status of Awards and Selected States* Use of Welfare-
toWork Grants. GAO/ HEHS- 99- 40. Washington, D. C.: February 5, 1999.
Related GAO Products

(130127)

The General Accounting Office, the investigative arm of Congress, exists
to support Congress in meeting its constitutional responsibilities and to
help improve the performance and accountability of the federal government
for the American people. GAO examines the use of public funds; evaluates
federal programs and policies; and provides analyses, recommendations, and
other assistance to help Congress make informed oversight, policy, and
funding decisions. GAO*s commitment to good government is reflected in its
core values of accountability, integrity, and reliability.

The fastest and easiest way to obtain copies of GAO documents at no cost
is through the Internet. GAO*s Web site (www. gao. gov) contains abstracts
and fulltext files of current reports and testimony and an expanding
archive of older products. The Web site features a search engine to help
you locate documents using key words and phrases. You can print these
documents in their entirety, including charts and other graphics.

Each day, GAO issues a list of newly released reports, testimony, and
correspondence. GAO posts this list, known as *Today*s Reports,* on its
Web site daily. The list contains links to the full- text document files.
To have GAO e- mail this list to you every afternoon, go to www. gao. gov
and select *Subscribe to daily E- mail alert for newly released products*
under the GAO Reports heading.

The first copy of each printed report is free. Additional copies are $2
each. A check or money order should be made out to the Superintendent of
Documents. GAO also accepts VISA and Mastercard. Orders for 100 or more
copies mailed to a single address are discounted 25 percent. Orders should
be sent to:

U. S. General Accounting Office 441 G Street NW, Room LM Washington, D. C.
20548

To order by Phone: Voice: (202) 512- 6000 TDD: (202) 512- 2537 Fax: (202)
512- 6061

Contact: Web site: www. gao. gov/ fraudnet/ fraudnet. htm E- mail:
fraudnet@ gao. gov Automated answering system: (800) 424- 5454 or (202)
512- 7470

Jeff Nelligan, managing director, NelliganJ@ gao. gov (202) 512- 4800 U.
S. General Accounting Office, 441 G Street NW, Room 7149 Washington, D. C.
20548 GAO*s Mission

Obtaining Copies of GAO Reports and Testimony

Order by Mail or Phone To Report Fraud, Waste, and Abuse in Federal
Programs

Public Affairs
*** End of document. ***