Holes in the Safety Net: Why Eligible Families Don’t Fully Participate in Assistance Programs

This article is the first in Child and Family’s five article series on the intersection of child and family policy and entitlement programs. For the rest of the series, click here.

Many American social programs seek to aid those who cannot help themselves. But eligibility for assistance is no guarantee that those who need aid will actually enroll. “Securing the Safety Net: Concurrent Participation in Income Eligible Assistance Programs,” an article published this June in the Maternal and Child Health Journal, examines how the social “safety net” designed to support at-risk children and infants is failing to catch its intended population.

The years since the 2008 economic downturn have left a greater percentage of Americans living at or below the poverty line. Compared to adults, children and infants living in poverty are at especially great risk. For children and infants, poverty means a greater likelihood of exposure to abuse, inadequate nutrition, and environmental pollution. These stressors can impact cognitive development and academic performance. Stressors can even “[increase] the odds of life-long health problems and criminal involvement,” according to the Maternal and Child Health Journal study.

To address these potential challenges, state and federal entitlement programs like Women, Infants, and Children (WIC); the Supplemental Nutrition Assistance Program (SNAP); Temporary Assistance for Needy Families (TANF); and Medical Assistance Programs (MAP) seek to alleviate the burden of poverty on those most at risk—particularly infants and children. However, barriers to participation have created situations in which vulnerable families may not participate in all programs for which they are eligible.

According to the study, which was conducted by researchers from Johns Hopkins University and Children’s Hospital of Pittsburgh, this underenrollment undermines entitlement programs’ effectiveness. The study examines the “safety net” these programs collectively comprise.

The authors examined Maryland’s WIC database for a one-year period beginning in October 2009, focusing on infants living at or below 100 percent of the Federal Poverty Level (FPL). They chose Maryland’s WIC program because it enrolls a high percentage—over 90 percent—of its eligible families. The authors compared families participating in multiple assistance programs to those enrolled only in WIC, since every family included in the survey data was also eligible for SNAP, MAP, and TANF.

Despite this eligibility for additional programs, few participated in programs other than WIC. 28.2 percent of WIC families claimed no other form of assistance, 42.5 percent were enrolled in WIC and one other program, and just 7.8 percent of eligible WIC families were actually enrolled in all four assistance programs.

The authors argue that, because many assistance programs complement each other, simultaneous participation by eligible families offers the strongest available safety net. For example, a family that receives food assistance from SNAP, immunization referrals and nutrition screenings from WIC, and health coverage under Medicaid is better supported than a family receiving only one of these eligible benefits.

According to the authors, three key trends drive underenrollment. First, mothers become increasingly less likely to participate in programs as they become older. Second, in terms of race, infants classified as Hispanic were least likely to be comprehensively enrolled, in part because English nonproficiency represents an additional barrier to participation. Third, findings indicate that participation in all four programs is far higher when newborn children are WIC certified in their first two weeks of life. But difficult application processes, language and literacy barriers, fears of social stigma, and poor health knowledge often pose barriers for families.

Programming efforts designed to address these challenges would promote more comprehensive enrollment. Such efforts include reaching out to Hispanic mothers in order to boost WIC enrollment, certifying infants within two weeks of birth, and encouraging “cross program integration” between WIC, TANF, SNAP, and medical assistance through means such as creating a single enrollment process.

Addressing the service gaps between assistance programs would reinforce their collective impact, tightening the social safety net supporting American children and families.

Feature Photo: cc/(Jon Fravel)