In 1996 the U.S. Congress passed the Personal Responsibility and Work Opportunities Reconciliation Act (PRWORA), substantially reducing a family?s rights to income support. PRWORA removed the entitlement to government-provided cash assistance and increased states? incentives to reduce welfare caseloads. At the same time it increased private responsibilities by encouraging greater work effort from mothers and more child support payments from non-resident fathers. The PRWORA provisions raised concerns within the medical community and among other advocates interested in the health and wellbeing of at-risk families. The changes to cash welfare and child support policies had potential direct and indirect consequences for women?s health. Most directly, by removing the entitlement to welfare, many feared that poor women would lose their health insurance coverage. While PRWORA included a provision to hold Medicaid eligibility constant, the administrative barriers to implementation by program staff and the confusing new rules suggested that many eligible women might lose coverage.
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