Welfare reform at the crossroads: pediatric nurses bridging the gap between self-sufficiency and health.

FOR MORE THAN 4 DECADES, care for some of our most vulnerable populations was paid for under the federal program entitled “Aid to Families with Dependent Children” (AFDC), which was authorized under Title IV of the Social Security Act in 1968. As the numbers enrolled in the program swelled, and public attitudes changed toward working mothers, policy also changed to require that women take a more active role in becoming self-sufficient and supporting their children by entering the workforce. Policymakers took advantage of the political climate to enact the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in 1996. In 1996 the new welfare reform program, entitled “Temporary Assistance for Needy Families” (TANF), was developed under PRWORA. PRWORA eliminated cash assistance for poor mothers and their children and replaced AFDC with TANF block grants, which provided states with funding for time-limited, work-based welfare programs. TANF imposed lifetime limits of no more than 60 months, and states have discretion to impose shorter time limits. TANF also required single mothers of school-aged children to work at least 30 hours per week by 2000, although states can set stricter guidelines. In addition, PRWORA mandated states to ensure that 50% of their caseload was engaged in work-related activities by 2002. All states have met these requirements. Separation of compulsory enrollment in the Medicaid program for TANF recipients was also mandated. With these sweeping changes, policymakers were able to implement historic welfare reform. During this past 107th Congressional Session, the TANF program was up for reauthorization. However, after passing the House and receiving much debate in the Senate, the program was not reauthorized, which means that the statute that establishes or continues the operation of the program for a period of time, in this case TANF, was not renewed. Reauthorization also sets a particular funding level for the program to function. Thus, at this point, the TANF program is operating on a day-to-day basis until Congress votes for its reauthorization, hopefully during the 108th Congressional Session. The original 1996 law and subsequent program TANF did not adequately address many of the special needs of women and children, because the program did not provide adequate educational training, child care, and transportation services to allow mothers the opportunity to successfully get off the welfare rolls. As a result, it is important for pediatric nurses to advocate for necessary modifications in the current program to help women and children receive the aid they need and achieve better social and health outcomes. Longest (2002) describes the first stage of policymaking as the agenda-setting phase, which “takes advantage of a window of opportunity— defined as a favorable confluence of problems, possible solutions, and political circumstance—to From the Center for Health Policy, Research and Ethics, George Mason University. Address correspondence and reprint requests to Elizabeth Thanh Truong, BA, 4913 Erie St., Annadale, VA 22003. Copyright 2003, Elsevier Science (USA). All rights reserved. 0882-5963/03/1801-0010$30.00/0 doi:10.1053/jpdn.2003.15