The costs of public services for teenage mothers post-welfare reform: A ten-state study
Background: More information is needed on the use and costs of public services by teens after the passage of major national polices in the 1990s. Both the1996 welfare reform and later changes to the Medicaid program have affected the access of low-income adolescents to public assistance programs. In turn, these changes have affected teenaged mothers and their infants and the costs that taxpayers incur in the 50 states. Study Question: What public services do teenage mothers use and what are their costs in the decade after the major policy changes to public assistance programs? How do patterns vary by state? Methods: This study examines the use by teenage mothers of four public services: cash assistance, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), food stamps, and Medicaid coverage at delivery. We used 2000 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to derive rates of use for these four programs in ten states-AK, AL, FL, ME, NY [excluding New York City], NC, OK, SC, WA, and WV. We combined the rates with data on per person and family costs of these four programs to present 'birth-year' costs for a cohort of teenage mothers in the ten states. To provide a baseline from which to measure incremental public service costs to teenage mothers, we also compiled the data for mothers ages 20 to 24 years who did not report births during their teen years. Results: Data from the ten states indicate that the birth-year expenses for teenage mothers for four public programs add up to more than $0.5 billion, and the costs per teenage mother exceed those for older mothers who did not have a teenage birth by almost $1,500. The largest component of these public costs is Medicaid coverage at delivery at 87 percent of the total. If all of the unintended births to teenage mothers in the ten study states were postponed, $75 million in public sector costs would be averted annually. Conclusions: The use of public programs by teenage mothers remains costly and varies markedly across the ten study states. A key reason for higher costs among teenage mothers than among mothers in their early twenties is their higher rates of enrollment in Medicaid at delivery. This rate of enrollment also varies markedly across the study states. The high level of incremental costs and rate of unintended births to teens indicate that cost-saving interventions could be developed. Public Health Implications: Data indicate that many teenage pregnancies are unintended. Thus, a clear public health goal should be to implement and evaluate programs aimed at reducing unintended pregnancies among teenagers. Initiatives are needed to help young women make well-informed decisions about sexual activity and other risky behaviors. Insurance coverage is important to all teens and especially to those who are sexually active.