Improving Access to TANF Cash Assistance is a Public Health Imperative

March 17, 2023 by Courtney Bernard

It is well-known that economic instability contributes to poor physical and mental health outcomes for adults and children alike.[1] This concept entered the societal consciousness even further with the onset of COVID-19 where economic insecurity was a significant risk factor for negative health outcomes connected to the pandemic.[2] Cash assistance can be an important anti-poverty policy mechanism to alleviate economic instability—and improve health. More economic security means less stress, better access to healthcare and nutritious food, and a greater ability to cover costs associated with housing, transportation, and education.[3]

Unfortunately, the key federal program for administering cash assistance to low-income families with children—Temporary Assistance for Needy Families (TANF), colloquially known as welfare—falls short as an anti-poverty measure.[4] Nationally, only about 21 percent of families living in poverty received TANF cash assistance in 2020.[5] In states including Texas, Michigan, Mississippi, and Indiana, that rate was much lower.[6] Further, the federal funding level for TANF has remained the same as when it was enacted in 1996, meaning that the real value of the funds contributed at the federal level has fallen by 40 percent due to inflation.[7]

For families who do receive income support from TANF, the program is notoriously rigid and punitive, making it a stressful and onerous benefit to maintain. To receive a monthly cash benefit, families must navigate myriad time-intensive requirements such as continuously submitting extensive documentation and complying with numerous work- and child support-related rules. Some states have additional requirements such as drug testing to receive benefits or if there is “reasonable suspicion” of drug misuse,[8] despite studies showing that the general population is more likely to test positively for drug use than TANF applicants.[9] If the state agency administering the program perceives even a small misstep, a family’s benefits can be “sanctioned” (i.e., reduced) or they can be kicked out of the program entirely. Some families are even threatened with fraud investigations and criminal penalties for simple misunderstandings or miscommunications, including those caused by the administering agency itself.

The experience of TANF recipients—and the use of TANF funds—varies amongst the states. Under TANF, the federal government provides a fixed block grant to states, which is then supplemented by state funds.[10] Although TANF replaced the Aid to Families with Dependent Children (AFDC),[11] which provided cash assistance to families with children in poverty, TANF funds do not solely have to be used for that purpose.[12] Rather, states have wide discretion to use the funds to accomplish four purposes set out in the 1996 law: (1) assist families in need so children can be cared for in their own homes or the homes of relatives; (2) reduce dependency of parents in need by promoting job preparation, work, and marriage; (3) prevent “out-of-wedlock” pregnancies; and (4) encourage the formation and maintenance of two-parent families.[13] These broad goals, rooted in racist, harmful narratives and antiquated conceptions of “family,” have led to the implementation of harsh, invasive requirements for families in need of income support and allowed for dubious misspending and advantages for the wealthy—demonstrated most infamously by TANF funds in Mississippi being pumped into a new university volleyball facility at the behest of former NFL quarterback Brett Favre.[14]

Rather than shepherding the majority of TANF funds to directly support families with children who need them most, some states have treated TANF like a “piggy bank” to plug budget holes and win political points with elites.[15] Other states have utilized TANF funds for things like college scholarships and homework help for kids[16]—these are worthy and important services, but not necessarily measures aimed at lifting low-income families out of poverty.

As Members of Congress and policy groups on both sides of the aisle debate reforms to TANF, it is important that they center the needs of families living below the poverty line. The focus should be on helping families who need cash assistance to cover the basics like food, utilities, diapers, rent and clothing—not forcing them to live under the constant threat of having their benefits sanctioned or denied if they do not perfectly follow paternalistic rules that seek to compel certain behaviors.[17] Just as direct cash assistance was used as a public health measure to help families weather the COVID pandemic,[18] it should be treated as a necessary support for the health and wellness of all families experiencing poverty.


[1] Paula A. Braveman et al., Socioeconomic Disparities in Health in the United States: What the Patterns Tell Us, 100 Am. J. Public Health 1, 8-9 (Sept. 1, 2010),; Samantha Artiga & Elizabeth Hinton, Kaiser Family Found., Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity 1-2 (May 2018),; Am. Acad. of Family Physicians, Poverty and Health: The Family Medicine Perspective (2021),; James H. Duffee et al., Poverty and Child Health in the United States, 137 Pediatrics 1, 1-2 (April 2016),

[2] Klaus Cavalhieri, Economic Insecurity as a Risk Factor During the COVID-19 Pandemic, 14 J. Health Disparities Rsch. & Prac. 79, 81 (2021),

[3] Sam Waxman, Arlox Sherman & Kris Cox, Ctr. on Budget & Pol’y Priorities, Income Support Associated With Improved Health Outcomes for Children, Many Studies Show 1-2 (May 27, 2021),

[4] Peter Edelman, So Rich, So Poor: Why it’s so Hard to End Poverty in America 2–4 (2012).

[5] Aditi Shrivastava & Gina Azito Thompson, Ctr. on Budget & Pol’y Priorities, Policy Brief: Cash Assistance Should Reach Millions More Families to Lessen Hardship 1 (Feb. 18, 2022),

[6] Anna Wolfe, Data Dive: Mississippi not the only state turning away most welfare applicants, Miss. Today, Oct. 5, 2022,

[7] Ctr. on Budget & Pol’y Priorities, Policy Basics: Temporary Assistance for Needy Families 2 (Updated Mar. 1, 2022),

[8] Amanda Michelle Gomez, States waste hundreds of thousands on drug testing for welfare, but have little to show for it, The Ctr. for L. & Soc. Pol’y (CLASP), May 7, 2018,

[9] Jess Staufenberg, Welfare recipients are less likely to be drug users than average American, results show, The Ctr. for L. & Soc. Pol’y (CLASP), Oct. 8, 2015,

[10] Ctr. on Budget & Pol’y Priorities, supra note 7, at 1.

[11] See generally Edelman, supra note 4, at 82–83.

[12] Ctr. on Budget & Pol’y Priorities, supra note 7, at 1.

[13] 45 CFR § 260.20.

[14] Annie Lowery, Mississippi Shows What’s Wrong With Welfare in America, The Atlantic, Oct. 29, 2022,

[15] Jenni Bergal, States Raid Fund Meant for Needy Families to Pay for Other Programs, Stateline, July 24, 2020,

[16] Id.

[17] Ife Floyd et al., Ctr. on Budget & Pol’y Priorities, TANF Policies Reflect Racist Legacy of Cash Assistance: Reimagined Program Should Center Black Mothers 3-5 (Aug. 4, 2021),

[18] Economic Impact Payments, U.S. Dep’t of the Treasury, (last visited Jan. 1, 2023).