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Income volatility can also interfere with the existing social safety net. Some welfare programs require beneficiaries to work a certain number of hours each week, assuming that the number of hours worked is under the control of the employee, rather than the employer.53 Qualification for programs like food stamps and health insurance subsidies is based on an average monthly income threshold. But of course volatile incomes mean that families bounce in and out of eligibility.54 Bouncing in and out of Medicaid ineligibility causes interruptions in care for chronic conditions, particularly in places where the doctors who accept Medicaid and private insurance don’t overlap.55 There can also be severe penalties for “fraud” in these programs, receiving benefits when your income is too high. But households subject to volatile incomes may not, themselves, know when or whether they will cross thresholds of eligibility. For instance, as of 2016, the Pennsylvania Medicaid Application asks whether anyone in the household has a hard time predicting their income, but in the very next question requires applicants to do exactly that—for the next twenty-four months—in order to establish eligibility.
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Jonathan Morduch (The Financial Diaries: How American Families Cope in a World of Uncertainty)