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This introductory chapter describes the thematic framework of this study, arguing that continuity rather than change forms the experiences of low-income women in the post-reform era. Drawing on anecdotes of these womens' experiences from the periods before and after the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), or welfare reform, was implemented in 1997, this chapter illustrates how the experiences of women navigating the worlds of welfare and low-wage work since reform differed from those of the women studied prior to reform. Though the chapter outlines some marked differences between the pre- and post-reform era, it indicates several expecations between the two time periods which had not been met—particularly in how the women interviewed in the mid-2000s described the same problems and the same distrust in much the same ways as women interviewed in the mid-1990s.

This concluding chapter urges reformers to think more broadly and deeply than they have about how distrust is produced and what its consequences are for low-income mothers. It pays particular attention to the ways in which policies designed without regard to the importance of building trust (such as welfare reform) may fall short of their intended goals. It looks to the possible structural roots of the untrustworthiness that the women encountered. Addressing these structures would go a long way to decrease untrustworthiness and the distrust it foments. Structural change is difficult, and often the political will to do it is lacking or nonexistent, but it would make social policies more effective and would improve the conditions of low-income women's and children's lives.

This chapter investigates the impact of public charge fears on low-income pregnant immigrant women's access to Medi-Cal. It begins with a more detailed discussion of the Medicaid fraud detection programs established at the Mexico–U.S. border, and later at the Los Angeles and San Francisco International airports, to illustrate the extensive and complex influence of policy on an everyday level. Of particular significance is the impact—or lack thereof—of government efforts to backtrack or “clarify” their mistakes (i.e., unintended consequences). Two case studies are examined in this light: a lawsuit brought against the State Department of Health Services regarding its handling of fraud detection programs at the border, and a state audit of a specific fraud detection program aimed at documented, low-income immigrants. These cases show that federal policies have little room for error, given these policies' actual consequences on people's everyday lives.