Largely absent in the congressional debate regarding U.S. welfare reform reauthorization are policy discussions aimed at preventing long-term welfare use for families at risk. This study examines three social science perspectives explaining the relationship between early poverty and health as a means to understand long-term welfare receipt. Using longitudinal data collected for more than 30 years from a cohort of African Americans living in inner-city Chicago, we examined whether a social causation, health selection, or bio-social perspective best characterized the route to long-term welfare receipt. Results indicated that a bio-social perspective provided the best explanation for how early life course factors relate to long-term welfare use later in adulthood. Thus, this theory merits further study as an explanation for the relationship between health status and income. These findings point to the vulnerability of those who are both poor and in ill health, and should direct our policies regarding how to best prevent long term welfare receipt in future generations.