Mathematica Reference Number:
U.S. Department of Health and Human Services
Assistant Secretary for Planning and Evaluation
200 Independence Ave., SW, Room 404E
Project Officer: Alana Landey
Mathematica Policy Research
600 Maryland Avenue, SW
Washington, DC 20024-2512
Telephone: (202) 484-9220
Facsimile: (202) 863-1763
Project Director: Jacqueline Kauff
Demand for public benefits is rising in response to two influences: continuing economic pressure on vulnerable families and individuals, and changes to eligibility rules for some safety net programs as a result of the Food, Conservation, and Energy Act of 2008; the American Recovery and Reinvestment Act of 2009; and the Affordable Care Act of 2010. In response to increasing demand and tightening state budgets that necessitate administrative efficiencies, public and private entities are exploring options for expediting and streamlining access to benefits. Although these efforts vary in form, reach, and intensity, information systems technology is often an essential component of a more comprehensive approach to helping Americans who are struggling to make ends meet.
As a major federal funder of public benefits, the U.S. Department of Health and Human Services (HHS) is committed to understanding the range and nature of these efforts, which can be based on web technology, systems integration, and/or electronic data matching. Accordingly, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with Mathematica Policy Research to (1) summarize existing benefits access efforts; (2) study the successes and challenges of a subset of these efforts through in-depth case studies; and (3) analyze the potential for sustaining, expanding, and replicating the most promising efforts. This report presents the results of the first step in this process.
A. Background and Study Context
1. The Policy Challenge
Federal, state, and local assistance programs provide an array of benefits to low-income families and individuals. They include funds to purchase food, subsidies and vouchers for housing or child care, cash for general living expenses, and help accessing health care and prescription drugs. Needy families and individuals can qualify for multiple programs, which may be funded, regulated, and administered by different federal, state, or local agencies. For a variety of reasons, however, these benefits may not reach the people they are intended to help.
Indeed, as much as an estimated $65 billion in public benefits has not been claimed by eligible individuals and families (Waters-Boots 2010), and only about two-thirds of those eligible for the nation’s key entitlement programs—Medicaid, SNAP, and SSI—actually participate (HHS 2008; Leftin 2010; GAO 2005). Eligible families may not participate for a variety of reasons, including perceived stigma associated with receiving public assistance. They may lack understanding of eligibility requirements application processes, or may decide the demands of the application and recertification process are not worth the amount of benefits they would receive. Additionally, the complicated mix of eligibility requirements can confuse potential applicants, who must deal with several agencies and provide the same information to different staff in different offices.
The extent of the burden on applicants depends on how—and how well—agencies coordinate procedures for intake, eligibility determination, and case management across programs. Their efforts have been stymied by poorly integrated technology systems, made even more complicated by the confidentiality issues associated with the cross-agency sharing of information. Data systems incompatibility, which makes data sharing across programs difficult or impossible, only adds to the burden on applicants and program staff. The resulting frustration can both discourage applicants from pursuing all benefits to which they are entitled and make it difficult for program staff to identify the full array of programs for which applicants might qualify.
2. The Nation’s Response
Since the late 1990s, policymakers and advocates for the poor have called for streamlined programs, better caseworker training, enhanced program management, and expanded public education to reduce barriers to participation (O’Brien et al. 2000; Shahin 2009; Waters Boots 2010). In response, the federal government began mounting efforts to reduce or eliminate barriers to program application and participation. For instance, the Social Security Administration and Veteran’s Administration instituted electronic application systems and the U.S. Department of Agriculture developed an online tool that individuals and families can use to determine their potential eligibility for SNAP. A collaborative effort of 17 Federal agencies launched in 2002 what is now benefits.gov, an effort to provide citizens with easy, online access to government benefit and assistance programs. And, several agencies offered states flexibility in relaxing program eligibility policies and procedures.
Most recently, the Economic Recovery and Domestic Poverty Task Force of the President’s Advisory Council on Faith-Based and Neighborhood Partnerships made the following four recommendations for a “streamlined, people-centered multiple-benefit access system based in the community” (President's Advisory Council on Faith-Based and Neighborhood Partnerships 2010):
- Create a taskforce to streamline and consolidate eligibility and application processes
- Expand single-site, multiple-benefit access programs
- Invest in the development and distribution of software applications to facilitate access to multiple benefits through online applications
- Create incentives for state and local governments to maximize program participation among low-income populations and to promote multiple-benefit access through faith- and community-based organizations
As part of the Affordable Care Act (ACA) signed into law in March 2010, DHHS—in consultation with the Health Information Technology (HIT) Policy Committee and the HIT Standards Committee—offered recommendations which “seek to encourage adoption of modern electronic systems and processes that allow a consumer to seamlessly obtain and maintain the full range of available health coverage and other human services benefits.” The recommendations are guided by the notion that “the consumer will be best served by a health and human services eligibility and enrollment process that:
- Features a transparent, understandable and easy to use online process that enables consumers to make informed decisions about applying for and managing benefits;
- Accommodates the range of user capabilities, languages and access considerations;
- Offers seamless integration between private and public insurance options;
- Connects consumers not only with health coverage, but also other human services such as the Supplemental Nutrition Assistance Program (SNAP) and the Temporary Assistance for Needy Families (TANF) program; and
- Provides strong privacy and security protections” (DHHS 2010).
In addition to federal agency efforts, states, localities, and private organizations that serve low-income populations have mounted their own responses. These different federal, state, and community efforts intervene at different stages of the process program applicants and participants go through—from learning about and applying for benefits, to going through an eligibility determination and enrolling in programs, to taking the necessary measures to remain on benefits. In rural communities, coordinated benefits access efforts have been seen as a means to address impediments to services for rural individuals and families, such as lack of public transportation, persistent poverty, and limited access to resources. At the same time, many of these efforts have been implemented in urban settings with high concentrations of low-income populations. Some efforts depend heavily on information systems technology, and some do not. Figure 1.1 illustrates the range of these efforts, and they are discussed briefly in the paragraphs below.
Learning about benefits. Benefits access efforts that provide information about different types of benefits are designed both to inform potential applicants about existing benefit programs and to dispel myths about the stigma—perceived or real—associated with program participation. Examples include marketing campaigns that consist of television, radio, newspaper or other printed advertisements and/or varied types of printed distribution materials such as flyers, brochures, postcards, or envelope/paycheck stuffers. Telephone hotlines providing resource and referral information also fall into this category. Many efforts at this stage also rely on the web to disseminate program descriptions, instructions on how and where to find more information and apply for benefits, and lists of other resources. Federal agencies, states, localities, and private organizations have used this type of outreach to educate potentially eligible families and individuals.
Applying for benefits. Efforts that intervene at this stage focus on making it easier for individuals and families to submit applications for benefits. Some benefit providers have attempted to make the process easier by combining program applications (thus reducing the time and effort required of the applicant), extending office hours, or implementing call centers to enable applicants to provide information and have questions addressed more conveniently. Some providers reach out to prospective clients by distributing and accepting applications at convenient community locations. Private nonprofit and for-profit organizations conduct this type of outreach as well, and they also may help individuals and families complete applications and compile the necessary documentation. Efforts at this stage can rely on electronic data exchange or data matching to identify a target group of individuals or families who are enrolled in one or more programs but not in others for which they are likely to qualify. Public and private entities may do the matching, but public agencies must supply the data.
Public and private organizations have also used the Internet to bring people into a program or programs. For example, online screeners and benefit calculators with interactive software help people assess their eligibility for programs and estimate their benefits. In some cases, people can fill out applications online, print them, and then deliver them to the program office(s). In others, online program applications may be submitted electronically, relieving the pressure of relying on mail delivery or delivering applications to programs offices that are not conveniently located or open during convenient times. Many efforts offer some combination of the above.
Determining eligibility and enrolling in benefits. Initiatives at this stage aim to speed up the eligibility determination and enrollment process in order to reduce the potential for attrition before people are certified for benefits. Attrition tends to occur at a few critical points in the eligibility determination process. Typical examples include failure to attend a required in-person interview or failure to provide documentation for the information on an application.
The shaded boxes in Figure I.1 on page 4 illustrate the types of efforts included in, and excluded from, the scan. Included are three distinct types of web-based technologies that help people apply for at least two federally-funded programs in which they do not currently participate:
- Screeners/benefit calculators that provide information to potential applicants
- Online applications that must be printed and delivered to relevant program office(s)
- Online applications that may be submitted electronically
Public agencies have attempted to address this problem by changing their policies and processes. With respect to policies, for example, some agencies have waived interview requirements or replaced a required in-person interview with a required telephone interview. Process changes have taken two forms. First, agencies have shifted their workflow and redefined staff roles to maximize productivity and to reduce processing time. Some have done this through specialization of staff roles and/or the institution of call centers. Second, agencies have used technology to obtain data more quickly and to reduce the burden on applicants. For instance, one agency may exchange data with another in order to directly certify individuals and families for certain programs based on their enrollment in others. Data exchange also can be used to verify eligibility information for one set of programs based on documentation provided for others. In addition, technology in the form of systems integration can facilitate enrollment by allowing electronic application data to be automatically transferred into a program’s eligibility and benefit determination system. Without this capability, program staff must re-type application data (whether submitted in hard copy or electronically) into the
Taking necessary steps to remain on benefits. In most programs, participants are certified to receive benefits for a certain period of time after they enroll. Once that period ends, they must provide documentation to the agency to prove that they are still eligible for benefits. In SNAP, for instance, the standard certification period is 6 or 12 months, and for Medicaid, it is 12 months or less. However, participants do not always take the necessary steps to recertify, either because they are not aware that they need to or because it is burdensome to acquire and submit the documentation. Access efforts at this stage are therefore designed to help individuals and families keep their benefits by reducing or simplifying the recertification requirements. Some are policy changes. For instance, agencies have extended the certification period for some programs or aligned certification periods across programs. Other efforts affect processes—for instance, enabling participants to report changes and re-certify for benefits through call centers or online. More progressive efforts involve “passive renewal,” whereby agencies send recertification forms to participants and inform them that their eligibilitywill be automatically renewed unless they respond. Such efforts are increasingly prominent in Medicaid and CHIP.
B. Research Approach and Methodology
In this section, we describe the types of benefits access efforts we included in this scan and the methods we used to identify them. The efforts selected for in-depth study in the next phase of the project will be a subset of those included in the scan.
1. Study Scope
For a variety of reasons, it is virtually impossible to document all of the benefits access efforts now underway. Many are happening at a very local level, and most are constantly evolving. We confined our scan to efforts stakeholders indicated were of most interest for this study. Generally speaking, these entail efforts that span multiple programs and public agencies. We also were mindful of HHS’ interest in assessing how the federal government can capitalize on promising efforts to sustain, replicate, and expand the use of existing web-based technologies. We therefore included efforts that meet the following three criteria:
- Their primary goal is to help individuals and families apply for programs for which they qualify but in which they do not participate.
- They facilitate access to at least two federally funded programs that target the low-income population and provide cash or the equivalent to cover some or all out-of-pocket costs for basic necessities. Key benefit programs (Table II.1)
- No effort promotes access to all of the 13 key federally funded benefit programs that were the focus of this scan, but almost three-quarters (62) of the 86 efforts promote access to three or more programs, and nearly one-quarter (19 efforts) promote access to at least half (i.e., seven or more) of the programs.
- Most efforts promote access to at least one of three keystone programs: SNAP, TANF, and Medicaid. Specifically, nearly 90 percent (77 efforts) promote access to Medicaid, four out of five (69 efforts) to SNAP, and more than two-thirds (59 efforts) to TANF; 53 of the 86 efforts in the scan (61 percent) promote access to all three.
- Of the efforts that promote access to only two programs, the majority (74 percent) promote access to Medicaid and CHIP. However, despite the increased focus on child health coverage in recent years, less than half of the efforts (41) promote access to CHIP.
- Programs with the least coverage include SSI/SSDI, Medicare Extra Help, federal housing programs, and veteran assistance programs.
Table II.1. Benefits Access Efforts by Key Benefits Program Effort Vol. II Page Key Benefit Programs TANF SNAP Medicaid CHIP Medicare Extra Help WIC SSI/ SSDI LIHEAP EITC School Meals Housing Assistance VA Programs Child
2-1-1 Navigator 67 X X X X X X X X ABC 68 X X X X X ACCESS FL 15 X X X ACCESS NYC 43 X X X X X X X X X X Access AR 6 X X X X X X Access NE 37 X X X X X X AK application for services 4 X X X X All Kids and Family Care Online Application (IL) 20 X X Application for MS Health Benefits 34 X X Benefits.Gov 1 X X X X X X X X X X X X Benefits CalWIN 7 X X Benefits Checkup 69 X X X X X X Benefits Plus 70 X X X X X X X X Bridge to Benefits 71 X X X X X X X X C4yourself 8 X X X Chipmedicaid.org (TX) 56 X X COMPASS GA 17 X X X X X X X COMPASS (PA) 51 X X X X X X X X Cover Kids (TN) 55 X X CT online benefits application 11 X X X DC IMA Combined Application for Benefits 14 X X X DE ASSIST 13 X X X X Disability Benefits 101 72 X X X X X X X Earn Benefits 73 X X X X X X X X X X X ePASS (NC) 46 X X FAMIS (VA) 61 X X Health-e-App (CA) 9 X X Healthlink (WY) 66 X X HealthNet On-line (MO) 35 X X Healthy Kids (FL) 16 X X Healthy Kids (OR) 50 X X Healthy MT Kids 36 X X HelpEngen 75 X X X X X X X X X HelpWorks 77 X X X X Husky Health (CT) 12 X X IA DHS online application 24 X X X X X ID DHW Application for Assistance 19 X X X X IL Web Benefits 21 X X X IN DFR 22 X X X InRoads (WV) 64 X X X X X Insure AL 3 X X KY multiple benefit application 26 X X X X LA DSS multiple benefit application 27 X X X MassResources.org 78 X X X X X X X X X X X X ME DHHS online application 28 X X MI Bridges/MARS/ Helping Hand 32 X X X X X MN combined application form 33 X X X MS DHS online printable application 34 X X MT DPHHS Application 37 X X X myBenefits (NY) 45 X X X X X X X myBenefits (VT) 60 X X X X NH EASY 40 X X X X NH Healthy Kids 39 X X NJ FamilyCare 41 X X NJ OneApp 41 X X X NM HSD online printable application 42 X X X NV DWSS Application for Assistance 38 X X X OASYS ND 47 X X X X X OH Online Benefit Application 48 X X X OK Request for Benefits and Services 49 X X X One-e-App 80 X X X X X X X OR Application for Services 50 X X X X OregonHelps 83 X X X X X X X X X X X X OTBET 82 X X X X ParentHelp123 85 X X X X X PEAK (CO) 10 X X X X QualCheck (IN) 23 X X X Real Choices HI 86 X X X RI DHS eligibility self screener 52 X X SAIL (MD) 29 X X X X X X SC DSS Multiple Program Application 53 X X SD CHIP/Medical Assistance Application 54 X X SD Economic Assistance Application 54 X X X Seamless Compassion 87 X X X X X Single Stop USA 88 X X X X X X X X SRS Online (KS) 25 X X X SSA BEST 2 X X TN Potential Eligibility Screening and Online Application 55 X X X The Benefit Bank 90 X X X X X X X X X X X UT Helps/eREP 58 X X X X X X X VA DSS Eligibility Screener 62 X X X X X X X Virtual Gateway 30 X X X X X X X WA Connection 63 X X X X X X X X X WI ACCESS 65 X X X X X Yes NM 43 X X X X X X Your TX Benefits 57 X X X Total Efforts with this Benefit Program 59 69 77 41 6 22 12 27 16 14 11 6 31 Percent of Efforts with this Benefit Program 69 80 90 48 7 26 14 31 19 16 13 7 36
Geographic reach (Table II.2)
- Among the privately hosted efforts, seven are available only in a single state and the rest are available to some degree in multiple states.
- Aside from the two efforts hosted on federal agency websites (Benefits.gov and SSA BEST), only one effort is currently implemented on a national scale—the National Council on Aging’s (NCOA’s) BenefitsCheckUp screening tool targeted to seniors. In addition to these three nationally-available efforts, all states have some other effort in place to facilitate access to multiple benefit programs using web-based technology (see Volume II, Section A).
- States in which the largest number of distinct publicly and privately hosted efforts operate include CT, CA, NJ, and NY, followed by FL, IN, MA, MD, NM, and TN.
- Seventeen states have only a single publicly hosted effort (aside from the two nationwide tools) currently available to low-income residents. In some of these states (such as Utah), however, the one publicly hosted effort is extremely comprehensive, streamlining procedures at each stage of the application and enrollment process for both applicants and public agency staff. In these states, low-income individuals and families may have greater access to program benefits than individuals and families in states with more efforts that are less comprehensive.
II.2 Privately Hosted Benefits Access Efforts by State Effort Vol. II Page States* AL AK AR AZ CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO 2-1-1 Navigator 67 S ABC 68 S Benefits Checkup 69 S S S S S S S S S S S S S S S S S S S S S S S S S Benefits Plus 70 Bridge to Benefits 71 S Disability Benefits 101 72 S S S Earn Benefits 73 S S P S P HelpEngen 75 P P P P S P HelpWorks 77 MassResources.org 78 S One-e-App 80 S P S P* OTBET 82 OregonHelps 83 S P P ParentHelp123 85 Real Choices Hawaii 86 S Seamless Compassion 87 S Single Stop USA 88 P P The Benefit Bank 90 S S S S S 2-1-1 Navigator 67 ABC 68 Benefits Checkup 69 S S S S S S S S S S S S S S S S S S S S S S S S S Benefits Plus 70 S Bridge to Benefits 71 S Disability Benefits 10 72 S Earn Benefits 73 P S P HelpEngen 75 P HelpWorks 77 S P MassResources.org 78 S One-e-App 80 OTBET 82 S OregonHelps 83 S S ParentHelp123 85 S Real Choices Hawaii 86 Seamless Compassion 87 Single Stop USA 88 P P P The Benefit Bank 90 S S S S S
*S=Operates statewide; P=Operates in part of the state. One-e-App is in the process of being implemented statewide in Maryland, but is currently available in Howard County only.
Note: In addition to these privately hosted efforts, each state has at least one publicly hosted effort. In AZ, the state (through the Department of Economic Security) adopted One-e-App as its benefits access effort and calls it Health-e-Arizona; there is no other publicly hosted effort in AZ. In HI, the state (through the Department of Human Services) adopted Real Choices Hawaii as its benefits access effort; there is no other publicly hosted effort in HI.
Key technological components (Table II.3)
- The overwhelming majority of efforts offer users an opportunity to interact online through a screener or application they can submit electronically. A benefits screener/calculator is a key component in more than half (48) of the efforts.
- Similarly, just over half (48 efforts) allow electronic submission of benefit program applications.
Table II.3. Benefits Access Efforts by Key Technological Components Effort Vol. II Page Web-Based Technology Screeners/Benefit Calculators Applications That Are Printed and Submitted on Paper Applications That Can Be Sent Electronically Online Application System Data Integrated with Eligibility System 2-1-1 Navigator 67 X ABC 68 X ACCESS FL 15 X X X ACCESS NYC 43 X X X X Access AR 6 X X Access NE 37 X X AK application for services 4 X All Kids and Family Care Online Application (IL) 20 X Application for MS Health Benefits 34 X Benefits.Gov 1 X Benefits CalWIN 7 X X X Benefits Checkup 69 X Benefits Plus 70 X X Bridge to Benefits 71 X C4yourself 8 X X Chipmedicaid.org (TX) 56 X X COMPASS GA 17 X X X COMPASS (PA) 51 X X X Cover Kids 55 X CT online benefits application 11 X DC IMA Combined Application for Benefits 14 X DE ASSIST 13 X X Disability Benefits 101 72 X Earn Benefits 73 X X ePASS (NC) 46 X FAMIS (VA) 61 X X Health-e-App (CA) 9 X X X Healthlink (WY) 66 X X HealthNet On-line (MO) 35 X Healthy Kids (FL) 16 X Healthy Kids (OR) 50 X Healthy MT Kids 36 X HelpEngen 75 X X X HelpWorks 77 X X X Husky Health (CT) 12 X IA DHS online application 24 X X ID DHW Application for Assistance 19 X IL Web Benefits 21 X IN DFR 22 X X X InRoads (WV) 64 X X X Insure AL 3 X KY multiple benefit application 26 X LA DSS multiple benefit application 27 X X MassResources.org 78 X ME DHHS online application 28 X MI Bridges/MARS/Michigan Helping Hand 32 X X MN combined application form 33 X MS DHS online printable application 34 X MT DPHHS Application 37 X myBenefits (NY) 45 X X X myBenefits (VT) 60 X NH EASY 40 X X NH Healthy Kids 39 X NJ FamilyCare 41 X NJ OneApp 41 X X NM HSD online printable application 42 X NV DWSS Application for Assistance 38 X OASYS ND 47 X OH Online Benefit Application 48 X OK Request for Benefits and Services 49 X One-e-App 80 X X OR Application for Services 50 X OregonHelps! 83 X OTBET 82 X ParentHelp123 85 X PEAK (CO) 10 X QualCheck (IN) 23 X Real Choices HI 86 X X RI DHS eligibility self screener 52 X SAIL (MD) 29 X X SC DSS Multiple Program Application 53 X SD CHIP/Medical Assistance Application 54 X SD Economic Assistance Application 54 X X Seamless Compassion 87 X X X Single Stop USA 88 X SRS Online (KS) 25 X X X SSA BEST (Benefit Eligibility Screening Tool) 2 X TN Potential Eligibility Screening and Online Application 55 X X The Benefit Bank 90 X X X UT Helps/eREP 58 X X X VA DSS Eligibility Screener 62 X Virtual Gateway 30 X X WA Connection 63 X X WI ACCESS 65 X X Yes NM 43 X Your TX Benefits 57 X X Total Efforts with this Technology 48 31 48 12 Percent of Efforts with this Technology 56 36 56 14
Target population and provision of application assistance (Table II.4)
Unless otherwise indicated by their own marketing materials, we assumed that all efforts were targeted broadly to low-income individuals and families. From publicly available sources, it was not always possible to identify efforts to reach subsets of the eligible population (as this targeting to subsets is often determined by the setting in which an effort operates). For example, the Ohio Association of Second Harvest Food Banks, which operates The Benefit Bank in Ohio, has trained probation and parole officers as counselors for their effort, but that level of detail is not available on the effort’s website or in other readily accessible public documents. There were two types of exceptions, however, to the broadly-targeted efforts that were the norm among efforts we identified:
- First, 15 of the identified efforts promote access solely to CHIP and Medicaid for children, and we characterized these as being targeted to families with children.
Table II.4. Benefits Access Efforts by Target Population and Provision of Application Assistance
Vol. II Page
Provision of Application Assistance
Families with Children
Individuals with Disabilities
AK application for services
All Kids and Family Care Online Application (IL)
Application for MS Health Benefits
Bridge to Benefits
CT online benefits application
DC IMA Combined Application for Benefits
Disability Benefits 101
HealthNet On-line (MO)
Healthy Kids (FL)
Healthy Kids (OR)
Healthy MT Kids
Husky Health (CT)
IA DHS online application
ID DHW Application for Assistance
IL Web Benefits
KY multiple benefit application
LA DSS multiple benefit application
ME DHHS online application
MI Bridges/MARS/Michigan Helping Hand
MN combined application form
MS DHS online printable application
MT DPHHS Application
NH Healthy Kids
NM HSD online printable application
NV DWSS Application for Assistance
OH Online Benefit Application
OK Request for Benefits and Services
OR Application for Services
Real Choices HI
RI DHS eligibility self screener
SC DSS Multiple Program Application
SD CHIP/Medical Assistance Application
SD Economic Assistance Application
Single Stop USA
SRS Online (KS)
SSA BEST (Benefit Eligibility Screening Tool)
TN Potential Eligibility Screening and Online Application
The Benefit Bank
VA DSS Eligibility Screener
Your TX Benefits
Total Efforts Targeting this Population
Percent of Efforts Targeting this Population
III. BROADER INITIATIVES Incorporating benefits access efforts identified in this study
The benefits access arena remains dynamic. New efforts are launched regularly, and existing ones incorporated into broader initiatives to alleviate poverty. In these broader initiatives, the use of web-based technology to increase benefits access is one component of a multi-pronged approach that may also include policy and procedural changes, other outreach strategies, and employment and financial management assistance. This chapter describes some of these broader initiatives as well as initiatives in development that have the potential to expand the portfolio of technological tools that can bring public benefits to those who need them the most. The chapter concludes with considerations about the future of benefits access initiatives.
A. Current Initiatives
As noted in Chapter I, efforts that entail web-based technology are often essential components of a more comprehensive initiative to expand access to benefits. We identified several broad initiatives that incorporate one or more of the efforts included in the scan.
Benefits Enrollment Centers. This community-based initiative has been in operation since March 2009 with grant funding from the Administration on Aging. Sponsored by the National Center for Benefits Outreach and Enrollment (the Center) within the NCOA, it uses a personalized, technology-based assistance model to promote access to benefit programs for seniors and younger adults with disabilities in 10 areas around the country. The Center established and supports local Benefits Enrollment Centers (BECs), which are tasked with helping these individuals find and apply for all the benefits programs for which they are eligible. According to a recent report on the initiative’s first year of operations (National Center for Benefits Outreach and Enrollment 2010), the programs include:
- Medicare Extra Help (or Low-Income Subsidy, LIS)
- The Medicare Savings Programs (MSP)www.familiesandworkinstitute.org 2011), the nine local and two national project grantees work with employer partners to help program participants secure a range of benefits and services, including:
- “Government-funded means-tested work supports such as Food Stamps [SNAP], Medicaid, State Children’s Health Insurance Program, and child care subsidies. These benefits largely target the lowest-income families.
- Free tax preparation and tax credits such as the Earned Income Tax Credit, Child Tax Credit, and the Dependent Care Tax Credit. Free tax preparation and these tax credits are generally available to families earning more moderate incomes.
- Benefits and services provided by other public and private entities in communities such as food banks, low-cost prescriptions, tuition assistance, and financial products adapted to their needs. Many of these programs have the advantage of having no income ceiling for participation.
- Employer-sponsored benefits including health care, retirement, resource and referral, etc.
- Financial counseling and financial literacy training that helps families avoid predatory financial systems and use the income they have earned in ways that are more likely to improve their economic stability and security.”
Grantees and employers use a variety of technologies to identify those who are eligible for means-tested and other benefits, and to support them through the application process. Examples include Help Engen, EarnBenefits, and ArizonaSelfHelp.org (a version of OregonHelps).
Work Advancement and Support Center Demonstration. The purpose of the Work Advancement and Support Center (WASC) Demonstration, developed by MDRC, is to help low-wage workers increase their incomes. In addition to employment stabilization and advancement services, the demonstration “provides easier access to a range of financial work supports for which workers may be eligible, such as child care subsidies, food stamps, and the Earned Income Tax Credit” (Miller et al. 2009). Demonstration sites are located in Dayton, Ohio; part of San Diego County, California; Bridgeport, Connecticut; and Fort Worth, Texas. The sites aim to offer clients intensive career and advancement coaching and increased access to financial work supports through, among other strategies, partnerships with employers. These work supports include SNAP, public health insurance, child care subsidies, and the EITC and other tax credits. One of the tools program staff use in their efforts is the Work Advancement Calculator, which is based in part on OregonHelps. The calculator not only estimates eligibility and benefits, but also quantifies the changes in income that would result from specific advancement moves, taking into consideration the loss of work supports and the increase in taxes. While the calculator was intended to be a tool first and foremost to support advancement decisions, WASC career coaches more often used it as a tool to facilitate and support clients through the benefits application process.
Cycle I and Tribal CHIPRA Outreach and Enrollment Grants. The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 together with the ACA provided a total of $140 million for grants to support outreach activities and enrollment of children who are eligible for Medicaid or CHIP and to keep them enrolled for as long as they qualify. In September 2009, CMS awarded $40 million to 68 grantees across 42 states, and in April 2010, CMS awarded $10 million to 41 tribal organizations in 19 states. Several grantees are utilizing web-based efforts identified in this scan, along with other outreach efforts, as a key strategy for reducing application and enrollment barriers. For instance, the Pima Community Access Program in Arizona is using Health-e-Arizona; Community Health Care, Inc. in Connecticut is using HelpEngen; Inter-Faith Ministries Wichita Inc. in Kansas is using the Kansas Benefit Bank; and several grantees are using their state’s publicly hosted efforts such as inRoads in West Virginia, ACCESS in Wisconsin, and FAMIS in Virginia. Other grantees are developing their own technologies. For instance, the Maryland Department of Health and Mental Hygiene is using its grant in part to “expand new technology-based eligibility and enrollment systems for the use of an online application tool which will provide real time decisions for Medicaid and CHIP applications” and the Oklahoma Health Care Authority is using its grant to pilot an online enrollment and eligibility program titled No Wrong Door, which allows the user to complete an application online and then determines eligibility (Centers for Medicare and Medicaid Services 2011). CMS recently announced the availability of an additional $40 million in outreach and enrollment grant funding, as described in more detail in section IIB below.
Connecting Kids to Coverage. One year after enactment of CHIPRA, DHHS Secretary Kathleen Sebelius “issued the Connecting Kids to Coverage Challenge, calling upon leaders at all levels of government and the private sector to find and enroll the nearly five million uninsured children eligible for Medicaid and CHIP and keep them covered for as long as they qualify” (2010 CHIPRA Annual Report: Connecting Kids to Coverage). In response, states have launched unprecedented efforts to insure low-income children and families including eligibility expansions, simplified enrollment and renewal procedures, outreach, and use of technology to promote access. According to the 2010 CHIPRA Annual Report, with respect to the latter, “Nearly two-thirds of states (32) have an on-line application that can be submitted electronically; 29 states allow electronic signatures on those applications. Six states have received approval to enroll children through the “Express Lane Eligibility” (ELE) option created by CHIPRA. Thirty-three states are utilizing the CHIPRA data matching process provided by the Social Security Administration to confirm U.S. citizenship for children.”
Maximizing Enrollment. As described on its website, “Maximizing Enrollment is a $15 million initiative of the Robert Wood Johnson Foundation (RWJF) launched in June 2008 and directed by the National Academy for State Health Policy (NASHP). The four-year program will help states improve their systems, policies, and procedures by providing them with an in-depth assessment of the strengths and weaknesses of their current Medicaid and CHIP enrollment and retention systems, and assisting them with implementation strategies to cover more eligible but unenrolled children and to measure their progress. The program aims to increase enrollment and retention of eligible children into Medicaid and CHIP programs and to establish and promote best practices among states in this area.” (http://www.maxenroll.org/page/about). The eight states awarded grants—AL, IL, LA, MA, NY, UT, VA, and WI—have taken varied approaches to increasing enrollment including simplifying enrollment and renewal procedures and using technology to overcome administrative barriers. As an example of the latter, IL has begun a multi-stage technology upgrade project designed to “transform access and customer services for families seeking public benefits” (http://www.maxenroll.org/grantees/illinois). The IL Healthcare and Human Services Framework Project is a collaborative effort across seven IL state agencies to develop an integrated, effective and efficient system that will increase access to services, while streamlining and standardizing processes across programs. The project will re-design and streamline application, eligibility, casework and provider management processes and provide additional benefits access points (for instance, through a web portal, call centers, and community one-stop centers).
B. Initiatives in Development
In addition to those described above, several other initiatives designed to promote benefits access are underway. As these fledgling initiatives unfold, they are likely to give rise to tools and technologies that may be added to the national scan. This section describes some particularly relevant developing initiatives that interested stakeholders may want to monitor.
Social Services and Income Maintenance Benefits Enrollment Coordination Grants. The Office of Community Services in the Administration for Children and Families/HHS recently awarded five one-year grants to support social services and income maintenance benefits enrollment coordination.According to the grant announcement, the grant program will supportefforts to develop and implement evidence-based, innovative programming in the area of benefits enrollment outreach and assistance.The program will also identify benefits enrollment and coordination models that could be strengthened, adapted, and assessed for community impact and results. Grantees will carry out three core functions: (1) use existing community access points to coordinate the benefits enrollment process for under-served residents; (2) combine technology and expert analysis to accurately assess individual and family eligibility for multiple benefits and services; and (3) provide mechanisms for sustaining collaboration between community nonprofit organizations and government agencies for benefits determination and eligibility. The grantees include:
- Amador-Tuolomne Community Resources, Inc., in Jackson, CA
- Legal Assistance Foundation of Metropolitan Chicago in Chicago, IL
- Maine Community Action Association in Augusta, ME
- 2-1-1 Tampa Bay Cares, Inc., in Clearwater, FL
- PathWays PA, Inc., in Holmes, PA
HHS Panel on Simplifying Eligibility for Health and Human Services Programs. HHS has convened a committee of experts to develop standards for multiple programs to share knowledge and information about the people they serve to facilitate cross-program enrollment.The group is charged with developing interoperable and secure standards and protocols that facilitate enrollment of individuals in federal and state health and human services programs, and is working on electronic matching, simplification of documentation, reuse of eligibility information, capability for individuals to manage their information on-line, and communication with individuals.
The Partnership Fund for Program Integrity Innovation. The 2010 Consolidated Appropriations Act (P.L. 111-117) created the Partnership Fund for Program Integrity Innovation (the Partnership Fund) to identify ways to improve service delivery, payment accuracy, and administrative efficiency in federal assistance programs while reducing barriers to access. As noted above, many federal assistance programs are either partly or fully administered by state and local governments in which program officials responsible for service delivery often work independently of those responsible for program oversight and payment accuracy. Similarly, these programs often operate independently of each other even though they serve similar low-income populations. The Partnership Fund will allow federal, state, and local agencies to pilot innovative program integrity improvements in a controlled environment. Pilot projects are being proposed and funded on a rolling basis. Funded projects will be evaluated, and successful ones will serve as models for other states and local agencies. In addition, evaluation results could be used to inform future administrative or legislative changes. The Partnership Fund seeks the public’s ideas for pilot projects through the Collaborative Forum (http://collaborativeforumonline.com), where proposals can be posted and discussed.
Work Support Strategies: Streamlining Access, Strengthening Families Grants. The Ford Foundation, in partnership with the Urban Institute and the Center for Budget and Policy Priorities, recently solicited proposals from states for grants to improve the delivery of work supports to low-income families. This new program, known as the Work Support Strategies: Streamlining Access, Strengthening Families grants, will provide up to eight states with an opportunity to design, test, and implement streamlined, integrated, and technologically innovative approaches to delivering key work-support benefits to low-income families, including health care coverage, nutrition benefits, and child care subsidies. For states and clients alike, the grants program is expected to reduce the burden associated with eligibility determination, enrollment, and retention. The nine states selected in early 2011 to receive grants:
- North Carolina
- New Mexico
- Rhode Island
- South Carolina
Cycle II CHIPRA Outreach and Enrollment Grants. In February 2011, CMS announced the availability of an additional $40 million in CHIPRA outreach and enrollment grant funding (see section III.A above) to states, local governments, community-based and nonprofit organizations, tribes and others. Grants will be awarded in the summer of 2011.The grant solicitation requires that proposals identify one of five focus areas for the prospective project. One of the areas is the use of technology to facilitate enrollment and renewal. Grantees who designate this focus area may receive up to $2.5 million to be spent over the course of 24 months. According to the initial grant announcement, efforts may include:
- “Creating on-line applications, augmenting existing applications (for example, adding electronic signature capability, a renewal module, and/or personal account management functions), or extending the reach of on-line applications through community-based organizations. Grant funds used to create or develop new on-line enrollment and renewal tools, or enhance existing tools, must be able to demonstrate that the enrollment or renewal processes have been simplified and streamlined as a result;
- Simplifying the renewal process by implementing administrative renewal, including implementing the use of pre-populated renewal forms;
- Creating or enhancing systems for verification of data provided by families (with the goal of minimizing the amount of documentation a family must submit at application and at renewal), including the ability to scan documents and conduct data matching with other program databases.”http://www.text4baby.org/index.html), “Mobile phones have potential to play a significant role in health care by delivering information directly to those who need it most…and can be particularly helpful in reaching underserved populations. While not everyone has access to the Internet, 90% of Americans have a mobile phone.” Mathematica is conducting an evaluation of the initiative that will look at the characteristics of women who used text4baby, assess their experience with the initiative, and determine whether text4baby is associated with timely access to prenatal care and healthy behaviors. The results could have implications for mobile information services designed to increase access to varied public benefit programs.
What may define the future of benefits access initiatives most prominently is the manner in which states implement the electronic enrollment and data exchange provisions of the ACA. While primarily intended to bolster participation in health insurance programs, DHHS guidance is clear about its intention to encourage seamless integration of all health and human services programs, particularly SNAP and TANF, over time.
This effort to catalog existing benefits access efforts highlights an evolving convergence of federal, state, and private efforts to use technology to reduce the administrative burden and cost of public benefit programs as well as support low-income individuals and families in times of need. The scan captures these efforts as they are at one point in time, but they will likely continue to evolve and expand. As implementation unfolds, it will be essential to monitor the implications of program innovations not only on benefits access but also on the related issues of privacy, data security, administrative costs and efficiency, and program accuracy.
2010 CHIPRA Annual Report: connecting Kids to Coverage. Available at [http://www.insurekidsnow.gov/professionals/reports/chipra/2010_annual.p…]. Accessed March 1, 2011.
Burman, L., and D. Kobes. “EITC Reaches More Eligible Families Than TANF, Food Stamps. Tax Notes. Washington, DC: Tax Policy Center, 2003.
Centers for Medicare and Medicaid Services. “FY 2010 CHIPRA Outreach Grantees Summaries.” Available at [http://www.cms.gov/CHIPRA/Downloads/Grantees.pdf]. Accessed March 1, 2011).
Centers for Working Families. “An Integrated Approach to Fostering Family Economic Success: How Three Model Sites Are Implementing the Center for Working Families Approach.” Baltimore, MD: The Annie E. Casey Foundation, 2010.
Department of Health and Human Services. “Patient Protection and Affordable Care Act Section 1561 Recommendations: Toward a More Efficient, Consumer-Mediated and Transparent Health and Human Services Enrollment Process,” 2010. Available at [http://healthit.hhs.gov/pdf/electronic-eligibility/aca-1561-recommendations-final2.pdf]. Accessed on February 22, 2011.
Families and Work Institute. “Supporting Work Project: About the Project.” Available at [http://familiesandwork.org/site/work/projects/supportingwork/about.html]. Accessed on March 1, 2011.
Government Accountability Office (GAO). “Means Tested Programs: Information on Program Access Can Be an Important Management Tool.” GAO‐05 321. Washington, DC, 2005.
Heberlein, Martha, Tricia Brooks, Jocelyn Guyer, Samantha Artiga and Jessica Stephens. “Holding Steady, looking Ahead: Annual Findings of a 50-State Survey of eligibility Rules, Enrollment and Renewal Procedures, and Cost Sharing Practices in Medicaid and CHIP, 2010-2011.” Kaiser Commission on Medicaid and the Uninsured. January 2011. Available on the Kaiser Family Foundation’s website at [http://www.kff.org/medicaid/upload/8130.pdf].
Kaiser Family Foundation. “Explaining Health Reform Eligibility and Enrollment Processes for Medicaid, CHIP, and Subsidies in the Exchanges.” Publication #8090. Menlo Park, CA, August 2010. Available on the Kaiser Family Foundation’s website at [www.kff.org].
Leftin, Joshua. “Trends in Supplemental Nutrition Assistance Program Participation Rates: 2001 to 2008.” Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Office of Research and Analysis, 2010.
Miller, Cynthia, Betsy L. Tessler and Mark Van Dok. “Strategies to Help Low-Wage Workers Advance: Implementation and Early Impacts from the Work Advancement and Support Center (WASC) Demonstration.” MDRC, June 2009.
National Center for Benefits Outreach and Enrollment. “Person-Centered Benefits Access: Lessons Learned from the Benefits Enrollment Centers’ First Year.” Washington, DC: National Council on Aging, 2010.
O’Brien, Doug, Kimberly Prendergast, Eleanor Thompson, Marcus Fruchter, and Halley Torres Aldeen. “The Red Tape Divide: State-by-State Review of Food Stamp Applications.” America’s Second Harvest, 2000.
President's Advisory Council on Faith-Based and Neighborhood Partnerships. “A New Era of Partnerships: Report of Recommendations to the President.” March 2010.
Shahin, Jessica. “Improving Access to SNAP Through Broad-Based Categorical Eligibility.” Food and Nutrition Service Memorandum. September 30, 2009.
The Children’s Partnership and Kaiser Commission on Medicaid and the Uninsured. “Express Lane Eligibility Efforts: Lessons Learned from Early State Cross-Program Enrollment Initiatives.” Washington, D.C.: Kaiser Family Foundation, August 2009. Available at [http://www.kff.org/medicaid/upload/7956.pdf].
U.S. Department of Health and Human Services (DHHS), Office of the Assistant Secretary for Planning and Evaluation. “Indicators of Welfare Dependence. Annual Report to Congress, 2008.” Accessed August 17, 2009, at http://aspe.hhs.gov/hsp/indicators08/report.pdf.
Waters Boots, S. “Improving Access to Public Benefits: Helping Eligible Individuals and Families Get the Income Supports They Need. Ford Foundation, Open Society Institute, & Annie E. Casey Foundation, 2010.
- First, 15 of the identified efforts promote access solely to CHIP and Medicaid for children, and we characterized these as being targeted to families with children.