Simplifying Programs

Lessons Churned: Measuring the Impact of Churn in Health and Human Services Programs on Participants and State and Local Agencies

Public benefit programs for low-income individuals and families typically require households to apply, establish eligibility, and then, at subsequent regular intervals, to re-establish eligibility. While periodically reviewing eligibility is important for ensuring that benefits are properly targeted to individuals and families that remain eligible for assistance, the redetermination process can result in eligible households temporarily losing eligibility, experiencing a short period without benefits, and then reapplying — a phenomenon sometimes called “churn.”

This paper presents preliminary lessons learned about churn derived from the states participating in the Work Support Strategies project (WSS) and other states, and highlights recent research.


State Innovations in Horizontal Integration: Leveraging Technology for Health and Human Services

Because most low-income individuals and families qualify for multiple public benefit programs, most states have a long history of using the same technology and staff to process eligibility for the means-tested programs that they administer.

This issue brief highlights examples of technology and services innovations that states are implementing in support of integration among health and human services programs and discusses common themes across efforts.

Related: Coordinating Human Services Programs with Health Reform Implementation
A Toolkit for State Agencies


Online Services for Key Low-Income Benefit Programs
What States Provide Online with Respect to SNAP, TANF, Child Care Assistance, Medicaid, CHIP, and General Assistance

Virtually all states have made basic program information on the five main state-administered low-income benefit programs — SNAP (Supplemental Nutrition Assistance Program, formerly known as Food Stamps), Medicaid, CHIP (Children’s Health Insurance Program), TANF (Temporary Assistance for Needy Families), and child care assistance — available to the public via the Internet.

This paper provides links to state information available online for these benefit programs.

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Complex and duplicative paperwork requirements prevent many low-income families — especially working families — from receiving benefits that can help them meet basic needs such as food, health care, and child care. Such requirements also add to state agency workloads and costs. The Center established the Project on Program Simplification and Coordination to make low-income programs easier both for eligible families to participate in and for states to administer.

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By producing analyses and providing technical assistance to states and others, the Project on Program Simplification and Coordination helps states:

  1. identify ways to streamline and coordinate the rules governing Medicaid, the Children's Health Insurance Program,  food stamps, child care subsidy programs, and TANF income assistance programs, and
  2. implement these changes in ways that will improve program participation rates while reducing red tape for both states and families.


Of Interest

The Center is interested in learning about innovative approaches to program simplification and alignment. If there are policies or procedures in your state that could be a model for others, please contact Stacy Dean at the Center on Budget and Policy priorities.

What Some States Are Doing

Arkansas and Louisiana use information collected by the food stamp program to renew people's Medicaid eligibility.

Oregon, Wisconsin and other states have online calculators that allow families to determine their likely benefit level.

In parts of Ohio, families applying for child care subsidies can apply for Medicaid on the same simple form.

The Medicaid applications in Maine and Nebraska ask families if they are interested in applying for other benefit programs.

Louisiana, Texas, and Washington state conduct many food stamp interviews by phone.

Utah electronically scans in applicants' documentation so they do not have to supply the same documents twice.

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