BEYOND THE NUMBERS
Q & A: Improving the Delivery of Key Work Supports at this Critical Moment
Stacy Dean, Vice President for Food Assistance Policy, and Dottie Rosenbaum, Senior Policy Analyst, discuss improving the delivery of key work supports:
Dottie, let’s get a little context for our discussion. Can you give us a picture of poverty and need in this country?
DR: Let’s just put the need into perspective. The numbers can tell it all.
- 1.6 million people were homeless in 2009,
- 44 million people were poor in 2009,
- 50 million people lacked access to adequate food at some point in 2009, and
- Similarly 51 million people lacked health coverage in 2009.
Because of this, the federal and state governments have created a support system to allow these families food through the SNAP program, formerly food stamps, health coverage through programs like Medicaid and CHIP, the Children’s Health Insurance Program, as well as housing vouchers and other assistance to help pay for home energy bills and child care and other expenses.
These programs can be very powerful in providing families with healthier lives, more opportunities, and much more successful futures. And many of these programs, particularly SNAP and Medicaid, which can expand when need grows, have really worked to buffer families during these tough economic times.
Recently you partnered with the Urban Institute in the Work Support Strategies Initiative. You also released a major report on how federal and state governments can best coordinate and deliver services to needy families.
Stacy, tell me a little bit about the Initiative.
SD: The Work Support Strategies Initiative is going to be a demonstration project through which a group of states are going to have the opportunity to design, test, and implement an effective, streamlined, and integrated approach to delivering their key work supports for low-income families. And the programs we expect to include are health coverage through Medicaid, the SNAP program, or Supplemental Nutrition Assistance Program, formerly food stamps, and child care subsidies.
How will the initiative work?
SD: The project, which is funded by the Ford Foundation and directed by the Urban Institute, will invest $15 million over a five year period to build on recent state and federal innovations to simplify and streamline these programs. The goal is to provide these states with expert technical assistance, peer support, and financial backing to take their efforts to the next level.
What spurred this initiative?
SD: I think the main reason for how the initiative came about was some of the recent experience at the state level in dealing with increased demand for services. As a result of the downturn, millions more families have lost income or are now out of work altogether. And many of these families have turned to their state governments for help through programs like unemployment insurance, SNAP, and health coverage.
But states haven’t had more resources to deal with the increased demand. To the contrary, human services offices have seen their budgets and staff cut as millions more people have walked through the doors. Yet despite these incredibly trying circumstances, states have managed to serve all of these new families in need, and several of them have actually improved their service delivery through the downturn.
So this initiative is aimed at building upon the kinds of innovation states have undertaken to meet recent increased demand, and again, taking those efforts to a new level and to more states.
So, what’s different about this report?
SD: The Center’s been working on reports like this for many years now, and typically we focus on individual program efforts. What’s different about this report is that instead of focusing on just one program, for example how to streamline and simplify SNAP, we try to show how states have worked to improve across their package of work supports. So SNAP, Medicaid, and in some instances child care and TANF.
Of course it’s really important to try to simplify the individual programs, and many more steps can be taken there. But as states simplify individual programs, if those efforts result in three separate, uncoordinated systems, it can still be very difficult for families to navigate and obtain a package of work supports, no matter how simple each individual piece is.
So it means that some families won’t get all the help they’re eligible for, and it means that programs are asking families to run through very redundant, uncoordinated processes. So that’s frustrating, and it’s wasteful.
I know that you both traveled around the country visiting human services offices. Can you give me an example of ways in which some agencies have streamlined their processes?
DR: Some states have really worked to streamline the process for families, and at the same time provide more effective service.
For example in some states, where it used to take two to four visits to a local human services office to get SNAP and Medicaid benefits, states are now finding ways to provide same-day services. They can basically interview the family right then, the first time they come to the office, instead of making them come back. They can use the data they already have in other administrative records, instead of asking families to go home and come back with their paperwork.
And in some states, for most households, families are now able to walk out of the office the same day with their SNAP and Medicaid cards.
SD: I just want to add one point to that. What Dottie’s talking about is making the process more efficient and effective. It in no way undermines program integrity. It’s still really crucial to all states that they carefully determine whether individuals are eligible and give them the right amount, but it is possible to do it much faster and with fewer repetitive steps, making it more effective for the state and certainly a better process for needy families.
So you’ve both made the case that it’s really important to streamline these programs and streamline how these benefits are delivered to the families. How can states move in this direction?
SD: Well, I don’t think that there are any clear-cut right or wrong answers here. I mean every state has to develop solutions that work for them, given their eligibility rules, their organizational structure, the level of technology in terms of computers and call centers that they have, as well as their own workforce.
But I’ll give you one example of something that we’ve seen that seems to be an important step forward and this is on the technology side. It is a tough times with respect to state budgets but states that do have the resources to make an investment say that moving to document imaging, which allows them to go paperless, is invaluable. So a document imaging system allows a state to move to creating electronic records and in this kind of system, for example, a case worker would take an image of a person’s social security card and their driver’s license as documents to verify this person’s identity and then the case worker would never have to ask for it again because they can easily find it in an electronic record.
So going paperless makes a big difference.
DR: Here’s another example: states that have online applications are able to really shorten the amount of time or length that is appropriate any individual family spends in applying for benefits. They can tailor their online applications to just ask the questions that are relevant for a particular family’s circumstances or for the particular programs that a given family might qualify for.
What’s the bottom line of your findings from this research and the initiative?
SD: Well, I think the bottom line of what we found is that it can be simpler and easier both for eligible families to obtain and keep benefits, as well as for states to administer them. We don’t need all of the layers of paperwork and bureaucracy to ensure that benefits are paid accurately to eligible people.
And this is really crucial today; even though the recession is over from an economist measure, tens of millions of people are in need and states are not going to get any more resources to help them, so finding ways to be more efficient and effective is crucial and of course making progress on this front is going to be crucial for 2014, when under health care reform many more people are going to be eligible for coverage through the Medicaid program. They will be walking in through these states doors seeking health coverage and states have got to find a way to serve them, to connect them both to health coverage and hopefully the other services for which they’re eligible and may need.
You know another thing I’d just like to add is that we don’t always think of government as being on the cutting edge or being paragons of effectiveness but really there’s some incredibly innovative things going on at the state level. And our goal with all of this work is to share best practices across states and to ensure that state administrators, regardless of where they live have access to some of; our goal is to ensure that states have access to all of the great ideas that are out there to help them improve their systems.