Policy Common Ground: Improving State Programs to Foster Work, Well-Being, Self-Sufficiency, and Program Integrity

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Document date: April 03, 2013
Released online: April 03, 2013

Abstract

Politically diverse state governments can find common ground in a commitment to improving access to work support programs for eligible low-income families, a new Urban Institute report demonstrates.


CONTACT: Stu Kantor, (202) 261-5283, skantor@urban.org

WASHINGTON, D.C., April 3, 2013 -- Politically diverse state governments can find common ground in a commitment to improving access to work support programs for eligible low-income families, a new Urban Institute report demonstrates.

Despite tight budgets and different perspectives about the role of Medicaid, the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps), and other safety net programs, state agencies participating in the Work Support Strategies (WSS) project, funded largely by the Ford Foundation with three other funders, reported numerous early gains in its debut year.

During the planning period (spring 2011 to spring 2012) devoted to examining their delivery of work supports and piloting ways to modernize services, Colorado, Idaho, Illinois, Kentucky, New Mexico, North Carolina, Oregon, Rhode Island, and South Carolina generally took initial steps to

  • implement policy, process, and technological changes to streamline and integrate benefit programs;
  • improve county-state relationships and collaboration between health and human services agencies;
  • reduce bureaucratic burdens for working families and accelerate benefit eligibility decisions;
  • reduce interruptions in eligible families’ access to benefits and the added workload for overstretched staff;
  • use available data to enroll children in health coverage and nutrition benefits;
  • lower barriers to families’ enrollment in child care subsidies;
  • improve staff morale; and
  • prepare for changes under the Affordable Care Act (ACA) by using federal grants to modernize their health and human services computer systems.

WSS seeks to improve public programs that address a major national challenge: many parents work yet earn too little to make ends meet. When parents cannot pay for necessities or emergencies arise, they risk derailing their stability on the job and their family’s well-being. WSS builds on research underscoring the value to work and child development when families get the full package of help available, including health insurance, nutrition assistance, and child care subsidies.

At the same time, overloaded state staff, outdated computer systems, and inflexible practices pose significant barriers for smooth, effective agency operations and for working families who want to sign up for benefits. Participation in individual programs has grown in recent years, but there has been far less progress in ensuring that families receive and keep the total cluster of benefits.

“Almost all the states shared one overriding reason for their interest: they believed their pre-reform systems weren’t working,” said Olivia Golden, an Institute fellow at the Urban Institute and WSS’s principal investigator. “New approaches promised to reduce burden and administrative costs while improving timeliness and reducing errors. States also thought reforms could lead to more responsive and less bureaucratic government -- valued across party lines -- and to benefits for families, such as healthier children or parents more able to sustain employment.”

The Ford Foundation is WSS’s lead funder, committing more than $20 million. Additional funding has been provided by the Special Fund for Poverty Alleviation of the Open Society Foundations, the Kresge Foundation, and the Annie E. Casey Foundation.

Early Wins for States
From the planning year, six states -- Colorado, Idaho, Illinois, North Carolina, South Carolina, and Rhode Island -- are now in the midst of the three-year implementation phase of WSS. Among their successes in the planning year:

  • State and county staff in Colorado trimmed a 26-page application form for the Medicaid, welfare, food assistance, and adult financial-support programs to 8 pages. The planning-year report for Colorado tells more about building new links between the state and counties and between health and human services agencies.
  • Data-informed changes in Idaho to the application for child care subsidies improved processing and reduced the number of eligible families losing assistance during recertification. The planning-year report details these and other improvements, such as the redesign of a family-focused eligibility review process that captures and verifies information in a single interaction to reduce administrative burden and keep eligible families from inadvertently losing medical and nutrition benefits.
  • In three Illinois pilot offices, the goal was to move from crisis management to process management by realigning workers’ tasks. Early signs show much quicker service delivery. Illinois’ report shows how the state approached transforming local office practices in the face of overwhelming caseloads.
  • North Carolina conducted a pilot program in two counties to align certification periods for clients’ SNAP and Medicaid benefits, reducing worker and client burdens and helping keep eligible families enrolled. The state then encouraged other counties to take up this innovation, reflecting its state-county approach to creating change as described in the planning-year report.
  • Rhode Island’s Providence office implemented same-day service to SNAP applicants, enabling certain clients to obtain benefits with just one visit. The state’s report charts its focus on changing the “as is” -- how its policies worked in practice -- to a more integrated and family-friendly future.
  • South Carolina’s Express Lane Redetermination helped sustain health coverage for tens of thousands of children and is projected to save $1 million a year, by using data in families’ SNAP records to certify children’s eligibility. As described in South Carolina’s report, this collaboration between previously isolated health and human services agencies exemplified a new vision of seamless services for families.

Lessons Learned
With passage of the ACA, a key question was whether states could maintain their commitment to integrating health and human services programs while meeting timelines for ACA implementation. In fact, most WSS states have redoubled their commitment to integration. New federal money to modernize computer systems allows states to improve technology for multiple programs at once, and policy and data assessments conducted for WSS showed that jointly streamlining programs is more efficient than changing rules one program at a time.

States also learned about what it takes to carry out reform. Despite multibillion-dollar programs under their leadership, state agency executives generally faced great barriers to data-informed management at the outset. Making progress required not just better technology to produce better data but also improvements to staff capacity and culture, such as facilitating data-sharing among technical and policy experts, state executives, and managers in county or local offices.

Strong leadership at all levels -- from political appointees to long-time career staff deep in the agencies -- helped move these reform agendas forward. But state team members interviewed for the evaluations also emphasized the role of flexible resources from WSS in supporting basic project management, particularly the ability to keep busy state executives on track. And they felt that technical assistance from national experts and the opportunity to exchange learning with peers are also crucial. The common theme: relatively small investments in staff capacity and support can help leverage major improvements in large public programs.

The Work Support Strategies Initiative
WSS is directed by the Urban Institute in partnership with the Center on Budget and Policy Priorities, which leads technical assistance to the states. States participating in the planning year received $250,000 grants each, plus individualized consultations, training, and technical assistance. During the three-year implementation phase, the annual grants range from $400,000 to $500,000.

Urban Institute researchers are evaluating each state’s efforts during the planning and implementation periods. State reports documenting the planning year can be found here. Olivia Golden’s “Early Lessons from the Work Support Strategies Initiative: Planning and Piloting Health and Human Services Integration in Nine States” distills and comments on the nine state evaluations.

The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic, and governance challenges facing the nation. It provides information, analyses, and perspectives to public and private decisionmakers to help them address these problems and strives to deepen citizens' understanding of the issues and trade-offs that policymakers face.



Topics/Tags: | Children and Youth | Families and Parenting | Health/Healthcare | Poverty, Assets and Safety Net


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