Brief Customer Service Experiences and Enrollment Difficulties Vary Widely across Safety Net Programs
Marla McDaniel, Michael Karpman, Genevieve M. Kenney, Heather Hahn, Eleanor Pratt
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Applying for federal safety net programs is often confusing, burdensome, and stigmatizing for families in need of immediate assistance to access food, housing, health care, and other essentials. In this brief, we used nationally representative data from the Urban Institute’s Well-Being and Basic Needs Survey to examine the customer service and enrollment experiences of nonelderly adults who reported their families applied for or participated in one or more safety net programs in 2021. We also examined experiences with the two programs with the largest enrollment, Medicaid/the Children’s Health Insurance Program (CHIP) and the Supplemental Nutrition Assistance Program (SNAP), among groups that have experienced long-standing inequities by focusing on differences by race, ethnicity, disability status, and history of diagnosed mental health conditions.

Our key findings are the following:

  • A majority of adults (55.1 percent) in families with incomes up to 400 percent of the federal poverty level reported that their families applied for or participated in at least one of seven types of safety net programs in 2021. The shares who applied or participated were higher among groups experiencing greater needs and greater structural and economic barriers, including people with lower incomes, people with disabilities, and Black/African American and Hispanic/Latinx people.
  • Customer service and enrollment experiences varied widely across programs. For instance, the share of adults reporting that program staff never or only sometimes treated them or their family members with courtesy and respect was highest for Temporary Assistance for Needy Families (TANF) and unemployment insurance (41.0 percent and 38.2 percent, respectively) and lowest for Medicaid/CHIP (18.1 percent).
  • More than 4 in 10 adults reported one or more enrollment difficulties with unemployment insurance, TANF, and SNAP, such as trouble with determining eligibility, providing required documentation, and getting benefits when needed. About 3 in 10 adults reported enrollment difficulties for Medicaid/CHIP, Supplemental Security Income, Social Security Disability Insurance, and rental assistance programs.
  • Hispanic/Latinx adults were more likely than non-Hispanic/Latinx white and Black/African American adults to report enrollment difficulties with Medicaid/CHIP and SNAP.
  • Adults with disabilities were more likely than those without disabilities to report Medicaid/CHIP program staff never or only sometimes treated them with courtesy or respect and to report not getting Medicaid/CHIP benefits as soon as needed. Likewise, we find that adults with a history of diagnosed mental health conditions were more likely than those without diagnosed mental health conditions to report experiencing poor treatment by program staff and not getting Medicaid/CHIP benefits as soon as needed.

In 2021, the Biden administration issued two executive orders focused on improving customer experiences in public programs and addressing racial and other inequities in access to opportunities and benefits available through federal programs and policies. In both areas, the survey results show that federal safety net programs have room to improve. Despite statutory and funding constraints that limit the ability to implement some changes through executive action, federal and state policymakers and agencies have significant authority over procedures that can improve program access and customer service experiences. Policies and practices that encourage respectful treatment and equitable access can reduce the barriers that prevent many families from meeting their basic needs.

Research Areas Social safety net Race and equity Disability equity policy
Tags Families with low incomes From Safety Net to Solid Ground Medicaid and the Children’s Health Insurance Program  Supplemental Nutrition Assistance Program (SNAP) Housing subsidies Racial barriers to accessing the safety net Supplemental Security Income (SSI) Temporary Assistance for Needy Families (TANF) Unemployment and unemployment insurance Welfare and safety net programs Disability Insurance
Policy Centers Health Policy Center Center on Labor, Human Services, and Population
Research Methods Data analysis Data collection Quantitative data analysis
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