When people in the US have difficulty meeting basic needs, they may turn to public benefits, such as cash assistance through Temporary Assistance for Needy Families (TANF) or public health insurance through Medicaid or the Children’s Health Insurance Program (CHIP). Whether people receive the assistance they are eligible for, and how they feel about it, may depend in part on the application processes and their customer service experiences. To better understand the experiences of people applying for public benefit programs and their perceptions of good and bad customer service within those programs, in 2022, we interviewed 27 adults who had applied for or received TANF cash assistance or Medicaid/CHIP in 2021 and reported at least one of four specified enrollment challenges.
Key questions and findings include the following:
- How did people learn they might qualify for assistance, to what extent did applicants seek help from others in completing the application process, and how long did the application process take?
- People we interviewed had varied knowledge about the programs before trying to enroll. They learned about the programs and eligibility requirements through various sources, including other public programs. Some applicants reported learning about eligibility and/or seeking help with application processes from other people, but most applied on their own. Many people felt there was a lack of clarity around eligibility requirements and whether they met those requirements.
- About half of interviewees reported having a disability, and several discussed finding out they were eligible for Medicaid when applying for Supplemental Security Income. Qualifying based on disability may have affected their enrollment processes.
- What challenges did people describe when applying for or renewing Medicaid/CHIP or TANF?
- People reported several challenges applying for, enrolling in, and renewing Medicaid/CHIP or TANF, including difficulties finding information about how to complete applications, unclear documentation requirements, long waiting periods and tight timelines to submit documentation, and frustrating renewal processes.
- Some people reported that these challenges caused delays in obtaining needed help and had negative consequences on their lives.
- What advantages and disadvantages did people report about various ways of interacting with the program?
- Though applicants reported various experiences with phone, online, and in-person systems and advantages and disadvantages of each, no one way of interacting was preferred by everyone.
- How did people characterize good and bad customer service when interacting with public benefit programs?
- Interviewees highlighted staff characteristics like kindness, friendliness, patience, empathy, and understanding when describing good customer service. They also wanted staff and agencies to be free of errors and to provide clear communication about program rules.
- To what extent did application processes and program rules seem fair, and how did applicants’ customer service experiences affect their perceptions of government more generally?
- Applicants had mixed feelings about the fairness of eligibility and program rules and about their experiences’ impact on their perceptions of government more generally. Applicants described an array of positive and negative impacts as well as no impact at all.
Learning about the experiences of people facing enrollment difficulties can provide insights into the effect of such experiences on applicants and can help identify promising strategies for improving application processes. Overall, we found that negative experiences with public programs can have real impacts on applicants and enrollees, including on their immediate health, emotional state, or well-being. Such experiences can also sometimes contribute to reduced trust in government more generally. People we interviewed also identified several ways public programs can improve customer service, including by reducing paperwork requirements, increasing automatic enrollment or joint applications between programs, improving state agency websites and online application systems, and hiring and training staff to be empathetic, nonjudgmental, and committed to resolving applicants’ questions and issues.