Table 3.
Themes Related to Processes and Structures needed to Achieve Co-Enrollment in Public Benefit Programs.
| Theme | Description | Illustrative quotes |
|---|---|---|
| Technology Innovation and Limitations | Building integrated technology systems that allow data sharing across agencies and combined applications created efficiencies for staff and reduced burden for participants, but lack of resources made it challenging to establish. | “Our goal is to have one portal where people can come in and access all of the programs and services administered by the Agency of Human Services…and then hopefully we're connected to the child support system and exchange data there. Our child welfare system will hopefully be connected to that at some point and then our child development or childcare system as well.” -State 2 |
| “In SNAP land, folks can be eligible for a higher benefit amount if they demonstrate medical expenses. And, many times, a barrier to folks was that they had turned in those receipts and documentation to the housing authorities, and no longer had copies, or were having difficulty getting those copies, because housing uses them to reduce rent, as well. So, I believe we were the first state to take this approach, but we have the authority to print out their rental computation forms, and on it is listed the individual's medical expenses, the cumulative amount. And, instead of, say, taking each individual receipt, or whatever it is that they turn into the housing authority, we can simply use that sheet, and that streamlines the process and kind of allows us to capitalize on information that was shared with the housing authority.” – State 10 | ||
| Communication and Collaboration Across Agencies | Public benefit program administration is segmented across agencies, making establishing trusting working relationships and information sharing protocols across agencies vital to co-enrollment success. | “In terms of the co-enrollment with Medicaid, we do provide a regular data dump of all SNAP recipients to our Medicaid agencies, they [Medicaid and SNAP] are two separate agencies. At the county level, most of them are co-located although the administrations remain separate, so on the SNAP side we do have that as a priority in terms of sending the data over, and I do know that Medicaid uses that for a large portion of their eligibility.”-State 13 |
| “We have an all-programs team meeting every Thursday where they sit down, the members of the team, and go over initiatives they're working on, how they might intersect with the other program, how we could leverage those benefits of whatever that new initiative is and also are there things happening that are adversely impacting maybe something in another program […] And so we just have a really strong team here between our programs that really just makes sure we're all rowing in the same direction and doing everything we can to maximize the programs for participants and make it as easy as possible to access the programs.” State 2 | ||
| “I actually am the sponsor for [State Housing Agency] to have access into our eligibility system to get all the information they need for their determination. So we communicate constantly, we have MOUs in place, and they have direct access into our system to see what they need so they know all the information they need to use our public assistance information in their determination.” -State 8 | ||
| Federal Mandates and need for State Authority | Varying degree of state/local authority over public benefit programs both promoted and hindered co-enrollment efforts; federal oversight and mandates left states wanting additional guidance of how to align program operations. | “So in other programs, they are totally state-operated or funded. Therefore we get to choose, right? We get to say how does one qualify for this program. And then in federal programs like TANF, you tend to have more flexibility for how somebody qualifies for basic cash assistance. So in many of those cases where there is flexibility, we've chosen to align policies more so to food assistance [SNAP], for instance, where we think that that is beneficial to create administrative efficiencies.” -State 11 |
| “I honestly think that in my world, managing SNAP, sometimes it puts you at a disadvantage when you have these combined applications and when you have a combined system because your reporting requirements can be different across programs […]Although it might be better for the customer in certain ways, I think the administrative part gets a little bit tricky.” -State 2 | ||
| Political Will | Shared visions across agencies and top government leadership, data, and pressure from community organizations and advocates promote agendas and change to achieve co-enrollment. | “We have a new governor, and the secretary of the health and human services agency has placed a really high priority in terms of guiding principles and a strategic vision of integration and coordination across and between programs and really taking a person-centered approach, thinking about the person being served and how the state can best fulfill all of the needs with the full package of benefits, services and other programs that they are entitled to with minimum duplication and minimum administrative burden.” – State 5 |
| “The one thing that I will say about our state and our state agency, in particular, is that because they are so under-resourced, they don't have the luxury of having a really long attention span. And, so, emergencies come up, their attention is sort of being very frequently and rapidly diverted away from, I think, more proactive things that they could be doing.” -- State 6 | ||
| “And I know from our leadership's standpoint we are placing a very large focus on social determinants of health and insuring that everybody is receiving all the benefits to which they are eligible to help support them in maintaining the best health and outcomes that they can so that they can go on and become independent, without relying on the Department of Human Services' benefits.” – State 3 | ||
| Frontline Staff | Caseworkers and outreach staff counseling patients on eligibility can fill gaps in technology systems, but inability to determine eligibility across multiple programs and lack of knowledge can hinder efficiency. | “We do something here called ‘with informed choice’. So whenever a household first comes in and applies or does a recertification for another program, our workers are trained to look at that information they're providing to determine if they might qualify for other benefits.” -State 1 |
| “One practice that we have is we actually have a WIC technician that is sited in our lobby-two days a week to process WIC applications so that we can do warm handoffs right in our lobby for SNAP enrollees to WIC. So not really a data strategy but definitely kind of an operational strategy.” -State 11 |