Integrating Public Assistance Programs: A Perspective from the Field

This past fall I worked with the San Diego Hunger Coalition as a fellow of the National Emerson Hunger Fellowship, which trains leaders to fight domestic hunger, poverty, and racism at both the local and policy levels.  At the San Diego Hunger Coalition we looked at how nonprofit organizations offering application assistance provide both CalFresh (SNAP) and Medi-Cal (Medicaid) programs in San Diego County, CA. We found that the best way to connect more eligible people to CalFresh and Medi-Cal is to integrate the programs: one application assister helps applicants complete a combined CalFresh and Medi-Cal application. It was a critical time to research integration practices since the implementation of the Affordable Care Act (ACA) began in October. Given the low CalFresh participation rate in San Diego County, our work aimed to help leverage the opportunities for integration that the ACA created.  It was through my experience in San Diego that I learned how streamlining CalFresh and Medi-Cal application assistance improves participants’ overall wellbeing.  

Working on the ground in San Diego gave me a lens into how public assistance programs shape the lives of the people they’re meant to help. Through interviews with CalFresh and Medi-Cal program managers and clients, I learned that many people felt marginalized during the application, eligibility, and enrollment processes. People reported that these administrative processes are so complex and time consuming that they are seemingly crafted to deter people from applying. Since most people who are eligible for CalFresh are also eligible for Medi-Cal and vice versa, applicants are required to tell their stories twice. These administrative inefficiencies are further compounded by the disrespectful treatment people received from eligibility workers. While integrating CalFresh and Medi-Cal application assistance does not erase the stigma of applying for public assistance programs, it does eliminate the duplication of stress and time for applicants and increases the likelihood that eligible people will be connected to nutrition assistance and health insurance in one sitting.

Increased funding under the ACA is making it possible for people’s experiences enrolling in public assistance programs to be improved drastically.  For instance, the federal government will match 90 percent of states’ cost to modernize and coordinate Medicaid eligibility systems through the end of 2015. To qualify, states must upgrade or design new IT systems that function to seamlessly connect people to health coverage (Medicaid, CHIP, or the exchange) and other public assistance programs.  Furthermore, for states that have opted to expand Medicaid, the federal government will fund 100 percent of states’ benefits costs from 2014 through 2016 and then gradually decrease to 90 percent in 2020 and will continue to fund 90 percent of costs thereafter.
 
California has already implemented some key administrative reforms that have resulted in better integration of CalFresh and Medi-Cal than other states. One reform, the Express Lane Enrollment (federally known as “Fast Track”), is facilitated by an ACA provision that gives states the option to apply for a waiver to use CalFresh client income information to determine Medi-Cal eligibility. By relying on CalFresh data, Medi-Cal eligibility determinations are simplified and accelerated. California has already made significant progress in enrolling CalFresh participants into Medi-Cal. In just 3 weeks they were able to sign-up 65,000 SNAP participants into Medi-Cal. Today they have signed up a total of 200,000 people for Medi-Cal through Express Lane Enrollment.
 
The success of the program is no surprise. First, most CalFresh participants are also eligible for Medi-Cal. According to the Center on Budget Policy Priorities, if all states expand Medi-Cal, 75-80 percent of all households with CalFresh (excluding elderly households and SSI participants) would be “virtually certain to be financially eligible for Medi-Cal”. Secondly, since clients do not have to fill out an additional application and the enrollment process is instant, the duplication of information, paperwork, and documentation is eliminated. An enrollment process such as Express Lane Enrollment could serve as a model for increasing participation in public assistance programs and lowering administrative costs and manual errors. Other policy changes that reduce unnecessary paper such as asset limit reform have translated to efficient gains for state agencies. Additional states implementing Express Lane Eligibility are: Arkansas, Oregon, West Virginia, and Illinois.
 
California is also working on policy reforms to maximize the opportunity the ACA has created to streamline eligibility and reporting for CalFresh and Medi-Cal. A state law, AB 191, improves alignment between CalFresh and Medi-Cal income guidelines by expanding CalFresh eligibility for households with Medi-Cal recipients. There is also legislation being passed, SB 1002, that aims to align CalFresh and Medi-Cal reporting periods. Specifically, the bill links a household’s Medi-Cal redetermination date with the household’s CalFresh certification date. Alignment between CalFresh and Medi-Cal policies has led to increased gains through improved efficiency.
 
Integrating CalFresh and Medi-Cal is critical to improve the wellbeing of people in need of nutrition assistance and health coverage. Administrative agencies also benefit since streamlining curtails administrative costs and staff time spent on eligibility and enrollment. The health of communities is also strengthened when more people have access to food security and health care. The ACA offers myriad opportunities to facilitate integration, including Express Enrollment Lane. Now is the time for more states to seize this unique and historic roll out of the ACA and connect more people to the public assistance programs they need.