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Integrating Health and Human Services Programs and Reaching Eligible Individuals Under the Affordable Care Act


Implementation of the Affordable Care Act presents an historic opportunity to get more eligible, low-income Americans enrolled in human services programs and covered by health insurance, and to streamline and integrate health insurance affordability and human services programs. In 2012, ASPE’s Office of Human Services Policy and Office of Health Policy co-funded the research project, “Integrating Health and Human Services Programs and Reaching Eligible Individuals Under the Affordable Care Act,” to support Affordable Care Act implementation by exploring these opportunities for integration and outreach. The information generated through this work will help inform state efforts toward program integration and outreach and enrollment activities. If such state efforts succeed, they could lower barriers to program participation, reduce the proportion of public spending needed for program administration, improve the accuracy of eligibility determination, and strengthen low-income families’ capacity to achieve self-sufficiency.

The study’s main objectives included:

  • Identifying ways in which Affordable Care Act changes can help bring eligible individuals into human services programs and ways in which human services programs can aid in identifying and enrolling those newly eligible in health insurance affordability programs, including Medicaid and subsidies available through state health insurance Marketplaces.

  • Assessing current integration and outreach efforts at the state and local levels, highlighting promising practices, and identifying ways to further integration efforts in the future.

  • Considering ways to help consumers make complex program participation choices as they navigate public benefits programs and the Marketplaces.

ASPE contracted with The Urban Institute to conduct the study, which ran from September 2012 to November 2014. The reports generated under the study are described and available below. For further information on the study or its products, please contact Alana Landey, the ASPE Project Officer, at or (202) 401-6636.


Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act, December 2013. This report presents information on overlaps in eligible and participating populations in various health and human services programs, and identifies three main human services programs – the Supplemental Nutrition Assistance Program (SNAP), the Low Income Home Energy Assistance Program (LIHEAP), and the Earned Income Tax Credit (EITC) – as having considerable overlap with health insurance programs and high potential for possible integration and coordination efforts in states that implement the Medicaid expansion. The paper’s appendix presents an analytic framework for possible data usage strategies across programs.

Examples of Promising Practices for Integrating and Coordinating Eligibility, Enrollment and Retention: Human Services and Health Programs under the Affordable Care Act, July 2014. This paper presents findings from case studies of selected state-level integration and coordination approaches under the ACA and identifies areas of notable success or potential which may be of interest to other states.

Using Behavioral Economics to Inform the Integration of Human Services and Health Programs under the Affordable Care Act, July 2014. This paper examines opportunities to apply findings from behavioral economics and decision-making theory to two specific health/human services program interaction contexts: using targeted enrollment strategies to get SNAP recipients into Medicaid, and encouraging individuals seeking health insurance through state Marketplaces to apply for SNAP.

Opportunities under the Affordable Care Act for Human Services Programs to Modernize Eligibility Systems and Expedite Eligibility Determination, July 2014. This paper summarizes opportunities for states to utilize time-limited federal cost-sharing to modernize human services program eligibility systems and to use data from health programs to streamline eligibility determination for human services.

Integrating Health and Human Services Programs and Reaching Eligible Individuals under the Affordable Care Act: Final Report, February 2015. This report provides an overview of findings from the various elements of the project and summarizes the challenges and prospects for integration in the future.