The Application Process For TANF, Food Stamps, Medicaid, and SCHIP. Chapter 1. Introduction


The Personal Responsibility and Work Opportunity Act of 1996 (PRWORA) made major changes to the nation’s safety net, and since its enactment, there has been some interest in factors associated with access to public benefits. This report explores one key dimension of accessing benefits — the application and eligibility determination process — with special emphasis on what this process entails for two overlapping populations: immigrant families and limited English speakers.

Several factors have been mentioned as indicating a need to better understand how individuals generally gain access to public benefits, and how the process may present different issues for human service agencies, immigrants, and limited English speakers. For example, there were relatively significant declines in Food Stamp Program (FSP) and Medicaid caseloads after PRWORA, and some speculated that at least some of the declines could be attributed to consequences of welfare reform changes. Overall, the declines in these programs as well as even larger declines in the TANF caseload have reinforced the interconnected nature of Medicaid, FSP and TANF participation and the recognition that changes affecting access to one public benefit program may impact access to other programs (Weil and Holahan 2002; Zedlewski 2001).

Efforts to promote work and reduce dependency on cash assistance under the Temporary Assistance for Needy Families (TANF) program have increased awareness of the important work support role of food stamps and medical assistance, and have provided impetus for implementing policies and procedures that make application for and participation in these programs more accessible to low-income, working families. At the same time, some contend that some program practices dissuade otherwise eligible families from applying for TANF and/or these other work supports (Maloy et. al. 1998).

On the other hand, the State Children’s Health Insurance Program (SCHIP), enacted in 1997, acted as a catalyst for developing simplified and streamlined up-front intake procedures in order to expand health insurance for uninsured children. These efforts were correlated with rising Medicaid and SCHIP enrollments, underscoring the relationship between up-front procedures and practices, and program participation.

Finally, recent analyses (Fix and Passel 2002) of public benefits use by legal immigrant families (many of which have citizen children) show that while low-income, legal immigrant families with children had lower use rates for TANF and food stamps than their low-income citizen counterparts in 1999, Medicaid use rates did not vary by citizenship. While not fully understood, this inter-program variation in participation raises the possibility that at least some of the variation may be due to differences between the application and eligibility determination processes of TANF and food stamps, compared to Medicaid-only applications. (For a description of which immigrants are eligible for federal and state benefits, see page 2-2 below.)

The increasing number and diversity of immigrants in different areas of the country has increased demand on agencies providing public benefits and services to structure their service delivery system in ways that adequately address the communication issues related to limited English speakers. To date there has been relatively little information available on the types of language accommodation strategies currently in use and the types of challenges and trade-offs they present for both human services agencies and limited English speakers who need to access these benefits.

This report examines application procedures and practices for four federal benefit programs — TANF, FSP, Medicaid, and SCHIP — in six local sites across the country. Of special interest is how systemic or administrative factors embedded in various application processes may generally facilitate or exacerbate access to benefits by eligible families, and, in particular, eligible immigrant and/or limited English speaking families.

The discussion and findings presented in this report are based primarily on the following activities conducted at each site: in-person and telephone discussions with program staff and relevant community-based organizations; observations of intake and application procedures; reviews of written materials such as policy manuals, outreach plans, and application forms; and (in three sites) group discussions with non-citizen and limited English proficient individuals who had applied for any of the four programs. Site visits took place during the period of June 2001 through December 2001 in the following six localities: Arlington (VA), Dallas (TX), New York (NY), Raleigh (NC), Seattle (WA), and Sedalia (MO).1

The remainder of this report is organized as follows:

  • Chapter Two provides background demographic and policy context for the study, including immigration trends, diversity of languages spoken in the six study sites, and federal welfare reform provisions affecting non-citizen eligibility.
  • Chapter Three describes local-level benefit application processes and procedures in the six study sites from the point at which a person initiates the application process to the point at which the application is reviewed and verified for eligibility determination purposes.
  • Chapter Four examines written application forms, comparing integrated and stand alone program applications and highlighting specific aspects of the application forms that may have a special impact on non-citizens.
  • Chapter Five discusses the eligibility documentation and verification practices that have special relevance for non-citizens, including the application of non-citizen eligibility rules.
  • Chapter Six discusses the prevalence and types of language assistance strategies used in the study sites to help overcome communication difficulties encountered by limited English proficient individuals applying for public benefits.

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