Applying for TANF, food stamps, Medicaid, or SCHIP can be a relatively simple and straightforward process or it can be a more complex process involving numerous steps, multiple visits, or visits to multiple offices. Any difficulties faced by individuals attempting to navigate the application process are compounded for non-citizens and limited English speakers. To fully appreciate the application experiences of non-citizens and other limited English speakers who face unique eligibility rules and language issues, it is important to understand the application process facing all individuals, regardless of their English proficiency or immigration status.
The type of assistance sought and the way in which the process is designed and implemented at the local level largely dictates the particular steps and procedures that make up the application process. Individuals applying for cash assistance, or TANF, typically apply for a full package of benefits, including food and medical assistance (i.e., food stamps and Medicaid). This is the traditional welfare package (referred to here as TANF/FSP/Medicaid), and the integrated application process associated with obtaining this package has, until recently, been the primary path to accessing any of these programs.
The establishment of SCHIP and Medicaid-expansion programs spurred the development of different application pathways to coverage under these programs that may have much, little or nothing in common with the traditional TANF/FSP/Medicaid application process. Under federal law, the SCHIP program provides states with the flexibility either to use the pre-existing Medicaid infrastructure or to adopt a stand-alone program for enrolling recipients, or a combination of the two. Among the study sites, one state (Missouri) chose to expand their existing Medicaid program; three states (North Carolina, Virginia, and Washington) chose to create a separate SCHIP program; and two states (New York and Texas) chose to combine both approaches. States may also accept electronic, mail-in, or telephone SCHIP applications and rely on private contractors to facilitate application and eligibility determination. The degree to which states have chosen to combine SCHIP and Medicaid-expansion programs, including providing an integrated application process, varies. In addition, there can be separate Medicaid-only and/or food stamp-only application processes that have their own distinct features.
Overall, there is considerable variation in program application processes across the study sites (and even across offices within sites) as well as across programs.1 For the applicant, the SCHIP application process is typically the most simple and least burdensome to complete and the same is often, but not always, true of Medicaid-only application processes.2 By contrast, the integrated TANF/FSP/Medicaid application process is the most complicated with respect to the number of steps, activities and (sometimes) trips required. Among our sites, the TANF/FSP/Medicaid application process is the simplest in Seattle and the most complicated in New York City.
This chapter describes benefit application procedures from the point at which a person initiates the application process to the point at which the application is ready to be reviewed and verified for eligibility determination purposes. First, an overview of initial points of entry to the application process is provided. A typical application process is then described, focusing primarily on: (1) where application activities take place, and (2) what the process entails. This is followed by a more in-depth description of how these two key dimensions of the application process play out in each of the study sites.