As noted in Chapter I, efforts that entail web-based technology are often essential components of a more comprehensive initiative to expand access to benefits. We identified several broad initiatives that incorporate one or more of the efforts included in the scan.
Benefits Enrollment Centers. This community-based initiative has been in operation since March 2009 with grant funding from the Administration on Aging. Sponsored by the National Center for Benefits Outreach and Enrollment (the Center) within the NCOA, it uses a personalized, technology-based assistance model to promote access to benefit programs for seniors and younger adults with disabilities in 10 areas around the country. The Center established and supports local Benefits Enrollment Centers (BECs), which are tasked with helping these individuals find and apply for all the benefits programs for which they are eligible. According to a recent report on the initiative’s first year of operations (National Center for Benefits Outreach and Enrollment 2010), the programs include:
- Medicare Extra Help (or Low-Income Subsidy, LIS)
- The Medicare Savings Programs (MSP)
- State Pharmacy Assistance Programs (SPAPs, where applicable)
They may also include SSI, state property tax relief, and pharmaceutical manufacturer-sponsored patient assistance programs, among others. To conduct screenings and assist clients in submitting applications for multiple benefit programs, BECs use web-based decision tools. The Center encourages BECs to use BenefitsCheckUp, in particular, as appropriate in their work. Launched in 2001, NCOA’s BenefitsCheckUp is a free, comprehensive online benefits screening tool that contains over 2,000 federal, state, local, and private benefits programs.
“Community mapping” is also essential to the BECs’ person-centered approach to outreach and enrollment. It involves identifying the right community partners to engage in the outreach and enrollment process and working with them to determine which outreach and enrollment strategies will be the best fit for a given community. Community mapping is also central to a BEC’s ability to build service capacity and achieve a seamless referral process for clients from one community partner to the next. It is expected that both expanded capacity and coordination between partners could provide the foundation for sustaining this benefit access initiative once the grant has ended.
Centers for Working Families. Operating in more than 20 cities and regions across the country, Centers for Working Families (CWF) is designed to help low-income families increase their earnings and income, reduce their financial transaction costs, and build wealth for themselves and their communities. While conceptualized and initially funded by the Annie E. Casey Foundation, CWF has garnered additional financial support from other national and local foundations as well as public agencies, businesses, and other sources. As described in a recent report on how three of the sites are implementing the approach (Centers for Working Families 2010):
“The CWF approach revolves around intentionally offering clients a set of focused services in three overlapping areas:
- Employment – including assistance with job readiness, job placement, occupational skills training, education and career advancement.
- Benefits and work supports – helping clients gain access to public benefits [through use of online screeners], tax credits, financial aid and other benefits to improve their financial security.
- Financial services – workshops, classes, one-on-one counseling and access to well-priced financial products and services to help clients improve their household finances and build assets.”
Organizations implementing the model use a variety of technologies such as EarnBenefits, HelpEngen, SingleStop, and The Benefit Bank to connect clients to additional sources of income.
The Supporting Work Project. Launched by the Ford Foundation in 2007, The Supporting Work Project is managed by the Families and Work Institute. Designed to form partnerships between employers, community-based programs, and public leaders, the project’s ultimate objective is to help low- to moderate-wage employees succeed at work and at home. To meet this objective, the project seeks to increase the number of eligible employees who use publicly and privately funded work supports. According to a description of the initiative on the Families and Work Institute website (www.familiesandworkinstitute.org 2011), the nine local and two national project grantees work with employer partners to help program participants secure a range of benefits and services, including:
- “Government-funded means-tested work supports such as Food Stamps [SNAP], Medicaid, State Children’s Health Insurance Program, and child care subsidies. These benefits largely target the lowest-income families.
- Free tax preparation and tax credits such as the Earned Income Tax Credit, Child Tax Credit, and the Dependent Care Tax Credit. Free tax preparation and these tax credits are generally available to families earning more moderate incomes.
- Benefits and services provided by other public and private entities in communities such as food banks, low-cost prescriptions, tuition assistance, and financial products adapted to their needs. Many of these programs have the advantage of having no income ceiling for participation.
- Employer-sponsored benefits including health care, retirement, resource and referral, etc.
- Financial counseling and financial literacy training that helps families avoid predatory financial systems and use the income they have earned in ways that are more likely to improve their economic stability and security.”
Grantees and employers use a variety of technologies to identify those who are eligible for means-tested and other benefits, and to support them through the application process. Examples include Help Engen, EarnBenefits, and ArizonaSelfHelp.org (a version of OregonHelps).
Work Advancement and Support Center Demonstration. The purpose of the Work Advancement and Support Center (WASC) Demonstration, developed by MDRC, is to help low-wage workers increase their incomes. In addition to employment stabilization and advancement services, the demonstration “provides easier access to a range of financial work supports for which workers may be eligible, such as child care subsidies, food stamps, and the Earned Income Tax Credit” (Miller et al. 2009). Demonstration sites are located in Dayton, Ohio; part of San Diego County, California; Bridgeport, Connecticut; and Fort Worth, Texas. The sites aim to offer clients intensive career and advancement coaching and increased access to financial work supports through, among other strategies, partnerships with employers. These work supports include SNAP, public health insurance, child care subsidies, and the EITC and other tax credits. One of the tools program staff use in their efforts is the Work Advancement Calculator, which is based in part on OregonHelps. The calculator not only estimates eligibility and benefits, but also quantifies the changes in income that would result from specific advancement moves, taking into consideration the loss of work supports and the increase in taxes. While the calculator was intended to be a tool first and foremost to support advancement decisions, WASC career coaches more often used it as a tool to facilitate and support clients through the benefits application process.
Cycle I and Tribal CHIPRA Outreach and Enrollment Grants. The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 together with the ACA provided a total of $140 million for grants to support outreach activities and enrollment of children who are eligible for Medicaid or CHIP and to keep them enrolled for as long as they qualify. In September 2009, CMS awarded $40 million to 68 grantees across 42 states, and in April 2010, CMS awarded $10 million to 41 tribal organizations in 19 states. Several grantees are utilizing web-based efforts identified in this scan, along with other outreach efforts, as a key strategy for reducing application and enrollment barriers. For instance, the Pima Community Access Program in Arizona is using Health-e-Arizona; Community Health Care, Inc. in Connecticut is using HelpEngen; Inter-Faith Ministries Wichita Inc. in Kansas is using the Kansas Benefit Bank; and several grantees are using their state’s publicly hosted efforts such as inRoads in West Virginia, ACCESS in Wisconsin, and FAMIS in Virginia. Other grantees are developing their own technologies. For instance, the Maryland Department of Health and Mental Hygiene is using its grant in part to “expand new technology-based eligibility and enrollment systems for the use of an online application tool which will provide real time decisions for Medicaid and CHIP applications” and the Oklahoma Health Care Authority is using its grant to pilot an online enrollment and eligibility program titled No Wrong Door, which allows the user to complete an application online and then determines eligibility (Centers for Medicare and Medicaid Services 2011). CMS recently announced the availability of an additional $40 million in outreach and enrollment grant funding, as described in more detail in section IIB below.
Connecting Kids to Coverage. One year after enactment of CHIPRA, DHHS Secretary Kathleen Sebelius “issued the Connecting Kids to Coverage Challenge, calling upon leaders at all levels of government and the private sector to find and enroll the nearly five million uninsured children eligible for Medicaid and CHIP and keep them covered for as long as they qualify” (2010 CHIPRA Annual Report: Connecting Kids to Coverage). In response, states have launched unprecedented efforts to insure low-income children and families including eligibility expansions, simplified enrollment and renewal procedures, outreach, and use of technology to promote access. According to the 2010 CHIPRA Annual Report, with respect to the latter, “Nearly two-thirds of states (32) have an on-line application that can be submitted electronically; 29 states allow electronic signatures on those applications. Six states have received approval to enroll children through the “Express Lane Eligibility” (ELE) option created by CHIPRA. Thirty-three states are utilizing the CHIPRA data matching process provided by the Social Security Administration to confirm U.S. citizenship for children.”
Maximizing Enrollment. As described on its website, “Maximizing Enrollment is a $15 million initiative of the Robert Wood Johnson Foundation (RWJF) launched in June 2008 and directed by the National Academy for State Health Policy (NASHP). The four-year program will help states improve their systems, policies, and procedures by providing them with an in-depth assessment of the strengths and weaknesses of their current Medicaid and CHIP enrollment and retention systems, and assisting them with implementation strategies to cover more eligible but unenrolled children and to measure their progress. The program aims to increase enrollment and retention of eligible children into Medicaid and CHIP programs and to establish and promote best practices among states in this area.” (http://www.maxenroll.org/page/about). The eight states awarded grants—AL, IL, LA, MA, NY, UT, VA, and WI—have taken varied approaches to increasing enrollment including simplifying enrollment and renewal procedures and using technology to overcome administrative barriers. As an example of the latter, IL has begun a multi-stage technology upgrade project designed to “transform access and customer services for families seeking public benefits” (http://www.maxenroll.org/grantees/illinois). The IL Healthcare and Human Services Framework Project is a collaborative effort across seven IL state agencies to develop an integrated, effective and efficient system that will increase access to services, while streamlining and standardizing processes across programs. The project will re-design and streamline application, eligibility, casework and provider management processes and provide additional benefits access points (for instance, through a web portal, call centers, and community one-stop centers).