As technologies advance at ground-breaking speed, it is difficult to imagine what the future holds for web-based benefits access tools and how their implementation will specifically affect vulnerable subgroups of the low-income population. The next generation of efforts will likely include applications for smart phones that provide benefit program information, screeners, calculators, and electronic application forms. The seeds for benefits access efforts using smart phones have already been planted through initiatives such as text4baby, a free mobile information service designed to promote maternal and child health. According to promotional materials (see http://www.text4baby.org), "Mobile phones have potential to play a significant role in health care by delivering information directly to those who need it most... and can be particularly helpful in reaching underserved populations. While not everyone has access to the Internet, 90 percent of Americans have a mobile phone." Mathematica is conducting an evaluation for the HHS Human Resources and Services Administration that will look at the characteristics of women who used text4baby, assess their experience with the initiative, and determine whether it is associated with timely access to prenatal care and healthy behaviors. The results could have implications for mobile information services designed to increase access to varied public benefit programs among other specific audiences, such as veterans, limited English speakers, and low-income students. Furthermore, mobile information services could also be used in outreach efforts to provide populations with limited access to broadband connections easier physical access to the benefits application process. For example, outreach workers carrying mobile information services could assist homeless populations, rural populations, and seniors to apply for programs through those devices.
The next generation of web-based benefits access efforts will undoubtedly be influenced by the Patient Protection and Affordable Care Act of 2010, which allows for the expansion of Medicaid coverage to include millions of previously ineligible Americans and establishes state exchanges for purchase of private insurance. This piece of legislation presents states with tremendous opportunities to reach and more holistically serve previously untapped low-income populations. While focused on Medicaid and CHIP, the Affordable Care Act encourages states to streamline access to human services as well as health programs. The extent to which states take advantage of these opportunities may be driven by resources (both financial and time), state priorities, and existing context within a state (for instance, whether health and human services programs currently share eligibility systems, and the history of administrative collaboration). The opportunities will also be shaped by the regulations issued by the HHS Centers for Medicare & Medicaid Services. For instance, the Affordable Care Act requires states to use either a single streamlined application for Medicaid and CHIP developed by HHS, or their own application with supplemental forms approved by HHS.
Engaging the millions of newly eligible individuals in Medicaid and other services presents enormous challenges. Web-based benefits access tools may become important methods of engaging the newly eligible population. This population will most likely include many of the vulnerable subgroups discussed in this paper, who face specific barriers in using web-based benefits access tools. Currently, the uninsured relative to the insured population are more likely to be young adult males, unmarried, childless, high school dropouts, Hispanic, and foreign-born noncitizens (O’Neil and O’Neil 2009). About a third of the uninsured nonelderly population comes from low-income families; about two-thirds have no college education, and more than one-quarter did not graduate from high school. About half of the uninsured are racial and ethnic minorities (Kaiser Commission on Medicaid and the Uninsured 2006). In order to take advantage of web-based tools, many of the newly eligible individuals, as well as currently eligible people, will need web-based tools that take these population characteristics into account, and even so may need consumer assistance available through various channels.
Entities working to engage the newly eligible population in benefits services may do well to consider some of the strategies discussed in this paper to help target specific subgroups of this population. While there are no rigorous evaluations proving that any of the strategies presented in this paper work, they do represent some of the most widespread and potentially promising methods used for engaging vulnerable subpopulations. Broadly speaking, three strategies appear to have considerable potential for engaging vulnerable subpopulations. These strategies, which follow, can be used alone but may be more beneficial when used together.
- Partnerships with CBOs. Because of the greater challenges that many subgroups of the low-income population experience (the most pervasive being low levels of digital and general literacy), it is helpful for trained counselors to walk clients through the web-based application process.
- Linguistically Appropriate Tools. Web-based benefits access tools that are culturally and linguistically representative of the populations they serve and written at the appropriate level of user literacy may be more successful in engaging the increasing population of limited English language speakers and others with lower levels of literacy.
- Mobile Outreach. Many vulnerable subgroups of the low-income population—including rural populations, homeless populations, and home-bound seniors—lack access to the Internet. Mobile outreach and application assistance can bring web-based benefits access tools to those who, for various reasons, may not be able or willing to engage with other service providers.