Content by Keyword: Integration of Health and Human Services

Fredric Blavin, Stan Dorn, and Jay Dev are, respectively, a Senior Research Associate, Senior Fellow, and Research Assistant at the Urban Institute’s Health Policy Center. The authors are grateful to ASPE for supporting this research and particularly appreciative of the assistance and substantive guidance furnished by our project officer, Alana

Structuring the interface between health and human services programs, in the context of ACA implementation, is likely to involve considerable experimentation and learning over time. Fortunately, much research has already identified many factors that influence, sometimes in surprising ways, consumers’ responses to the options they encounter. Base

Several issues arise in all the above settings for raising the SNAP question when people apply for health coverage. First, Marketplaces need to decide which consumers will be presented with the option of seeking SNAP. In theory, a Marketplace could offer all applicants for health coverage the opportunity to connect with SNAP. In practice, it wil

A third approach would raise the SNAP issue as Medicaid or Marketplace subsidy eligibility is being renewed. At this point, consumers are likely to experience much less cognitive and choice overload than during the initial coverage application.

A second strategy would raise the SNAP issue before the initial health enrollment process is complete. 78 For example, a consumer who appears likely to qualify for human services programs could be given the option to complete either a health-only application or a multi-program application that requests the information needed by both SNAP and heal

One possible approach would delay questions about SNAP until after the health application process is complete. This would ensure that SNAP questions pose no barrier to enrollment into health coverage, thereby meeting the requirements of the CMS guidance described earlier. It would also avoid burdening state health programs with the need to modify

The above analysis suggests that the process of enrolling into subsidized Marketplace coverage is likely to deplete the cognitive resources of many who go through the process. Asking such consumers to then begin the process of enrolling into SNAP, an entirely new benefit program, could prove challenging.

This report does not analyze how Marketplaces and Medicaid programs can best structure the application and health plan choice process. Rather, we focus on that process’s cognitive demands to understand the consumer’s mindset when faced with the additional questions posed by possible SNAP enrollment.

Depending on the individual’s situation, the following steps may be required:

This second context focuses on how potentially eligible consumers could be connected to the SNAP program while they are applying for health insurance at the Marketplace. Here, we draw on behavioral economics findings related to cognitive psychology and consumer choice. The discussion emphasizes online applications for health coverage, but much of

In sum, the literature described above finds that apparently modest procedural burdens—the requirement to complete a form or even check a box, for example—can have a substantial impact on program participation, as can eliminating such burdens by completing forms on consumers’ behalf. This has important implications for implementation of targ

A randomized, controlled experiment tested the impact of tax preparers actually filing SNAP applications for eligible consumers, compared to completing applications and providing instructions about how and where the consumers could file them. Low-income clients at H&R Block offices were provided information about the monthly SNAP benefits for

Different countries take different approaches to organ donation. Johnson and colleagues reported that, in six out of the seven European countries where organ donation takes place unless people object by mailing a form or making a telephone call, at least 98 percent of decedents effectively consented to have their organs donated.

Louisiana’s experience illustrates the impact of requiring families to check a simple opt-in box before their children can obtain expedited Medicaid coverage based on SNAP receipt. Since February 2010, Louisiana has implemented Express Lane Eligibility (ELE) to qualify children as financially eligible for Medicaid using findings already made by

In theory, whether someone must complete a simple form to enroll in a retirement savings plan or to opt out of enrollment should not have a major impact on participation levels. A minor, short-term inconvenience hardly seems commensurate with the long-term benefits of accumulating retirement savings. In reality, considerable research shows that su

For this first operational context, we focus on the behavioral literature involving many people’s aversion to the completion of paperwork. This can take the form of procrastination or failing to submit required forms. As a result, whatever arrangement goes into effect by default—that is, in the absence of consumer action—winds up being widel

Neoclassical economics assumes that people have rational, fairly consistent preferences over time. Each person seeks to maximize his or her overall well-being by obtaining, understanding, and rationally acting upon available information. In contrast, behavioral economics focuses on human limitations, empirically testing the ways in which human beh

Expected utility maximization theory can help explain why many eligible individuals do not take up seemingly free public benefits for which they qualify. Two major literature reviews analyze the impact of multiple factors on participation levels in many different programs.

Many eligible people do not participate in SNAP and Medicaid.