By Cemeré James

Two new reports from the Center on Budget and Policy Priorities (CBPP) and the CLASP-led Work Support Strategies (WSS) initiative offer practical, high-impact lessons on integrating systems through policy and technology reform.  Both reports aim to increase program efficiency for state agencies while ensuring eligible families get and keep the help they need from Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and child care assistance programs.

Lessons Churned: Measuring the Impact of Churn in Health and Human Services Programs on Participants and State and Local Agencies reports lessons from states participating in WSS, other states, and recent research. Six states (CO, ID, IL, NC, RI, SC) receive expert technical assistance, peer learning, and modest direct funding from WSS—a multiyear, multi-state project to help low-income families get and keep a comprehensive package of work supports.

Lessons Churned identifies systemic issues that cause eligible families and individuals to lose benefits when they apply for renewal, often forcing them to restart the application process.  For example, a family may have missed a renewal notice because of an address change; a new address is not reported or the state agency does not update its records promptly. This phenomenon (often referred to as “churn”) not only places financial hardship on recipients because of lost benefits, but also creates extra burden and cost for state agencies, since processing new applications is more time- and resource-intensive than simply re-evaluating continuing eligibility.

As state agencies, other policymakers, and advocates pay closer attention to churn, this new report provides insight into lessons learned by measuring and addressing its impact. By measuring churn, states can get an accurate account of the avoidable rework caused by their system failures. The report closely examines three ways of measuring churn, each of which has pluses and minuses; explains how different program rules may aggravate churn; analyzes thecost of churn in terms of financial hardship for program participants and administrative costs to state agencies; and provides real-life, practical strategies for addressing churn. 

The second report, State Innovations in Horizontal Integration: Leveraging Technology for Health and Human Services, offers practical insight on technology reform and an important new funding stream for states to revamp and replace their existing technology to help families access multiple programs. The Affordable Care Act required large-scale changes to states’ eligibility and enrollment systems for Medicaid and offered enhanced funding to underwrite the costs for doing so. Leveraging this opportunity for technology modernization and reform, many states (including all six WSS states) are modernizing their enrollment services across health and human services programs. State agencies are using technology to streamline application processes and eliminate duplication of effort across programs, which reduces the burden on applicants and on state workers.

Technology reform and horizontal integration are daunting concepts, which the State Innovations in Horizontal Integration report puts into practical terms by compiling interviews and experiences from health and human services officials in states as diverse as Vermont and California (including some WSS states). The brief provides examples of technology innovations that state agencies are implementing, including web-based services, call center technologies, integrated eligibility systems, and data management tools with enhanced performance measures.  The report also addresses common themes related to technology reform, such as the importance of leadership and creating a governance structure that supports reform and ensures new systems enhance business processes and meet customer service goals.

Leaders in state agencies face a complicated mix of policy, operations, and technology challenges. These two reports detail opportunities to build systems in which policy, processes, and technology come together to deliver a modern, efficient enrollment process that can help low-income families and individuals get and keep the benefits they deserve, thereby stabilizing their lives and supporting parents’ work and children’s wellbeing.