Gaining access to health and human service programs is seldom easy, and the process is rarely simple-for either the prospective participants seeking help or for the human service staff who are trying to help them. In fact, the process often discourages people trying to obtain services and frustrates those trying to provide them.
Participants face problems at each step of the intake and eligibility process. They have difficulty finding out what services are available to them. Gaining access to intake processes is not easy: Participants face logistical barriers such as transportation problems and geographically dispersed intake offices. Providing information and documentation is an onerous task that participants must repeat with each application for service. Applicants are likely to wait a long time to learn whether they are eligible for services, and they have to wait for a decision on each application they make.
But streamlining can simplify the process for both prospective participants and staff because it removes unnecessary tasks, cuts repetitive work, and reduces manual transfers of information. It also builds partnerships among agencies and helps staff address problems facing people who use several programs.
In this article, we describe real-life approaches to streamlining and suggest how governments can streamline their services while maintaining respect for confidentiality, laws and regulations, processing deadlines, and agency turf. We have divided the changes we discuss into three categories:
* Policy changes involve the basic laws and regulations used to make eligibility decisions.
* Administrative changes deal with the location, configuration, and staffing of services.
* Technological changes enhance streamlining as automated systems are developed and refined.
Conflicting federal eligibility laws and regulations cause many problems. State and local governments add to the confusion by imposing their own verification and procedural requirements. Together, these discourage some people from applying and lead others to withhold information or to construct different scenarios for different eligibility offices. Complicated webs of procedures, training modules, and specialized tasks for staff lead to confusion, errors, and frustration.
Simplifying eligibility policies is one streamlining strategy. This can be accomplished either at the federal level, through legislative and regulatory changes, or at the state and local levels, using waivers to federal rules. State and local governments can also simplify their own administrative policies.
Changing federal laws and regulations. Efforts to simplify and reconcile federal rules date back to the 1970s. Unfortunately, few reforms have ensued, due to the complexity of the task and the many program specific legislative and administrative interests, among other reasons. Recently recommended rules changes from the American Public Welfare Association's Program Coordination Task Force and the Congressional Welfare Simplification and Coordination Advisory Committee await administrative and congressional review.
Congress has taken simplification seriously when it comes to Medicaid, combining streamlining with extensive changes in eligibility limits. These changes focus primarily on newborns, their mothers, and pregnant women--discrete and relatively sympathetic target groups for whom preventive care has proven cost-effective. These changes allow states to
* ignore all personal assets when determining eligibility;
* extend eligibility to pregnant women throughout their pregnancies--"continuous eligibility"; and
* provide eligibility immediately following application--"presumptive eligibility."
Dropping the personal-assets test encouraged states to streamline Medicaid intake forms--sometimes down to only two pages. Some states leave the shortened forms in providers' offices, where participants can use them by themselves. …