Streamlining Intake and Eligibility Systems: Agencies Find Ways to Simplify the Process for Both Clients and Staff

Kraus, Allen, Pillsbury, Jolie Bain, Public Welfare

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 partner ships 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.

Policy Changes

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. Providing continuous eligibility has ensured that once a pregnant woman is certified as being eligible for prenatal services under Medicaid, she is guaranteed continued eligibility even if her financial circumstances change.

Presumptive eligibility has allowed states to provide Medicaid coverage immediately upon application, as compared with waiting for up to 45 days. Faster Medicaid certification opens more doors to health services and brings more federal support to state and local governments. The law also delegates eligibility authority to qualified health care providers. Unfortunately, a complicated administrative process accompanies presumptive eligibility: The process requires designating and training qualified providers, designing application forms and unique Medicaid cards, and changing computer systems to track different eligibility periods.

Waiving federal rules. Using waivers for test projects is one way to get around the federal government's reluctance to revamp rules. Some federal programs, including child welfare, do not allow waivers. Others do, including Aid to Families with Dependent Children (AFDC), food stamps, and Medicaid. Waivers are not the best way to streamline, however. State governments alone can propose them. If approved, states must limit them to short-term experiments covering relatively small proportions of the states' caseloads. They also place all the risk for increased benefit or service cost on state and local governments.

Alabama's Avenues to Self-Sufficiency Through Employment and Training Services (ASSETS) creates a common set of rules for AFDC and food stamps and a common intake process for AFDC, food stamps, child support, and the Job Opportunities and Basic Skills Training Program. Alabama gained waivers to resolve many differences in rules. The state cashed out food stamps to provide a single cash grant to participants and also consolidated intake and eligibility in the hands of individual case managers, with help from a new automated eligibility determination system--the Family Assistance Comprehensive Employment and Training System, or FACETS.

Federal waivers allow …

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Publication information: Article title: Streamlining Intake and Eligibility Systems: Agencies Find Ways to Simplify the Process for Both Clients and Staff. Contributors: Kraus, Allen - Author, Pillsbury, Jolie Bain - Author. Magazine title: Public Welfare. Volume: 52. Issue: 3 Publication date: Summer 1994. Page number: 21+. © 1993 American Public Human Services Association. COPYRIGHT 1994 Gale Group.

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