ODDC- Access Denied

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TITLE: Access Denied-Federal Neglect Gives Rise to State Lawlessness; Families Denied Access to Medicaid, Food Stamps, CHIP, and Child Care- May 2000

AUTHOR: Lissa Bell and Carson Strege-Flora, Northwest Federation of Community Organizations (NWFCO), National Campaign for Jobs and Income Support

THE PROBLEM: Enrollment in four major support programs- Medicaid, Food Stamps, Children Health Insurance Program (CHIP) and Child Care- is very low relative to the number of people eligible for them. Moreover, with Medicaid and Food Stamps, the gap between the number of people eligible and those enrolled has grown. One reason for the low enrollment is that states violate both the spirit and the letter of the law daily by diverting large number of people away from programs they desperately need. States do this in two ways; one, they keep the eligible population ignorant about the availability of the programs and their likely eligibility for such programs; two, they create needless administrative problems and hassles throughout the enrollment process which make the price of enrollment prohibitively high for many low-income families. Another reason for the decline is that states are, in many cases illegally, dropping people off Medicaid when they leave welfare. Thirty to forty percent of those pushed off welfare are unemployed. Most of the other sixty to seventy percent have jobs that pay wages below the federal poverty line and provide no health insurance. Seventy percent of those who have left welfare and are employed receive no childcare subsidies. One third report severe difficulties in affording food while the remaining two-thirds say they had some difficulty affording food. However, the great majority of them are still eligible for Medicaid and food stamps and most of them working are very likely eligible for childcare.

BARRIERS TO ENROLLMENT: Many community organizations united through the National Campaign for Jobs and Income Support. As part of the campaign, community organizations throughout the country began to systematically evaluate the service provided by welfare offices. In May 2000, six testing projects were completed or underway in Arkansas (Medicaid), Idaho (Child Care and CHIP), Montana (Medicaid and CHIP), Oregon (Food Stamps), South Carolina (Food Stamps) and Washington (Child Care). The preliminary findings reveal common barriers to enrollment to all states and programs. They include:

States Fail To Counsel Applicants About The Rights: Federal law guarantees applicants certain rights during the enrollment process. States also must also inform applicants about how to appeal decisions and that the information that they provide is confidential. States must screen Food Stamps applicants for expedited service. CHIP law requires children who apply for CHIP to be screened for and enrolled in Medicaid, if they are eligible. However, the study showed sixty-eight percent of food stamps applicants were not screened for expedited service; eighty-eight percent of applicants were not told about their right to appeal a decision; sixty-five of applicants were not told that the information they provided was confidential; no childcare applicants were told about quality differences among childcare options; and no children who were denied CHIP were screened and enrolled in Medicaid.
States Counsel Applicants Incorrectly: TANF recipients were wrongly sanctioned because they could not locate childcare for their children in order to complete required TANF activities; Medicaid applicants were told of a waiting list for service; and CHIP, Medicaid and Food Stamp applicants were required to watch a disparaging video before they were provided with a CHIP, Medicaid or Food Stamp application or allowed to have their required interview.
States Do Little Outreach: Money for outreach is available to states at little or no cost to them, but few states have aggressively engaged in significant outreach programs. States can receive matching funds to outreach for Medicaid and CHIP. They can also use a special $500 million fund to ensure that families leaving welfare retain access to benefits. The fund has been available since 1998, but as of October 1999, states had spent only twenty percent of the fund. The study showed only twenty-three percent of applicants learned of a support program from their local welfare office or their state welfare agency, although about half of the applicants were already on one income support program; sixty percent of applicants learned of a support program from a grassroots organization; seventeen percent heard about the program through a friend or their child’s school; and seventy-one percent of all applicants had never seen or heard a public service or other mass outreach announcement about an income support program.
States Do Not Inform Applicants Of All Available Programs: The study showed seventy-eight percent of applicants were not told about the availability of other support programs when they applied; seventy-one percent of CHIP or Medicaid applicants were not screened for the correct program and about twenty-five percent applied for the wrong program, were denied, and had to start again; twenty-nine percent of those who were denied Medicaid were told about CHIP; all the applicants who were denied CHIP received a Medicaid application with their denial letter but were not screened and enrolled in Medicaid and half of the applicants leaving cash assistance because of employment were not told about child care in the interview.
States Do Not Provide Limited-English Speakers With Adequate Service: The Office of Civil Rights requires all agencies and entities receiving financial assistance from the Department of Health and Human Services to make reasonable efforts to provide services and information in languages other than English. The study showed that forty-four percent of people who had limited-English had to locate their own translators; thirty-three percent of limited-English speakers were not provided with an application in their language; and limited-English speakers waited, on average three times longer than English speakers to receive an application in their language.
States Use A Needlessly Long And Cumbersome Application Process: The U.S. Department of Agriculture and the Health Care Financing Administration have urged states to simplify their application forms for Medicaid, CHIP and Food Stamps. However, the study showed that; fifty-five percent of applicants did not have the application process explained to them; only forty-six percent of Food Stamp applicants were told to submit their application on the same day the received it; forty-eight percent of applicants were not told how to submit their application; eighty percent of applicants were not told which documents they needed to submit with their application and seventy-seven percent were not offered help if there were errors on their application.
States Are Unresponsive to Applicants’ Needs: The study showed that forty percent of applicants who requested alternative interview times were denied such an appointment; few offices stay open on weekends or during evening hours; only fifteen percent of applicants were provided with a phone number to call when they needed help or another way to get help with filling out the application; thirty-seven percent of applicants did not understand where to apply when they entered the welfare office; and fifty percent of CHIP and childcare applicants were required to return to the welfare office for an interview.
States Do Not Treat Applicants With Dignity and Respect: The study showed that fifty percent of all applicants felt that they were not treated with respect; applicants gave front desk staff at welfare offices an average rating of "not helpful;" twenty-six percent of applicants said the front desk staff made the enrollment process more difficult; and only nineteen percent of applicants were asked if they had any questions about the application process.

SOLUTIONS: The report made recommendations to three federal agencies, the Food and Nutrition Service at the U.S. Department of Agriculture; Medicaid and CHIP, Health Care Financing Administration at the U.S. Department of Health and Human Services and the Child Care Administration for Children and Families at the U.S. Department of Health and Human Services, to address the problems.

Food Stamps: Food and Nutrition Service, U.S. Department of Agriculture
- Retain existing food stamp regulations that protect access to benefits for low-income families: The Department of Agriculture is proposing regulations that represent an unprecedented retreat from the protections that low-income families now enjoy.
- Change aspects of the proposed food stamp regulations that would reduce access to food stamps for immigrants.
- Require states to find and reinstate all the low-income families who have been, and continue to be, improperly terminated from the food stamps program when they leave welfare.
- Require states to recertify low-income people for their eligibility for food stamps only once a year.
- Dramatically increase its audits of states for compliance with federal laws and enforce better existing protections for low-income families.
Medicaid and CHIP: Health Care Financing Administration (HCFA), U.S. Department of Health and Human Services
- Monitor state practices better: collect data on access and enrollment by race and make it public, do an annual report card that grades the states’ performance in simplifying enrollment procedures for Medicaid and CHIP; and HCFA should monitor state compliance with the April 7, 2000 HCFA order that they will reinstate all low-income families who were illegally dropped from Medicaid when they left welfare.
- Enforce provisions of existing law that prevent states from discouraging applications by asking for unnecessary information: Require states to remove questions about parents’ social security numbers on applications and eliminate the question on the application about "absent parents."
- Mandate states to adopt best practices to enroll eligible low-income families: Prohibit home visits unless there is compelling and specific information regarding fraud, mandate translation services, prohibit states to require children to be uninsured for a year before they can be enrolled in CHIP, and require states to drop monthly and quarterly reports from families unless they promote eligibility.
- Mandate states to reduce burdensome procedures that keep low-income families from getting health insurance.
Child Care: Administration for Children and Families (AFC), U.S. Department of Health and Human Resources

Include states’ performance on childcare enrollment among the criteria used to determine which states receive the TANF "high performing" bonus.
Require states to do affirmative outreach informing families of their eligibility for childcare subsidies.
Require states to inform welfare recipients at every contact with the welfare agency that they may not be sanctioned for failure to comply with a work requirement if they have a child under six and childcare is not available.
Monitor state performance in providing childcare to low-income families.
Mandate translation services for people who need them.

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