Initiatives
Supporting Families After Welfare Reform
Just because children and adults are eligible for benefits like health
coverage through Medicaid or the State Children's Health Insurance
Program (SCHIP) doesn't guarantee they will ever receive these services.
The process of applying for benefits can be frustrating for families
because of requirements like face-to-face interviews that can pull
them away from work and long applications that are difficult to understand
and complete. These barriers are further amplified by county and state
eligibility systems that employ unnecessary policies and procedures
and rely on antiquated and sometimes erroneous computer systems to
decide whether or not someone will be approved or denied. The outcome
is too often discouraged families and a stressful, unproductive environment
for eligibility agencies.
In 2000 The Robert Wood Johnson Foundation (RWJF) decided to fund
a project that would help states and large counties solve problems
in their eligibility systems and processes that make it difficult
for lower-income families to access or retain Medicaid, SCHIP or Food
Stamps, particularly families moving from welfare to work. The Southern
Institute on Children and Families was selected to lead this effort
as the National Program Office (NPO) for Supporting Families After
Welfare Reform: Access to Medicaid, SCHIP and Food Stamps. Led by
Southern Institute Vice President, Vicki C. Grant, PhD, MSW, and including
a project staff with experience in government eligibility systems,
Supporting Families grantees tackled challenges in states and counties
that resulted in positive changes in terms of the way children and
adults access benefits for which they are eligible.
Initially Supporting Families grantees were selected to receive technical
assistance either to identify key improvement measures for their eligibility
systems (Alabama, Connecticut, Delaware, Maine, Minnesota, South Carolina
and Cuyahoga County in Ohio), or to implement improvement plans in
their eligibility systems (Georgia, New Jersey, Los Angeles County
and San Bernardino County in California and Nassau County in New York).
In 2002 RWJF and the Southern Institute evaluated the existing model
for technical assistance and a decision was made for project staff
to study and adapt an innovative method developed by the Institute
for Healthcare Improvement known as the Breakthrough Series Collaborative.
Following a period of training, Southern Institute Supporting Families
staff adapted the model to their needs and the result was the Supporting
Families Breakthrough Series Collaborative.
The Supporting Families Breakthrough Series Collaborative consisted
of a group of teams that worked towards a common goal of process improvements,
and used each other as a resource for learning by sharing ideas and
experiences. Teams tested specific improvement strategies that have
proven to be successful in addressing their areas of concern and implemented
changes based on results from their small scale testing (testing strategies
in small increments or brief time periods). Teams had access to each
other, faculty members who are experts in the topic field and the
collaborative leadership comprised of Supporting Families staff. Grantees
participated in three learning sessions, independent action periods,
monthly conference calls and technical assistance site visits during
the collaborative.
The final Supporting Families Annual Meeting took place in San Antonio,
Texas, in February 2004. Project staff led participants in general
sessions and facilitated discussion groups where they heard and shared
promising practices from their experiences with the Supporting Families
project. A comprehensive report also was developed, which chronicles
the Supporting Families experience. The Supporting Families Story:
A Movement Toward Quality Improvement is a record of challenges and
successes in the quest to improve the way families apply for and access
public benefits.
In 2003 RWJF announced a special opportunity for Covering Kids & Families
(CKF) grantees to participate in a process improvement collaborative.
Covering Kids & Families also is a project directed by the Southern
Institute. The CKF Process Improvement Collaborative was designed
to capitalize on lessons learned from the Supporting Families Breakthrough
Series Collaborative while focusing on improvements related to the
goals and strategies of the CKF project. The CKF Process Improvement
Collaborative took place between September 2003 and November 2004.
Positive feedback from participants and interest generated by non-participating
CKF grantees were factors in approval of a second CKF collaborative
by RWJF to take place in 2005.
The Supporting Families project officially ended on December 31,
2004. Supporting Families established a legacy that continues in the
form of the Southern Institute Eligibility Process Improvement Center.
Developed from the knowledge and experience gained during Supporting
Families, the Eligibility Process Improvement Center will focus on
quality and process improvements in the health coverage eligibility
processes under Medicaid and SCHIP. The Eligibility Process Improvement
Center will assist public programs and related business leaders and
administrators in cultivating a practical skill set and knowledge
level to effectively implement process improvements in their respective
programs. The Eligibility Process Improvement Center will conduct
a second CKF Process Improvement Collaborative and a national Children's
Hospital Collaborative in 2005. Additional information about the Eligibility
Process Improvement Center appears on page 14.
Information about Supporting Families, including a downloadable version
of The Supporting Families Story: The Movement Toward Quality Improvement
is available on the Southern Institute Web site at http://www.thesoutherninstitute.org/sf.asp.
During the course of the Supporting Families Breakthrough Series
Collaborative, participating teams tested strategies to improve Medicaid
and SCHIP eligibility processes. The examples on the next page provide
information on changes that were initiated during the collaborative
period and the results that followed. Additional results can be found
in The Supporting Families Story. Limited hard copies of The Supporting
Families Story are available at no cost. Interested parties should
contact the Southern Institute at (803) 779-2607 or send an email
message to info@thesoutherninstitute.org.
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