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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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