Relatively simple policy changes can make a big difference in helping people get access to health insurance – and health coverage helps many families stay afloat in the wake of a medical issue. In the span of just a few months, approximately 750,000 people were newly identified as eligible for Medicaid in California. How? California recently implemented a new, streamlined approach to let people know they qualify for Medicaid. In anticipation of the increasing number of adults applying for health coverage due to the Medicaid expansion under the Affordable Care Act, Centers for Medicare and Medicaid Services (CMS) promoted a strategy called Fast Track to accelerate eligibility and enrollment processes. Fast Track has been highly successful in connecting more families with services they qualify for and states have also saved significantly because of its efficiency; however, California has provided a textbook example of how implementation challenges influence a policy’s effectiveness.
Fast Track is an innovative option states have to use Supplemental Nutrition Assistance Program (SNAP/food stamps) information, such as income and household size, to identify people who qualify for Medicaid, but do not yet participate. The degree to which each state implements the program is dependent upon their current program eligibility standards. In the case of California, data from the state’s SNAP program is useful in determining Medicaid eligibility because SNAP eligibility requirements are more restrictive than those of Medicaid. For instance, the income threshold for SNAP is lower than the income threshold for Medicaid and takes into account additional sources of income, such as TANF and child support. In California, advocates estimate the figure is as high as 90 percent.
A particularly striking finding from the implementation of Fast Track in California is that more than one in 7 of Californians recently identified as eligible for Medicaid are children. Thus, Fast Track has not only helped the state reach the newly eligible adult population, but also children who were already qualified for Medicaid, but were not yet participating. According to a leading California SNAP advocate, this uptick in the identification of previously eligible children was a huge surprise that left advocates asking a lot of questions about why these children were previously missed. While there are no clear answers, Fast Track’s success in reaching both previously eligible children and newly eligible adults suggests that its simple approach to enrollment must be working.
The actual mechanics of Fast Track can take various forms. One early effort in February involved a mailing to SNAP households. After the California Department of Health Care Services (DHCS) identified SNAP participants who qualified for Medicaid, a subset of eligible residents received letters in the mail notifying them about their eligibility and offering the opportunity to automatically enroll in Medicaid (provided they meet non-financial eligibility criteria). Upon receiving a letter, individuals could choose between phone, mail, or online pathways to provide consent. For instance, if a person chose to mail in their form, all they would need to do is check a box and provide a signature.
Upon release of the letter, DHCS worked with the California Department of Social Services to update SNAP applications to include a box asking applicants, “Are you interested in applying for Medicaid?” The intention is for people who qualify for SNAP to benefit from Fast Track when they apply for SNAP online or in-person at any of California’s county SNAP offices. If the county deems the person eligible, they should be automatically enrolled into Medicaid without having to fill out an additional cumbersome application.
Although Fast Track has had many wins, there are numerous lessons learned and opportunities for improvement. Amanda Schultz, SNAP Outreach Director of the San Diego Hunger Coalition, shared some of the challenges of implementation on the ground, many of which underlined the importance of strong communication systems and clear messaging, particularly when programs like SNAP and Medicaid are decentralized to the county level. A lack of clarity around how people were chosen to receive letters offering Express Enrollment created confusion for SNAP participants whose neighbors, friends, or relatives received a notice in the mail while they did not. As a result, some people were led to believe that Fast Track into Medicaid was only an option for those who received a notice in the mail.
This initiative became further complicated, according to Schultz, when DHCS and CDSS opened up the opportunity for clients to Express Enroll through local county offices in addition to through letters that were previously handled by the state. Due to a combination of factors, including rushed rollout, limited communication of directives, and competing demands with the implementation of ACA, many counties felt ill equipped to provide consistent training to eligibility workers. “While county implementation of Fast Track is a wonderful concept, it seems to be a missed opportunity for those counties who have been unable to leverage capacity to adequately train staff. In San Diego, we have seen variation in implementation levels across the county, and those offices who have been most successful seem to be those with staff trained to recognize and take advantage of this opportunity to streamline eligibility and ultimately reduce administrative burden.”
One specific outcome identified by Schultz was that SNAP participants who went to a public assistance program resource center to apply for Medicaid were told by eligibility workers that they needed to fill out an entire Medicaid application and were not offered the opportunity to Express Enroll. In response, community-based organizations like the San Diego Hunger Coalition did outreach to inform SNAP participants that they should ask eligibility workers specifically for “Fast Track” in order to automatically enroll in health care. As of June 2014, the checked box discussed earlier was not being utilized to Express Enroll in San Diego. Schultz is hopeful that continued collaboration with San Diego County leadership will lead to more consistent implementation of this innovative provision.
Fast Track reflects both an excellent potential option to ensure eligible people can easily access benefits, but also persistent challenges in ensuring effective implementation of policy changes designed to ease access to public assistance programs by low-income families. For example, over the past decade, most states have eliminated their “asset limits” for SNAP—caps on savings and other resources that exclude very few people from the program, but create tremendous red tape for both applicants and administrators. Yet many of these states still require SNAP applicants to provide extensive information about their bank accounts and other resources on their application forms, which mitigates the benefits of asset limit reform. While reforming the policies themselves is foundational, states also need the resources and infrastructure to effectively put these reforms into practice. In the case of Fast Track, states should provide timely and comprehensive communication and coordination at the county and community levels to guarantee that more families have access to the programs for which they qualify.![Publication Image]( "Publication Image")
Fast Track is an innovative option states have to use Supplemental Nutrition Assistance Program (SNAP/food stamps) information, such as income and household size, to identify people who qualify for Medicaid, but do not yet participate. The degree to which each state implements the program is dependent upon their current program eligibility standards. In the case of California, data from the state’s SNAP program is useful in determining Medicaid eligibility because SNAP eligibility requirements are more restrictive than those of Medicaid. For instance, the income threshold for SNAP is lower than the income threshold for Medicaid and takes into account additional sources of income, such as TANF and child support. In California, advocates estimate the figure is as high as 90 percent.
A particularly striking finding from the implementation of Fast Track in California is that more than one in 7 of Californians recently identified as eligible for Medicaid are children. Thus, Fast Track has not only helped the state reach the newly eligible adult population, but also children who were already qualified for Medicaid, but were not yet participating. According to a leading California SNAP advocate, this uptick in the identification of previously eligible children was a huge surprise that left advocates asking a lot of questions about why these children were previously missed. While there are no clear answers, Fast Track’s success in reaching both previously eligible children and newly eligible adults suggests that its simple approach to enrollment must be working.
The actual mechanics of Fast Track can take various forms. One early effort in February involved a mailing to SNAP households. After the California Department of Health Care Services (DHCS) identified SNAP participants who qualified for Medicaid, a subset of eligible residents received letters in the mail notifying them about their eligibility and offering the opportunity to automatically enroll in Medicaid (provided they meet non-financial eligibility criteria). Upon receiving a letter, individuals could choose between phone, mail, or online pathways to provide consent. For instance, if a person chose to mail in their form, all they would need to do is check a box and provide a signature.
Upon release of the letter, DHCS worked with the California Department of Social Services to update SNAP applications to include a box asking applicants, “Are you interested in applying for Medicaid?” The intention is for people who qualify for SNAP to benefit from Fast Track when they apply for SNAP online or in-person at any of California’s county SNAP offices. If the county deems the person eligible, they should be automatically enrolled into Medicaid without having to fill out an additional cumbersome application.
Although Fast Track has had many wins, there are numerous lessons learned and opportunities for improvement. Amanda Schultz, SNAP Outreach Director of the San Diego Hunger Coalition, shared some of the challenges of implementation on the ground, many of which underlined the importance of strong communication systems and clear messaging, particularly when programs like SNAP and Medicaid are decentralized to the county level. A lack of clarity around how people were chosen to receive letters offering Express Enrollment created confusion for SNAP participants whose neighbors, friends, or relatives received a notice in the mail while they did not. As a result, some people were led to believe that Fast Track into Medicaid was only an option for those who received a notice in the mail.
This initiative became further complicated, according to Schultz, when DHCS and CDSS opened up the opportunity for clients to Express Enroll through local county offices in addition to through letters that were previously handled by the state. Due to a combination of factors, including rushed rollout, limited communication of directives, and competing demands with the implementation of ACA, many counties felt ill equipped to provide consistent training to eligibility workers. “While county implementation of Fast Track is a wonderful concept, it seems to be a missed opportunity for those counties who have been unable to leverage capacity to adequately train staff. In San Diego, we have seen variation in implementation levels across the county, and those offices who have been most successful seem to be those with staff trained to recognize and take advantage of this opportunity to streamline eligibility and ultimately reduce administrative burden.”
One specific outcome identified by Schultz was that SNAP participants who went to a public assistance program resource center to apply for Medicaid were told by eligibility workers that they needed to fill out an entire Medicaid application and were not offered the opportunity to Express Enroll. In response, community-based organizations like the San Diego Hunger Coalition did outreach to inform SNAP participants that they should ask eligibility workers specifically for “Fast Track” in order to automatically enroll in health care. As of June 2014, the checked box discussed earlier was not being utilized to Express Enroll in San Diego. Schultz is hopeful that continued collaboration with San Diego County leadership will lead to more consistent implementation of this innovative provision.
Fast Track reflects both an excellent potential option to ensure eligible people can easily access benefits, but also persistent challenges in ensuring effective implementation of policy changes designed to ease access to public assistance programs by low-income families. For example, over the past decade, most states have eliminated their “asset limits” for SNAP—caps on savings and other resources that exclude very few people from the program, but create tremendous red tape for both applicants and administrators. Yet many of these states still require SNAP applicants to provide extensive information about their bank accounts and other resources on their application forms, which mitigates the benefits of asset limit reform. While reforming the policies themselves is foundational, states also need the resources and infrastructure to effectively put these reforms into practice. In the case of Fast Track, states should provide timely and comprehensive communication and coordination at the county and community levels to guarantee that more families have access to the programs for which they qualify.
