Tuesday, February 19, 2013

There Oughta Be an App for That!

How “Obamacare” can transform the California safety net

By Jeff Selbin

“Obamacare” – the Patient Protection and Affordable Care Act (ACA) – is a once-in-a-generation opportunity to transform California’s safety net. Having survived a landmark Supreme Court decision last summer and a presidential election last fall, the ACA is now being implemented by the states. California has been a national leader in this regard, and the state legislature recently convened a special session on the issue. EBCLC’s Policy Advocacy Clinic is working closely with The Center for the Next Generation and other advocates statewide to modernize and improve health and human services for all Californians.

The Problem

 Last month, the Center on Budget and Policy Priorities (CBPP) released a report on web-based accessibility to key safety net programs administered by the states, including SNAP (formerly Food Stamps, called CalFresh in California), Medicaid (MediCal), and TANF (CalWORKs). As the CBPP map indicates, such access varies considerably by state, and California is in the middle of the pack.

In response to the CBPP report, the Washington Post published a blog: “Want welfare? There isn’t an app for that.” The blog noted low participation rates nationally in the Medicaid and SNAP programs – in fact, California ranks 15th in Medicaid participation rates and 51st in SNAP participation rates – and argued that better on-line access would boost these rates. The piece concluded by noting that “[t]he situation is due to improve next year, when health care exchanges will start offering online Medicaid enrollment to all states.”

The Opportunity

Under the ACA, California is required to integrate its new Health Benefit Exchange – where individuals and small businesses can shop for insurance – into the current health and human services delivery system. California’s exchange is called Covered California. Under the ACA, Covered California must be fully-integrated with MediCal and other health subsidy programs. That is, anyone applying for health coverage through the exchange must be screened for eligibility for all related health programs. This is an important first step.

The ACA further encourages, but does not require, so-called “horizontal integration” with other human services programs. In other words, the state has the opportunity to streamline all of its basic safety net programs into a single portal where an application for one is treated like an application for all. 

There Should Be an App for That!

The best safety net system would allow individuals – by themselves or with the assistance of a friend, family member or advocate – to do all of the following things:

  • Calculate their benefits (what am I eligible for?)
  • Apply for and renew benefits (for everything at once)
  • Check their status (have I been approved, denied, what else do they need?)
  • Update their application/file (change of address, circumstances, etc.)
  • Trouble-shoot (my benefits didn’t arrive, were the wrong amount, etc.)

An actual phone “app” would be great, but not all low-income Californians have smart phones or internet access. Nonetheless, the development of a centralized and simplified eligibility process will help applicants, regardless of whether they enter the system on-line, in person or by telephone or mail. 

Challenges and Optimism 

Of course, there are obstacles in developing such a system. First, California operates the nation’s most decentralized health and human services programs, with multiple on-line portals developed and run by 58 counties. Second, each safety net program has different criteria for who is eligible, what income counts, what deductions are allowed, etc. Third, even if a single statewide portal can be established and eligibility criteria aligned, the technological and business services demands of a one-stop system are significant.

Nevertheless, there is reason for optimism. Last session, the Legislature passed SB 970 (De Leon), which mandated that an application for health care coverage simultaneously initiate an application for CalWORKs and CalFresh. The bill required the state to convene a workgroup of advocates, legislative staff, and others to tackle the feasibility, costs, and benefits of horizontal integration. Although Governor Brown vetoed SB 970, he pledged that his administration would continue to work with the Legislature and other stakeholders to implement the ACA.

The Alliance to Transform CalFresh commissioned an independent assessment of ACA-related horizontal integration. In a report published last June, the authors identify at least two scenarios for automating and coordinating such integration in California. Now is the time to remind the Governor and the legislature about this critically important issue.

As President Obama noted in his second inaugural address last month, “[t]he commitments we make to each other [through safety net programs] do not sap our initiative. They strengthen us. They do not make us a nation of takers. They free us to take the risks that make this country great.” We should heed the president’s call – and take advantage of his signature healthcare reform – to strengthen the Golden State for all Californians. 

Jeff Selbin is a Clinical Professor of Law at UC Berkeley and Faculty Director of the East Bay Community Law Center.