Redesigning the journey to critical benefits for Americans in poverty

By Jess Kahn & Mollie Ruskin

If you walked by William on the street, you wouldn’t know that behind the warm demeanor is a man with diabetes and stage 3 kidney failure. A man who is raising a little boy with asthma and epilepsy as a single parent who has needed benefit programs in hard times.

Even with a smartphone and digital savvy, William has struggled to successfully navigate the complex application processes for these benefit programs. The processes require documents he doesn’t always have and time out of his work day he can’t always afford. Each program has different steps and each must be renewed on different timelines; he doesn’t always understand where one ends and the other begins. In the past, William has spent weeks waiting to hear if he’s been approved for medical assistance or money to pay for food, leaving him and his family in a lurch.

When process is a barrier to support

For people who need timely access to critical benefits, interacting with the government can become as time consuming as a part-time job.

As William has encountered time and again, enrolling in these programs can be cumbersome, duplicative and at odds with the demands of working and caring for one’s family.

The applicant journey our teams mapped through the steps of enrolling in public assistance.

In recent years, non-profits, academia and state and federal government agencies alike began studying and experimenting with a shift toward a more family-centered — as opposed to program or agency-centered — approach to program delivery. This has meant simplifying steps, creating more efficiency and effectiveness in how applications are processed, and connecting people to the right suite of services at once in times of need.

Many states and communities have made significant strides in improving benefit application and renewal processes. In some states, for example, families can renew their participation in multiple programs at the same time — even if they enrolled in these programs at different times. This sharply reduces the number of meetings and documents a family must provide over the course of a year. Many states have adopted simpler rules about when families must report changes in their circumstances to the state human service agency, reducing paperwork for both families and states.

Building on the work of Medicaid modernization, the Centers for Medicare and Medicaid Services and the U.S. Digital Service have been working to use the tools of design and technology to improve how applicants get access to critical services.

Today, we’re excited to share the story behind two products of our work from this past year.

Data-driven and human-centered service design

1. Mapping the journey to enrollment

Applying a human-centered design approach, we began by exploring the current state of benefit enrollment and delivery across agencies and states in an extensive qualitative user research field study.

We had two aims. First, to better understand the applicant experiences of enrolling in programs such as food assistance, cash assistance and Medicaid. Second, to gather needs and best practices from state and county program administrators working to improve their systems.

In partnership with state program offices, community based organizations and 18F, the team conducted 80 contextual interviews, site visits and service trials with applicants, non-profit staff and local program administrators across seven states.

The insights we learned from this work underscore the need for simplified, integrated and automated enrollment processes:

APPLICANT NEEDS

1. The ability to determine eligibility and apply for multiple programs all in one place, in as few steps as possible.
2. Notifications and feedback loops about benefits that are reliable, timely, and easy to understand.
3. The option to interact with benefits programs through the channel (phone, text, email, in-person, etc.) with which applicants are most fluent and comfortable.
4. Information that is clear, easy to find, and in simple, straightforward language.

ENROLLMENT PROCESS DESIGN PRINCIPLES

Principles for creating family-centered benefit program enrollment services

Design for real-time eligibility determination and same-day enrollment. Model how states would collect data to verify against other government systems when possible.
Work to connect people to the programs they want and need, in as few steps as possible. Give applicants the option to apply for multiple benefits at once or to apply for just one benefit while informing them of other programs available to them.
Plain language and warm voice. Because these programs are complicated, do the hard work to keep the wording very simple. Use a conversational, encouraging tone to keep people moving and show people where they are in the process at all times.
Mobile-first responsive design. Ensure that people can apply on all devices by designing first for small screens.
Fewer prompts per screen. Ask people questions in small bite sized chunks, so as not to overwhelm with multiple complex questions at any single step. Always let people know where they are in the process.
Personalize and tailor applications. Only show applicants’ information related to their specific circumstances.
Read about more about our findings from this research:
User Research Insights: Mapping the applicant experience of benefit enrollment

2. Designing online multi-benefit applications

In sharing our findings with state benefits administrators around the need to offer simplified eligibility determination and applications, we heard a common request: we are all working to modernize our online applications, can you help?

We took this request to heart and spent this fall rapidly designing a prototype for a streamlined online application that allows people to apply for one or more programs. The goal has been to create a baseline template designed with and for users that state program offices can adopt and customize to accelerate their modernization efforts.

Our team analyzing user feedback on a multi-benefit application prototype.

The alpha release of our multi-benefit application — which models a generic SNAP and Medicaid application) — is now available. It is designed for easy reading, mobile-responsiveness, and policy compliance with feedback from real users, and is founded on the design principles that emerged from our research.

Demo of the multi-benefit mobile responsive application template.

This prototype is just the beginning, but we’re excited that, with the help of state and federal policy and program partners, we’ve been able to make progress toward a simpler, more user-friendly online enrollment model.

Making these systems and processes work better for people like William is a complex endeavor. There is incredible work being done at all levels of government to address these gaps, and we’re hopeful that our collective efforts can help to build momentum to scale human-centered pathways to benefits.

Our team shares the story of building more human-centered enrollment systems at the Code for America Summit in November, 2016.

We are actively seeking feedback on this work. Check out our GitHub repo to take a peek behind the scenes (it’s a work in progress, so it may be a little messy). Leave us a note if you have questions, ideas or improvements.

Thank you to the numerous members of the public and partners in the field who shared their stories, expertise and time with our team.


Jess Kahn is the Director of Data and Systems for Medicaid at the Center for Medicare & Medicaid Services (CMS).

Mollie Ruskin is a designer and user researcher with the U.S. Digital Service.

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