Every year, millions of Americans cope with poverty, unemployment, a disability or even a combination of these and other challenges. And each of this disparities can have long-term impacts on an individual or family’s overall health and well-being, especially if left unaddressed.
In the early 1900s, as the country was coming out of the Great Depression, the Federal Government passed The Social Security Act and established programs such as social security and unemployment insurance to assist Americans facing these challenges. In the years following, additional programs were authorized, including Medicaid, Medicare and the Children’s Health Insurance Program (CHIP). Collectively, these programs have come to be referred as our “safety net system.”
Safety net programs provide subsidies, assistance and education to low-income and/or individuals with disabilities and their families.
Safety net programs provide subsidies, assistance and education to low-income and/or people with disabilities and their families. Generally, these programs are funded by the federal government and administered by the states, which supplement the allocated federal funding with state dollars to broaden the public benefits available to their residents.
Excluding Medicaid, Medicare and CHIP, 19% of the U.S. population — or approximately 59 million people — currently receive assistance through this social safety net every month, with children receiving the majority of the benefits.1 And as of July 2020, more than 75 million individuals were enrolled in Medicaid and CHIP, and more than 67 million were accessing services through the Medicare program.2, 3
The primary safety net programs can be grouped into four main categories: health care, nutrition, housing and financial/cash assistance.4 Below highlights some of the more widely-known safety net system programs.
Supplemental Nutrition Program for Women, Infants and Children (WIC)
Supplemental Nutrition Assistance Program (SNAP)
Department of Housing and Urban Development’s public housing, subsidized housing, and voucher programs (e.g. McKinney- Vento, Housing Choice Voucher Program)
Low Income Home Energy Assistance Program (LIHEAP)
Earned Income Tax Credit (EITC)
Supplemental Security Income (SSI)
Temporary Assistance for Needy Families (TANF)
Determining safety net program eligibility and enrolling for benefits
All safety net programs use income levels to determine eligibility. The Federal Poverty Level (FPL) scale is the measure of income used most frequently to determine an individual or families’ qualifications for the benefits offered by these programs (one exception is Medicare). As of 2020, the poverty threshold for a family of four is $26,200; however, the FPL increases or decreases depending on family size.5
In addition to income, these programs also use categorical (e.g., age, disability and family size) and residency requirements to determine eligibility. Due to federal statutory requirements, each of the safety net programs listed above utilizes different income limits, as well as a range of categorical and residency requirements, when assessing an individual’s eligibility. As a result, the process to determine one’s eligibility and the enrollment process to access benefits through a safety net program is not consistent from program to program or state to state. And processes — including eligibility determination, enrollment application processes and even benefit access — can also be notably different.
Though many low-income and/or people with disabilities are eligible for assistance across these programs, it can be difficult to connect eligibility information across agencies and support streamlined enrollment.
Adding to the complexity of various requirements, safety net programs are often siloed and managed by different agencies at both the federal and state levels, making them challenging to navigate. Though many low-income and/or people with disabilities are eligible for assistance across these programs, it can be difficult to connect eligibility information across agencies and support streamlined enrollment.
Integrating eligibility and enrollment
Integrated eligibility systems (IES) can link health and human service systems across a state. Specifically, IES can streamline the application process, decrease verification and administrative inefficiencies, leverage data for analytic capabilities, and coordinate programmatic information for individuals in a single system.6
Specific benefits of an IES include:
Easier experience for the individual. Data collected for one program, such as income and residency, could be used to support enrollment in other programs. This way, the individual does not have to make multiple calls or appointments and the system can help facilitate access to eligible services.
Improved administrative efficiency. An IES brings multiple, usually disparate systems together into one eligibility and enrollment system. This allows for efficiencies at the state level, reduces the need for duplicative platforms and allows for improved data analysis on the populations receiving services within the state.
Increased program integrity capability. An IES platform can support improved program integrity by allowing for cross-program evaluation and audit capability. With these capabilities, states will be able to identify and address member or system control issues that could enable individuals to access services for which they are not eligible.
As the COVID-19 pandemic continues to impact the economy, we can anticipate an increase in the number of individuals eligible for safety net program services. During these difficult and uncertain times, an IES can ease access to and enrollment in needed services for our members, while also streamlining the administrative process for state and local agencies.
MPH Candidate 2021, UNC Gillings School of Global Public Health
Paige Newman is a Master of Public Health, Health Policy and Management graduate student and graduate teaching assistant at the University of North Carolina Gillings School of Global Public Health. In 2020, she served as a Strategic Initiatives Graduate Intern with UnitedHealthcare Community & State where she focused on addressing social determinants of health and health needs for the Medicaid population in North Carolina. Prior to her internship with Community & State, Paige held various positions with federal and state government including the United States Department of Justice and North Carolina Department of Justice, Medicaid Investigations Division. Paige holds a B.A. in Political Science from Virginia Tech.