Prioritize Customer Needs in Ohio Benefits System

Prioritize Customer Needs in Ohio Benefits SystemFindings and Recommendations from the Ohio Benefits User Experience Study

By: Rachel Cahill, Consultant, The Center for Community Solutions

Hope Lane, Public policy and External Affairs Associate

Executive Summary

The Ohio Benefits User Experience Study was a joint collaboration between The Center for Community Solutions, Northern Ohioans for Budget Legislation Equality, Contact Center and Ethiopian Tewahedo Social Services, to document and elevate the perspectives of Ohioans enrolled in public benefits. This study team interviewed 156 individuals in 10 counties who applied or reenrolled in Medicaid or the Supplemental Nutrition Assistance Program (SNAP) between mid-2018 and mid-2020. While not meant to be representative of all benefit recipients in Ohio, this study offers important insights for Ohio policymakers and state agency administrators to consider when making new investments in the Ohio Benefits eligibility system. The individuals who access public benefits are the Ohio Benefits system’s most important stakeholders and their recommendations for improvement should be prioritized.

The individuals who access public benefits are the Ohio Benefits system’s most important stakeholders and their recommendations for improvement should be prioritized.

Findings

1. The majority of survey respondents were satisfied with their most recent enrollment experience through their County Job and Family Services (CJFS) offices. Overall, 76 percent of respondents had a positive or neutral experience with their CJFS office.
2. The Ohio Benefits Self-Service Portal is not meeting the needs of survey respondents. The online system is not mobile friendly, it is difficult to navigate, and is riddled with system errors. Despite long wait times, the phone enrollment process works better for many Ohioans.
3. Survey respondents want CJFS to use multiple communication channels to share information and instructions. Mailed notices are appreciated, but hard to understand. Some survey respondents would also like to receive text and email notifications, since mail delivery can be unreliable.
4. Families experience hardship while waiting for benefits. Survey respondents would like to see CJFS offices do more to shorten the time period between application submission and approval and minimize periods of disenrollment due to administrative barriers.
5. Documentation requirements are a significant challenge. Some survey respondents struggle to identify and submit the correct paperwork, especially since pandemic-related closures have restricted access to publicly available copy and fax machines. A mobile app that captures photographs of required documents would dramatically simplify the enrollment process.

Recommendations

Several policy and process changes in response to the COVID-19 pandemic, such as postponed recertifications for SNAP and Medicaid, resulted in meaningful improvements for customers and should be continued for as long as possible.^[1] As this User Experience Survey demonstrates, significant system changes are also needed. New investments in the Ohio Benefits system should be responsive to needs and priorities identified by customers, not vendors. Ohio should not continue to invest in an online system that low-income Ohioans cannot easily access.

1. Improve the Ohio Benefits Self-Service Portal using human-centered design principles. Ohio policymakers and agency administrators should hold technology vendors accountable to usability standards to ensure Ohioans have access to a high-quality, mobile-friendly and user-friendly website and online application platform that includes the ability to submit pictures of required documents.
2. Redesign benefit notices to improve readability. Simplify the language used in notices, create more white space, and provide the most important information up front. Partner with literacy experts and benefits recipients to ensure readability and comprehension.
3. Restore funding for a statewide benefits navigator program. Community-based application assisters are critically important to ensure vulnerable Ohioans can access the public benefits that help stabilize their lives. The loss of benefits navigators, through state and federal budget cuts in 2017 and 2018, left many Ohioans to navigate the complicated benefits enrollment process alone. Ohio policymakers should reinvest in a community-based benefits navigator network, especially to support English language learners, individuals with disabilities, rural areas and communities of color. In addition to providing funding, Ohio should build a portal into Ohio Benefits for community-based application assisters.
4. Redesign county workflows to process benefit applications faster. Although federal regulations generally allow for 30 and 45-day processing timeframes for most SNAP and Medicaid applications, Ohioans endure hardship while waiting for benefit applications to be processed. Ohio should improve SNAP application timeliness for households eligible for expedited service, and follow the example of other states that have redesigned their business processes to provide same-day service.
5. Improve customer service and reduce wait times. To ensure high quality customer service across Ohio, all call center interactions should be recorded and monitored. To maintain reasonable wait times for customers, Ohio must adequately fund and staff CJFS offices and adopt long-term policy changes to streamline renewals, which take up the vast majority of CJFS staff time.

The loss of benefits navigators, through state and federal budget cuts in 2017 and 2018, left many Ohioans to navigate the complicated benefits enrollment process alone.

Beyond these specific recommendations, a central goal of the Ohio Benefits User Experience Study is to motivate state and county agency administrators to proactively seek out customer feedback and recommendations on the benefits enrollment experience as part of a practice of continuous improvement. The study team hopes this report provides inspiration and a model for interested leaders, and stands ready to participate in future efforts.

Introduction

The purpose of the Ohio Benefits User Experience Study is to elevate the perspectives and concerns of the Ohio residents our public benefits programs are meant to serve. The expertise needed to improve the public benefits enrollment process cannot only come from policy and government agency program staff or even advocates working in community-based organizations. The true experts are the struggling parents, older adults and low-wage workers who turn to public programs for food, cash and medical assistance to help weather difficult periods in their lives. The ideas and opinions of these experts about what an effective and efficient enrollment system would look like are too often ignored, overlooked or simply not captured.The Ohio Benefits User Experience Study was modeled on the principles of user-centered design from the civic tech sector which include starting every project with a deep understanding of real people’s needs, designing a system around those needs, and continually testing the system with real users.^[2]The ultimate goal of this study is to ensure that the county, state and federal administrators responsible for Ohio’s public benefits system view their customers as their first and most important stakeholders, and make future investments that are responsive to their needs.

Background

About Ohio BenefitsOhio Benefits is the name of the eligibility system in Ohio that manages Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and Cash Assistance (known as Ohio Works First (OWF), which is funded through the Temporary Assistance for Needy Families (TANF) program). The Ohio Benefits system is technically two separate, related systems: the Ohio Benefits Worker Portal, which is used by eligibility workers in county Departments of Job and Family Services to process applications and manage cases; and the Ohio Benefits Self-Service Portal, which is used by Ohio residents to apply for and self-manage the public benefits they are eligible to receive.Ohio Benefits launched in late 2013 to accommodate major changes to Medicaid eligibility and enrollment required by the Patient Protection and Affordable Care Act (ACA). From 2013 to mid-2018, Ohio Benefits supported the Medicaid program, while SNAP and Ohio Works First (OWF) continued to be managed by Ohio’s legacy computer system, known as CRIS-E. In mid-2018, SNAP and OWF caseloads were migrated into the Ohio Benefits system and CRIS-E was phased out as the state’s eligibility system.Ohio Benefits was built, and continues to be owned, by global consulting firm Accenture under a large, long-term contract with the Ohio Department of Administrative Services (DAS).^[3] Policy and program guidance come from the Ohio Department of Medicaid (ODM) and the Ohio Department of Job and Family Services (ODJFS). As of January 2020, the State of Ohio, with financial support from the federal government, had invested $1.2 billion in the Ohio Benefits system.^[4] While Ohio’s transition from CRIS-E to Ohio Benefits avoided the major systems failures experienced by some other states, an audit by the Centers for Medicare and Medicaid Services (CMS) published in November 2019, identified weaknesses with the Ohio Benefits system’s management of Medicaid eligibility records, leading to the need for corrective action.^[5]

There at least 30 known issues related to the Self-Service Portal that have not been scheduled for resolution.

Perhaps because of the critical nature of some of the deficiencies with the Ohio Benefits Worker Portal, very little attention has been paid to improving the Ohio Benefits Self-Service Portal since it was introduced in 2013. There at least 30 known issues related to the Self-Service Portal that have not been scheduled for resolution.^[6] Examples include the online application unexpectedly crashing, electronic notices being unviewable for Self-Service Portal users, and information and documents not transferring properly from the Self-Service Portal to the Worker Portal. These are “known” errors because CJFS staff report them to the state, but there is no mechanism for Self-Service Portal users to report problems and offer constructive feedback to the state.

About the Study Partnership

In 2017 and 2018, The Center for Community Solutions (Community Solutions) monitored Ohio’s transition of SNAP and OWF to the Ohio Benefits platform, and encouraged the intentional inclusion of community stakeholders and CJFS customers in this process^.[7] Community Solutions supported Cuyahoga Job and Family Services’ development of community partner forums in 2018, which the agency continues to host today.^[8] Since August 2019, Community Solutions, the Greater Cleveland Food Bank and the Legal Aid Society of Cleveland (LASC) have met with leadership from Cuyahoga JFS to discuss systemic barriers to SNAP within the county.

Since August 2019, Community Solutions, the Greater Cleveland Food Bank and the Legal Aid Society of Cleveland (LASC) have met with leadership from Cuyahoga JFS to discuss systemic barriers to SNAP within the county.

Meanwhile, in the fall of 2019, Northern Ohioans for Budget Legislation Equality (NOBLE), a grassroots organization that works to bring the voices of low-income individuals and families to state budget issues, conducted a survey of people who had applied for and/or received public benefits, with a focus on Medicaid. The goal of NOBLE’s original survey was to document the challenges Northeast Ohio residents faced since the Ohio Benefits platform expanded to include SNAP and OWF, and to give voice to some of the most vulnerable recipients of benefits.In early 2020, Community Solutions and NOBLE began meeting to share information and discuss opportunities for collective impact. When NOBLE decided to pursue a second round of customer surveys to capture more precise feedback, it asked Community Solutions for support and the partnership was born.MethodsAs noted above, the Ohio Benefits User Experience Study was co-developed by Community Solutions and NOBLE in the spring of 2020, building upon NOBLE’s 2019 Benefits System Survey. With financial support from the George Gund Foundation and the Center for Law and Social Policy, Community Solutions provided $5,000 grants to three organizations that committed to conduct 50 surveys each with their members or clients, and to provide for participant compensation ($25 gift cards).^[9] The three funded partner organizations were:

• NOBLE, a grassroots organization based in Cuyahoga County that works to bring the voices of low-income consumers to state budget issues and works on local issues that are funded all, or in part, by the state budget. Protecting Medicaid is one of NOBLE’s advocacy priorities.
• The Contact Center, a membership-based organization of low-income citizens based in Hamilton County that provides opportunities for skill and leadership development so members have a voice in influencing policy decisions that impact their lives. The Benefits Rights Advocacy Group is one of the Contact Center’s core initiatives.
• Ethiopian Tewahedo Social Services (ETSS), a social service organization that serves immigrants and refugees from more than 50 countries in a variety of programs across seven counties in Central Ohio, including Franklin County.

An additional six surveys from Cuyahoga County were conducted by LASC with individuals referred by the Greater Cleveland Food Bank.After some delays associated with the beginning of the COVID-19 pandemic, the study partnership conducted interviews between June and August 2020. NOBLE recruited survey participants through existing membership engagement, targeted social media outreach, and email outreach. Contact Center recruited through existing member engagement and foot traffic in and around their office (once it was safe to reopen). To avoid in-person contact, most interviews were conducted by telephone and recorded with participant consent. The survey took between 10 and 40 minutes to complete, based on the complexity of the individual’s experiences and language spoken. All participants were given a $25 gift card as compensation for their time.Altogether, study partners conducted 156 interviews, 151 of which were sufficiently complete and interpretable to include in this analysis. Surveys collected by NOBLE, the Contact Center, and LASC were generally recorded and later transcribed and coded by an independent member of the study team. Surveys collected by ETSS were completed on paper by an ETSS staff member, rather than capturing an audio recording, due to the diversity of languages spoken by study participants.See Appendix A for copy of the survey, which was used by Contact Center, ETSS and LASC. NOBLE used a slightly longer survey that included four additional questions.

Ninety-four percent of survey respondents were current recipients of SNAP and/or Medicaid benefits at the time of their interview.

Survey ParticipantsThe Ohio Benefits User Experience Study was not designed to be representative of all Ohioans who access public benefits. Instead, the study sought to survey and collect responses from low-income individuals and people of color by following the lead of grassroots organizations led by these individuals. The study also aimed to support these organizations to conduct the survey in their own communities. This partnership approach was an explicit value of the study team and its funders.

• Ninety-four percent (94%) of survey respondents were current recipients of SNAP and/or Medicaid benefits at the time of their interview. This survey mostly does not include those who applied for but were never able to access benefits. In addition to SNAP and Medicaid, a smaller percentage of survey respondents reported receiving federal benefits, such as Social Security, Supplemental Security Income (SSI), and Social Security Disability Insurance (SSDI), as well as other state benefits, including OWF and Child Care Assistance. See Figure 1.

• Ninety-one percent (91%) of survey respondents applied in one of Ohio’s three large metropolitan counties – Cuyahoga, Franklin or Hamilton – based on the location of study partners. These counties account for about one-third of the state’s SNAP and Medicaid caseloads. The remaining 9 percent (9%) of survey respondents applied for benefits in neighboring counties, including Delaware, Fairfield, Licking, Lorain, Montgomery, Portage and Summit Counties. See Figure 2.

• According to the U.S. Department of Agriculture (USDA) in 2018, 67 percent of SNAP heads of household in Ohio identify as white, 29 percent identify as Black or African-American, 0.2 percent identify as Hispanic, 2 percent identify as another race (non-Hispanic), and 1 percent are unknown.^[10] This mirrors the overall racial diversity for the three major metro counties included in this survey in 2019, with 64 to 67 percent of residents identifying as white and 24 to 30 percent identifying as Black.^[11] By comparison, in this Ohio Benefits User Experience Study, the majority (70%) of surveyed individuals identified as Black or African-American, 16 percent identified as white, 12 percent identified as Asian, and 3 percent identified as Hispanic. This overrepresentation of Black and Asian perspectives and underrepresentation of white perspectives, while not intended, aligns with the study’s intentional design of following the lead of grassroots groups led by people of color.
• Sixty-seven percent (67%) of survey respondents identified as women, 30 percent as men, one percent as non-binary, and 2 percent were unknown. Forty-six percent (46%) of all survey respondents identified as Black women, 21 percent as Black men, 12 percent as white women, 7 percent as Asian women, 5 percent as Asian men, 3 percent as white men, with all other categories at 2 percent or below. See Figure3.

• By partnering with ETSS, the Ohio Benefits User Experience Study was able to include the perspectives of 37 non-English speakers who made up nearly 25 percent of survey respondents. Languages spoken include Nepali (11), Amharic (10), Kiswahili (6), Tigrinya (3), Maay (2), French (2), Arabic (1), Somali (1) and Oromo (1). See Figure 4. This representation allows for deeper insight into the experience of those in immigrant and refugee communities who are eligible for public benefits in Ohio that could not have been gleaned through a traditional survey design.

Study Findings

1. The majority of survey respondents were satisfied with their most recent enrollment experience through their County Job and Family Services (CJFS) office.

Overall, 76 percent of respondents had a positive or neutral experience with their CJFS office. Fifty-two percent (52%) reported a positive experience, 24 percent a neutral experience, 19 percent a negative experience and with the remaining 5 percent having a mixed experience (i.e. some parts positive, others negative), or not remembering well enough to report.

Seventy-six percent of respondents had a positive or neutral experience with their CJFS office.

Seventy percent (70%) of surveyed individuals said their most recent enrollment experience was in 2020, with nearly 50 percent occurring after the COVID-19 pandemic closures began in March 2020. No meaningful differences in satisfaction responses were found between those who applied or renewed their benefits in the beginning of 2020 or earlier. In 2020, the percentage of JFS customers reporting a positive experience was higher for those who applied for or renewed benefits after the COVID-19 pandemic began (58 percent vs. 48 positive). See Figure 5. This was likely due to the administrative waivers that Ohio adopted during the pandemic to simplify applications and renewals for SNAP and Medicaid which significantly reduced call wait times – options which Ohio now has the opportunity to continue through mid-2021.^[12]

Survey respondents who reported a positive experience often mentioned helpful, friendly and professional CJFS employees. Here are some examples:

Among the 19 percent of respondents who reported a negative enrollment experience, challenges included difficult paperwork requirements, long phone wait times, language barriers and poor treatment by county caseworkers. Each of these areas is explored further in this paper.

2. The Ohio Benefits Self-Service Portal is not meeting the needs of survey respondents. The phone enrollment process works much better.

Overall, only 25 percent of survey respondents said they applied or renewed their benefits online. By comparison, 57 percent reported applying or renewing their benefits by phone and 36 percent applied or renewed their benefits in person. See Figure 6.

Survey respondents described a variety of challenges using the Ohio Benefits Self-Service Portal, including:

• The website is not easily accessible from a mobile device (i.e. not “mobile friendly”) and is only designed to be accessed from a computer. Yet, only 37 percent of respondents reported having a computer with internet access at home. By contrast, 73 percent of respondents said they have internet access through a mobile phone. See Figure 7. When analyzing these results by age, respondents who only have access to a phone (without internet access) tended to be older.

• The online application is long and complicated, taking some users an hour or longer to complete. Some survey respondents expressed frustration that the online application they believed they submitted never made it to county workers to be processed.

• The Ohio Benefits Self-Service Portal requires users to create an account before applying or accessing case details. The account creation barrier has been well-documented, especially for those who do not use email.^[13] To simplify usability, account creation should be optional, as in some other states.^[14]
• A related problem identified by JFS customers is that passwords created for the Ohio Benefits Self-Service Portal accounts automatically expire every 60 days, which ODJFS says aligns with the state’s security standards. Unfortunately, by the time users need to log-in again to renew their benefits (e.g. Six to 12 months later), their passwords have expired and they report being “locked out” of their accounts. Benefits access experts recommend that customer passwords not expire for at least one year.^[15]
• The online system does not seamlessly link documents submitted through the Ohio Benefits Self-Service Portal with the individual’s case in the Ohio Benefits Worker Portal, resulting in applicants being asked to submit documents a second time, e.g. by mail, fax or in-person drop-off.
• Survey respondents generally expressed disappointment that the online benefits application is outdated and hard to use. Some examples:

• A few survey respondents said the online application worked well for them. For example, a non-English speaker in Licking County applied for SNAP and Medicaid in March 2020 with help from an interpreter and reported a positive experience, despite the application taking more than an hour to complete. After submitting, the applicant followed up by sending the requested documents in the mail. He was grateful to not have to go in person to apply, since the pandemic had just begu

3. Survey respondents want JFS to use multiple communication channels. Mailed notices are appreciated, but hard to understand.

Survey respondents generally appreciated receiving enrollment information and instructions through multiple communication channels. For mail and phone-based communication, JFS communication methods offered nearly matched customer preference rates. (Note that this survey may over-represent individuals with stable addresses who are likely to receive mailed communications from JFS.) Respondents reported preferring more text and email communication from JFS than they currently receive, as shown in Figure 8.

Apart from communication method, a majority of survey respondents (66%) reported understanding the information and instructions that JFS communicated to them. Twenty-three percent (23%) said they understood some but not all of what JFS communicated, and 11 percent did not understand the information and instructions provided by JFS, as shown in Figure 9.

Among survey respondents who did not understand some or all of the information and instructions provided by CJFS, they explained what was difficult, which generally fell into three categories –

• Complex, legal language

• Too much text that is difficult to read

• Language barriers for non-English speakers

4. Families experience hardship during the waiting period between application submission and approval and during periods of disenrollment from administrative barriers.

One unanticipated finding from the study was the extent of hardship respondents described while waiting for benefit applications to be processed, particularly for SNAP. This is because households typically turn to public benefits for help when they are already desperate for resources and have spent down savings and informal networks of support. As of 2018, 53 percent of all SNAP applicants in Ohio are eligible for expedited service (meaning they have no income or resources and/or their expenses exceed their income in the month of application), yet 40 percent of those applicants did not receive benefits in the federally-mandated 7-day timeframe.^[16]

Survey respondents also shared the fear and uncertainly they felt at the possibility of benefits being cut off if some piece of renewal paperwork does not get submitted on time.

5. Documentation requirements are a significant challenge for many.

At least 15 percent of survey respondents experienced significant challenges finding and submitting all of the documents requested by CJFS to verify their eligibility for SNAP and/or Medicaid.

Although policy changes in response to the COVID-19 pandemic have alleviated some paperwork requirements, survey respondents who applied after the pandemic began expressed the additional challenge of closed CJFS offices, libraries and other community-based locations where scanners and fax machines are available.^[17]

Unlike other states, Ohio does not have a mobile app for self-service management or document submission. Several survey respondents said it would be easier to comply with documentation requests if a mobile app was available to take a photo of documents and send them to the county securely.^[18]

­RecommendationsThe Ohio Department of Job and Family Services and Ohio Department of Medicaid have made rapid and heroic policy and business process changes since the outset of the COVID-19 pandemic that cannot be overlooked or overstated.^[19] These administrative flexibilities helped more than 232,811 gain access to SNAP as of June 2020 – an 18 percent increase from February 2020.^[20] These policies also helped 235,000 Ohioans gain access to Medicaid coverage between February 2020 and August 2020 – an 8 percent increase.^[21]

These policies also helped 235,000 Ohioans gain access to Medicaid coverage between February 2020 and August 2020.

In addition to continuing these successful policy changes, the recommendations described in this section should be considered by ODJFS, ODM and the Ohio Department of Administrative Services (DAS) before future state investments in the Ohio Benefits System are made, including any budget items under consideration for inclusion in the 2022-2023 state budget.

1. Improve the Ohio Benefits Self-Service Portal using user-centered design principles.^[22] Hold Ohio’s technology vendors accountable to usability standards to ensure Ohioans receive a high-quality, mobile-friendly, user-friendly, website and online application platform.

Develop a mobile-friendly website and/or mobile app that allows individuals to submit pictures of documentation through the app.

Develop a mobile-friendly website and/or mobile app that allows individuals to submit pictures of documentation through the app, rather than needing to submit verification documents by mail and fax. Such apps are widely used in other states and are relatively inexpensive to develop, so Ohio should not need to commit significant resources in the system maintenance contract with Accenture to provide this service.^[23]

2. Redesign benefits notices to improve readability. Nearly one-third of survey respondents reported not understanding some or all of the information and instructions provided by CJFS, primarily because of the complexity of the notices mailed to households. Simplifying the language used in notices, putting the most important information first (such as application outcome and actions the recipient must take), and creating more white space on documents would help everyone, especially individuals with low literacy. Ohio could do this by working with human-centered designers, as well as hiring a team of literacy professionals and CJFS customers – such as NOBLE and Contact Center’s members – to review and revise notices to achieve a sixth grade or lower reading level. Ohio should also make notices available in more languages to accommodate the state’s diverse population that is eligible for public benefits.
3. Restore funding for a statewide benefits navigator program. Community-based application assisters play a critically important role in ensuring the most vulnerable and least technologically-connected have access to public benefits. Federal cuts to the ACA-created Navigator program in 2017, combined with the elimination of state funding for the Ohio Benefit Bank in 2018, left many Ohioans to navigate the complicated benefits enrollment process alone. This loss of community-based enrollment may have contributed to Medicaid and SNAP enrollment declines from late 2018 through early 2020.

Ohio policymakers should reinvest in a community-based benefits navigator network designed to support low-resourced rural communities, English language learners, individuals with disabilities, and communities of color. Such a network would allow for more in-person benefit enrollment assistance in community settings and reduce case management demands on overstretched CJFS offices. Although the Ohio Benefits Self-Service Portal was not designed to be used by application assisters, many people need help navigating the system, resulting in Community Based Organizations (CBOs) being the most knowledgeable about this system. Ideally, the Ohio Benefits system would have a separate portal for application assisters, as recommended by Community Solutions in the past. ^[24]

4. Redesign county workflows to process benefit applications faster. Benefits are taking too long to reach people in need. Ohio also must improve SNAP application timeliness for households eligible for expedited service, and ensure EBT cards arrive from the state’s EBT card vendor within federally-mandated time-frames. Ohio should also consider following the example of other states, like Idaho, that redesigned their business processes to prioritize same day service.^[25]
5. Improve customer service and reduce wait times for in-person and call center interactions. Thirty percent (30%) of survey respondents said they experienced long wait times to reach a caseworker, especially through the call center. Wait times significantly improved across Ohio from April through June 2020 when federal waivers for SNAP and Medicaid reduced administrative requirements on CJFS staff, but wait times began to climb again in July 2020 with the return of SNAP recertifications. Maintaining reasonable customer wait times long-term will require (1) adequate staffing levels in CJFS offices, (2) adaptative intra-day queue management, and (3) policy changes to streamline renewals, which absorb the vast majority of county resources.

In addition to wait times, a small number of survey respondents reported being treated disrespectfully by county staff or enduring explicit and implicit discrimination. These negative experiences leave lasting impressions on low-income families and communities, and deters them from accessing help for their families in times of need. To ensure quality, respectful caseworker-client interactions across Ohio, all calls should be recorded and monitored by county managers who have received anti-bias training. Caseworkers should also receive ongoing training on customer service expectations and de-escalation tactics. Cuyahoga County recently received a federal grant to implement a new phone system that will record all calls and plans to train call center managers to do quality assurance, better aligning with the county’s declaration of racism as a public health emergency.^[26]

Acknowledgements

First and foremost, the authors would like to thank the 156 Ohioans who shared their time and expertise with members of the study team to help us better understand Ohio’s benefits enrollment system. Thank you to NOBLE for their vision and leadership on the survey in particular and project overall. To our other community-based study partners, Contact Center and ETSS, thank you for your commitment to the project that required quickly training interviewers, recruiting participants, and safely storing survey data to protect the confidentiality of survey respondents.The study team also thanks the Ohio Benefits User Experience Study’s funders - the George Gund Foundation for the larger partnership that also explored reasons for declining children’s health insurance coverage rates, and the Center for Law and Social Policy, whose explicit commitment to both racial equity and inclusion of individuals with lived experience with hunger supported our unique study design.

The study team thanks our county partners and all the caseworkers who show up – including during a global pandemic – to serve customers and respond to personal crises each and every day.

Finally, the study team thanks our county partners and all the caseworkers who show up – including during a global pandemic – to serve customers and respond to personal crises each and every day. We also thank our state partners who work tirelessly to put policies in place and give counties the flexibility needed to keep families connected to life-saving public benefits.[1] One example is Food Assistance Change Transmittal 66: Approved Waivers in Response to COVID-19 – Extending Certification Periods and Adjusting Interim Reporting Requirements, March 24, 2020. Available at https://emanuals.jfs.ohio.gov/CashFoodAssist/FACM/FACT/FACT-66.stm[2] To learn more about User-Centered Design from Code for America, see https://www.codeforamerica.org/practices/user-centered-design[3] “Accenture Getting 301M to overhaul IT for Ohio Medicaid, welfare programs,” Columbus Business First, February 7, 2013. Available at https://www.bizjournals.com/columbus/blog/2013/02/accenture-getting-301m-to-overhaul-it.html[4] “State reveals $1.2 billion Ohio Benefits system riddled with defects a year out from Medicaid work requirements,” Cleveland.com, January 16, 2020. Available at https://www.cleveland.com/open/2020/01/state-reveals-12-billion-ohio-benefits-system-riddled-with-defects-a-year-out-from-medicaid-work-requirements.html[5]Ibid.[6] Ohio Benefits Project Website: https://ohiobenefitsproject.ohio.gov/Resources/Workarounds[7] Cahill, R. “As Ohio and Counties Modernize Work Support Programs, Community Engagement Critical to Success,” Center for Community Solutions, April 2018. Available at https://www.communitysolutions.com/research/ohio-counties-modernize-work-support-programs-community-engagement-critical-success/[8] Cahill, R. and Mutillo, E. “Cuyahoga Job and Family Services Demonstrates Transparency and Commitment to Improving Customer Service at Community Forums,” Center for Community Solutions, August 20, 2018. Available at https://www.communitysolutions.com/cuyahoga-job-family-services-demonstrates-transparency-commitment-improving-customer-service-community-forums/[9] Community Solutions originally identified a fourth partner organization from Southeast Ohio but they ultimately did not have staff capacity to facilitate the study in the midst of their COVID-19 response efforts.[10] Cronquist, K. “Characteristics of Supplemental Nutrition Assistance Program Households: Fiscal Year 2018.” Mathematica for USDA Food and Nutrition Service, November 2019. Available at https://fns-prod.azureedge.net/sites/default/files/resource-files/Characteristics2018.pdf. See page 92.[11] See Census Quick Facts for Cuyahoga, Hamilton and Franklin Counties at https://www.census.gov/quickfacts/fact/table/cuyahogacountyohio,US/PST045219; https://www.census.gov/quickfacts/fact/table/hamiltoncountyohio/PST045219;  https://www.census.gov/quickfacts/fact/table/franklincountyohio/PST045219[12] See Section 4603 of H.R. 8337 – Continuing Appropriations Act, 2021 and Other Extensions Act. Available at https://www.congress.gov/bill/116th-congress/house-bill/8337[13] See Wagner, J. and Gaudet, G. “Improving Users’ Experience with Online SNAP and Medicaid Systems, Center on Budget and Policy Priorities, April 22, 2020. Available at https://www.cbpp.org/research/health/improving-users-experience-with-online-snap-and-medicaid-systems[14] See Colorado’s PEAK application at https://coloradopeak.secure.force.com[15] Wagner, J. and Gaudet, G.[16] See https://fns-prod.azureedge.net/sites/default/files/resource-files/Characteristics2018.pdf, Page 91[17] For summary of SNAP policy changes in Ohio in response to COVID-19, see “Seeking Unemployment Insurance? Remember to apply for SNAP too.” The Center for Community Solutions, April 1, 2020. Available at https://www.communitysolutions.com/seeking-unemployment-insurance-remember-apply-snap/[18] Some counties, including at least Hamilton and Cuyahoga counties, allow documents to be submitted via email, but this is considered much less secure than a mobile app.[19] Corlett, J. “Policy recommendations to flatten the coronavirus curve,” Center for Community Solutions, April 13, 2020. Available at https://www.communitysolutions.com/policy-recommendations-flatten-coronavirus-curve/[20] Ohio Public Assistance Monthly Statistics (PAMS) Report. Available at https://jfs.ohio.gov/pams/index.stm[21] Ohio Medicaid Demographic and Expenditure Dashboard. Available at  https://analytics.das.ohio.gov/t/ODMPUB/views/MedicaidDemographicandExpenditure/WhoWeServe?%3AisGuestRedirectFromVizportal=y&%3Aembed=y[22] See “Modernizing online enrollment for Michigan’s largest assistance programs,” from non-profit design firm, Civilla. Available at https://www.civilla.com/modernizing-online-enrollment[23] See DTAConnect in Massachusetts at https://www.mass.gov/service-details/learn-what-you-can-do-on-the-dta-connect-mobile-app-and-website[24] Ohio community groups face challenges helping needy Ohioans navigate new benefits system, January 14, 2019. Available at https://www.communitysolutions.com/research/ohio-community-groups-face-challenges-helping-needy-ohioans-navigate-new-ohio-benefits-system/[25] See Isaacs, J. et, al, “Improving the Efficiency of Benefit Delivery: Outcomes from the Work Support Strategies Evaluation.” Urban Institute, November 16, 2016. Available at https://www.urban.org/research/publication/improving-efficiency-benefit-delivery/view/full_report[26] USDA Food and Nutrition Service FY2020 SNAP Process and Technology Improvement Grants: Project Summaries. Available at https://fns-prod.azureedge.net/sites/default/files/resource-files/FY20-PTIG-Award-Summaries.pdf[/cmsmasters_text][/cmsmasters_column][/cmsmasters_row]