SUBJECT
Title
Receive the final report ON INCREASING ACCESS AND ENROLLMENT IN COUNTY SELF-SUFFICIENCY PROGRAMS TO SERVE EVERY COMMUNITY MEMBER IN NEED WITHOUT BARRIERS TO ENTRY (DISTRICTS: ALL)
Body
OVERVIEW
Due to the COVID-19 pandemic, an increased number of San Diego County residents now depend on support from resources and services provided by the County of San Diego (County) to combat food insecurity, lack of access to adequate healthcare, and unemployment or underemployment. Although there has been increased enrollment in the County’s self-sufficiency programs to historically high levels, such as CalFresh, CalWORKs, Medi-Cal, Cash Assistance Program for Immigrants (CAPI), and General Relief, barriers still exist that prevent qualifying individuals and families from accessing the services and benefits for which they may be eligible.
On April 6, 2021 (10), the San Diego County Board of Supervisors (Board) requested that the Social Services Advisory Board (SSAB) establish a temporary ad-hoc subcommittee called the Outreach, Accessibility, and Enrollment Ad-Hoc Task Force (Task Force) to undertake a comprehensive review of enrollment barriers and plans to overcome these barriers for the County’s self-sufficiency programs. In addition, the Board requested the following:
• For the Task Force to obtain the input of local experts and advocates with knowledge of health and human services in outreach, analyzing, and increasing enrollment in self-sufficiency programs in California;
• For SSAB to provide a monthly status report to the Board describing the Task Force’s progress; and
• For SSAB to report the Task Force’s initial findings and final recommendations to the Board.
On December 7, 2021 (9), the County Health and Human Services Agency returned to the Board to provide the Task Force’s initial findings and interim recommendations. Today’s action requests that the Board receive the County’s Consultant to the SSAB Task Force Final Report and Recommendations (Attachment A) and the SSAB Task Force’s Final Report and Recommendations (Attachment B).
This item supports the County’s vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe and thriving communities. This will be accomplished by identifying and addressing barriers to access and enrollment in the County’s self-sufficiency services and programs to ensure individuals and families in need may obtain any benefits for which they may be eligible. Additionally, today’s action aligns with the Board’s Framework for Our Future, by incorporating an equity lens when developing and implementing programs and services, and ensuring fiscal stewardship of County resources, use of impact data, and contracting processes that align with community priorities.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFIs CER
1. Receive the County of San Diego’s (County) Consultant to the Social Services Advisory Board (SSAB) Outreach, Accessibility, and Enrollment Ad-Hoc Task Force (Task Force) Final Report and Recommendations.
2. Receive the SSAB Task Force Final Report and Recommendations.
3. Direct the Chief Administrative Officer to report back to the San Diego County Board of Supervisors quarterly on the progress of implementing the recommendations made by the County’s Consultant to the SSAB Task Force and the recommendations made by the SSAB Task Force.
EQUITY IMPACT STATEMENT
Today’s action presents recommendations to accept the Final Report and Recommendations of the Social Services Advisory Board (SSAB) Outreach, Accessibility, and Enrollment Ad-Hoc Task Force (Task Force) and the County of San Diego (County) Consultant to the SSAB Task Force as the first step in addressing existing barriers that prevent individuals and families in need from accessing and enrolling in the County’s self-sufficiency programs. The Final Findings and Recommendations of the Task Force will enable the County to better understand the root causes of under-enrollment in its assistance programs and to develop new strategies that target San Diego County residents in all communities and ensure qualifying individuals and families are able to easily access available services and benefits, regardless of their race, ethnicity, national origin, religion, gender identity, and/or sexual orientation.
FISCAL IMPACT
There is no fiscal impact associated with these recommendations. There will be no change in net General Fund costs and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
This item was presented to the Social Services Advisory Board at its regular meeting on
February 16, 2022.
BACKGROUND
As a result of the COVID-19 pandemic, an increased number of San Diego County residents are experiencing food insecurity, lack of access to adequate healthcare, and unemployment or underemployment. Individuals and families depend on various resources provided by the County of San Diego (County) and seek assistance and financial support from the County’s self-sufficiency programs. Despite increased enrollment in these assistance programs, barriers still exist that prevent individuals and families in need from accessing the services and benefits for which they may be eligible. Thus, there is a need for the County to take steps once again to further understand the reasons for under-enrollment in its self-sufficiency programs, such as CalFresh, CalWORKs, Medi-Cal, Cash Assistance Program for Immigrants (CAPI), and General Relief, and to address these barriers to ensure access for all San Diego County residents, regardless of their race, ethnicity, national origin, religion, gender identity, and/or sexual orientation.
On April 6, 2021 (10), the San Diego County Board of Supervisors (Board) requested that the Social Services Advisory Board (SSAB) establish a temporary ad-hoc subcommittee called the Outreach, Accessibility, and Enrollment Ad-Hoc Task Force (Task Force) to undertake a comprehensive review of enrollment barriers and plans to overcome these barriers for the County’s self-sufficiency programs. The SSAB was also requested to obtain the input of local experts and advocates with knowledge of health and human services in outreach, analyzing, and increasing enrollment in self-sufficiency programs in California, as well as provide to the Board monthly status reports on the Task Force’s progress. Additionally, the Board authorized the County to competitively procure and enter into an agreement for a comprehensive assessment of the outreach, enrollment, and accessibility of the County’s CalFresh, CalWORKs, Medi-Cal, CAPI, and General Relief programs.
On December 7, 2021 (9), the County Health and Human Services Agency (HHSA) returned to the Board to provide the SSAB Task Force’s initial findings and interim recommendations. Today’s action requests that the Board receive the County’s Consultant to the SSAB Task Force Final Report and Recommendations (Attachment A) and the SSAB Task Force’s Final Report and Recommendations (Attachment B). Below is an overview and summary of the overall recommendations.
Summary of Recommendations from the County’s Consultant to the SSAB Task Force
(Attachment A):
|
Number |
Recommendation |
|
Program Outreach |
|
1 |
Leverage and expand partnerships with Community Based Organizations (CBO’s) that serve prioritized subgroups and are trusted messengers in those communities. |
|
2 |
Align County and CBO approaches to outreach with customer preferences. |
|
3 |
Conduct cross-program outreach using electronic communication channels. |
|
4 |
Create digestible fact sheets and ensure availability in multiple languages. |
|
5 |
Leverage and expand mobile outreach unit and inter-disciplinary street outreach teams that include HHSA, CBO’s and police. |
|
Applications and Eligibility Processing |
|
6 |
Pursue with California Department of Social Services (CDSS) a demonstration of a simplified universal application paper packet that uses plain talk in multiple languages, gives applicants a clear explanation of what to expect in the process, and is supported by a mobile-friendly online application with easy-to-understand instructions. |
|
7 |
Give CBO assisters and outreach workers access to a private, universalized customer and case manager dashboards or databases and data sharing agreements, so CBOs can check on application status themselves and assist customers with paperwork, appointments, and due date. |
|
8 |
Establish County and CBO initiative to reduce denied applications - with emphasis on denials related to failure to provide verification. |
|
9 |
Create two-way communication channels so customers can easily ask follow-up questions about their case and check the status of their application. |
|
10 |
Streamline phone applications by replicating 211’s abbreviated rights and responsibilities approach. |
|
Renewals, Recertifications, and Change Reporting |
|
11 |
Continue the positive trend related to program churn in CalWORKs, CalFresh, and Medi-Cal. |
|
12 |
Create an HHSA welcome packet with all of the information customers need to successfully continue their benefits. |
|
13 |
Simplify redetermination paperwork and forms. |
|
14 |
Leverage best practices using behavioral economics principles for renewal reminders like HHA’s text reminders and robocalls. |
|
15 |
Improve the redetermination process for General Relief. |
|
16 |
Conduct refresher training for staff on alternatives to paper for verification and create desk guides. |
|
Program Access |
|
17 |
Expand availability of County application assistance by increasing outstationed eligibility workers in high-impact locations. |
|
18 |
Create desk guides for difficult forms HHSA cannot fix with examples of completed forms. |
|
19 |
Hire more bilingual staff. |
|
20 |
Procure improved translation services. |
|
21 |
Expand and streamline video conferencing options for customers. |
|
22 |
Address fears about public charge amongst customers living in mixed-status immigrant households. |
|
HHSA County Staffing and Workload Levels |
|
23 |
Monitor workload ratios by Family Resource Center (FRC) on an ongoing basis. |
|
24 |
Explore new ways to motivate staff and create incentives for high performers. |
|
25 |
Adjust the training model to give trainees experience in an FRC earlier in the training so dropping out happens earlier in the process. |
Summary of Recommendations from the SSAB Task Force (Attachment B):
|
Number |
Recommendation |
|
1 |
Establish County and CBO initiative to reduce denied applications - with an emphasis on denials related to failure to provide verification. The initiative should include the following activities, as well as any other priorities identified by the County and CBOs during planning and implementation. As part of initiative: • Conduct refresher training for staff on alternatives to paper for verification and create desk guides. • When waivers expire, consider expanding focus to include denials due to failure to interview. • Create additional two-way communication channels (text, chat and video conferencing) so customers can easily ask follow-up questions about their case and check the status of their application. |
|
2 |
Simplify eligibility and redetermination processes and paperwork, including a focus on cash programs (eg, General Relief, Cash Assistance Program for Immigrants, County Medical Services, etc.). |
|
3 |
Benchmark staff workload levels with other counties and states; consider emerging best practices; and monitor, report and balance workload ratios across FRCs and other County sites. Continue to monitor and increase “first contact resolution.” |
|
4 |
Increase equity of access to County Self-Sufficiency Services by (1) hiring more bilingual staff so they are consistently accessible and (2) by improving wait times and quality of third-party translation services to better serve clients in threshold and other languages and to lessen the impact on worker performance. |
|
5 |
Give trained CBO assisters access to a private, universalized customer and case manager dashboards or databases and data sharing agreements, so CBOs can check on application status themselves and assist their customers with paperwork, appointments, and due date. Pursue and advocate for this feature in the CalSAWS platform. |
|
6 |
With a clear statement from the County and through outreach with trusted community partners, address fears among customers living in immigrant, refugee and mixed status households about the use of public benefits affecting their pathways to citizenship (ie, concerns about the Public Charge rule). |
|
7 |
Assess and adjust the training model to ensure Human Services Specialists are empowered and equipped to provide excellent customer service. Include intermittent on-the-job training between program trainings to give trainees experience in an FRC earlier. Create desk guides for difficult forms HHSA cannot fix with examples of completed forms. |
|
8 |
Expand availability of County application assistance by increasing outstationed eligibility workers in high-impact locations. |
|
9 |
Review the compensation study for eligibility staff to make sure pay is commensurate with neighboring counties and the County of San Diego's cost of living. |
|
10 |
The study team and SSAB encourage HHSA and the County Board of Supervisors to embrace the County’s deserved leadership role by advocating for meaningful program improvements at the State and Federal level that will enable local systems improvements. In particular, HHSA should advocate for the continued positive changes in service delivery created by the pandemic (e.g. eliminating interviews). |
|
11 |
Leverage and expand partnerships with CBOs that serve prioritized subgroups and are trusted messengers in those communities. |
|
12 |
Create digestible fact sheets and ensure availability in multiple languages. |
|
13 |
Align County and CBO approaches to outreach with customer preferences. |
|
14 |
Conduct cross-program outreach using electronic communication channels. |
|
15 |
Leverage and expand mobile outreach unit and inter-disciplinary street outreach teams that include HHSA, CBOs, and other agencies. |
|
16 |
Streamline phone applications by replicating 211’s abbreviated rights and responsibilities approach. |
|
17 |
Continue the positive trend related to program churn in CalWORKs, CalFresh, and Medi-Cal. |
|
18 |
Create an HHSA welcome packet with all of the information customers need to successfully continue their benefits. |
|
19 |
Leverage best practices using behavioral economics principles for renewal reminders like HHSA’s text reminders and robocalls. |
|
20 |
Explore new ways to motivate staff and create incentives for high performers. |
|
21 |
HHSA should continue collaboration and building trust with community partners through a lens of equity and inclusion. |
|
22 |
HHSA should begin involving customers as advisors when improving the system. |
|
23 |
HHSA would benefit from procuring organizational development support to help leadership promote the culture and procedural changes throughout the organization. |
|
24 |
Pursue with California Department of Social Services (CDSS) a demonstration of a simplified universal application paper packet that uses plain talk in multiple languages, gives applicants a clear explanation of what to expect in the process, and is supported by a mobile-friendly online application with easy-to-understand instructions. |
If today’s recommendations are accepted by the Board, HHSA will develop a plan to begin implementation. Additionally, if today’s actions are approved, HHSA will report back to the Board quarterly on the progress of implementing the recommendations made by the Consultant to the SSAB Task Force and the recommendations made by the SSAB Task Force.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s action supports the strategic initiative of Equity (health) in the County of San Diego’s (County) 2022-2027 Strategic Plan by creating policies that: reduce and eliminate poverty, reduce disparities and disproportionality, and ensure access for all through a fully optimized health and social service delivery system. Implementing the recommendations put together by the Social Services Advisory Board (SSAB) and SSAB Outreach, Accessibility, and Enrollment Ad-Hoc Task Force will facilitate linkage to the Strategic Plan; in order to address issues within the County’s Self-Sufficiency Services programs, these recommendations were developed with input from stakeholders including customers, community-based organizations, County eligibility staff, local experts, and advocates. Removing these barriers to enrollment increases access to critical services and programs and improves service delivery that is sensitive to the needs of all individuals and families in San Diego County.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Chief Administrative Officer
ATTACHMENT(S)
Attachment A - County of San Diego’s Consultant to the Social Services Advisory Board Outreach, Accessibility, and Enrollment Ad-Hoc Task Force Final Report and Recommendations
Attachment B - Social Services Advisory Board Outreach, Accessibility, and Enrollment Ad-Hoc Task Force’s Final Report and Recommendations