Fighting Hunger, Increasing Health

Many Californian who received health insurance through Medi-Cal are also eligible to receive CalFresh – and vice-versa. With both health coverage and nutrition assistance, families with low incomes can have better health and greater opportunity. The challenge is that California has been the best state at signing up eligible people for health coverage, but historically among the worst at signing up eligible people for CalFresh. The Alliance to Transform CalFresh (ATC) maintains that enrolling CalFresh-eligible Medi-Cal clients is a key strategy for improving the CalFresh participation rate.

On January 31, 2017, the ATC hosted the Dual Enrollment Summit: New Strategies to Maximize Program Efficiency and Enrollment at the Capital Event Center in Sacramento. 68 participants attended, representing the California Department of Social Services (CDSS), the Department of Health Care Services, the CalWIN and C-IV Consortium, 22 counties, and 7 advocacy and community-based organizations. The following day, the CalFresh Forum also included a break-out session on Strategies to Increase Medi-Cal and CalFresh Dual Enrollment.

CDSS Perspective

Jeff Lasiter, Manager of the CalFresh Outreach Unit, presented CDSS’ perspective on the importance of maximizing dual enrollment between CalFresh and Medi-Cal. His presentation provided an overview of the methodology that ATC and CDSS have developed together to identify Medi-Cal participants that are the most likely to be eligible for CalFresh using Medi-Cal aid codes. CDSS has yet to finalize that methodology and post related metrics for counties. See the SF-Marin Food Bank’s summary of the proposed methodology here.

Adam Dondro, CDSS’ Assistant Director for Horizontal Integration, presented on the digital mechanism for sending Medi-Cal applicants on the Covered California website to apply for CalFresh. The new design informs Medi-Cal applicants that they may be eligible for CalFresh and CalWORKs based on the information they provided. They can choose to “Apply Now,” starting an online application for those benefits. See his presentation here.

San Francisco Efforts – Outbound Call Campaign

Tiana Wertheim, Program Manager at the San Francisco Human Services Agency, and Peri Weisberg, Senior Analyst from San Francisco Human Services Agency shared the work that their county has been doing to reach likely-CalFresh-eligible Medi-Cal participants:

San Francisco has contracted with San Diego 211 to conduct an outbound call campaign.

  • Each month, the county identifies 1,200 cases that are likely eligible for CalFresh.
  • The county sends a letter and a postcard with information about CalFresh, including a phone number and website for people to contact on their own if they desire.
  • San Diego 211 follows up with outbound calls, working with those they reach to encourage them to apply for CalFresh. They complete as much of the application over the phone as possible.
  • San Diego 211 successfully reaches nearly half of the leads. A quarter of those reached submit an application, and 61% of those are approved.

Most recently, San Francisco has refined their method for identifying likely-CalFresh-eligible cases by implementing the ATC’s aid code methodology along with additional refinements from local SAWS data. They have reviewed the demographics of the population that is not receiving CalFresh and aligned their strategies according to which populations have had the most success in local CalFresh Outreach work and San Diego 211’s efforts to date. The result of that analysis is a tailored outbound call campaign targeted toward older adults in the coming months, supported by the collaboration of the SF-Marin Food Bank, and other local CBOs. Text campaigns and other “lower touch” approaches will be considered for other key populations, such as families with children or young adults.

San Francisco has also pursued parallel strategies of staff training to “rebut” typically reasons that clients resist applying for CalFresh, as well as measuring and celebrating unit or worker-level dual enrollment successes.

Alameda Efforts – Prefilled CalFresh Applications with Medi-Cal Recertification Packets

Alisa Loveman, CalFresh Program Specialist from Alameda County Social Services Agency, presented the dual enrollment pilot that they are undertaking in partnership with the Alameda County Community Food Bank. Encouraged by “All In, Alameda County,” an initiative of the Alameda County Board of Supervisors, the ACSSA sought to increase CalFresh enrollment among Medi-Cal clients as seamlessly as possible, and with the least possible onus on the client.

The county is sending pre-populated CalFresh applications to 20,000 households over the course of the next year. Applications are:

  • Included in the same envelope as their Medi-Cal renewal packet;
  • Accompanied by a marketing piece that includes a phone number for the Alameda County Community Food Bank for people who have questions or need help with their application;
  • Available in 6 threshold languages; and
  • Target 10,000 households with seniors, and 10,000 households with children.

CalWIN has developed a separate service request to make this pilot possible, including a CalWIN application source name to be able to track applications received a result of the mailing.

For the batch 1,800 packets mailed in October, the county had received 232 returned pre-populated applications as of January 27th (13% return rate).

Workgroups formed on the following topics:

  • Federal Threats including possible executive orders related to CalFresh and food insecure populations.
  • Data and further opportunities to utilize aid codes for in reach either to specific individuals or to demographic groups.
  • Myths/Stigma and opportunities improve communication regarding the minimum benefit amount, low enrollments among seniors and immigrant populations.
  • Outreach strategies including the use of Facebook ads to reach older adults and “Rx for CalFresh” partnerships with hospitals and clinics.
  • Business Process Engineering problems solving related to text messaging and phone number churn.
  • Intake promising practices such as weekly or monthly check-ins with specialists to ensure they are up-to-date with all BPR developments.
  • Small Counties and the ways CDSS could better support and connect regions with limited resources.

What can you do next to promote dual enrollment?

Use these tools for getting the ball rolling in your county:

  • Use the  one pager on why it’s important RIGHT NOW to help move this work along in your county.
  • See how your county compares to others in terms of enrolling all Medi-Cal participants in CalFresh.
  • Ask CDSS for dual enrollment data for likely-CalFresh-eligible Medi-Cal participants for your county, along with demographic breakdowns for those that are not enrolled in CalFresh. When those data are publicly available, look out for an ATC summary.
  • Dig into the Aid code methodology, and stay tuned for updates about resources in development to implement the methodology in C-IV counties.
  • Look out for a summary of Smart Dual Enrollment Practices in California Counties (the report).