What's Next for State HHS Agencies?

In brief:

  • In the wake of the COVID-19 pandemic, state HHS agencies needed to find new ways to provide benefits to constituents remotely.
  • To continue providing essential HHS programs, federal agencies gave states flexibility to adapt their ways of working. However, there is no guarantee that these temporary measures are here to stay.
  • States must now take matters into their own hands and design permanent solutions supported by innovative technology and infrastructure.

The COVID-19 pandemic has fundamentally changed the ways many state health and human services (HHS) agencies, specifically field offices, interact with their constituents.

Before the pandemic, people usually went to a field office to apply for and receive support to access public assistance programs and benefits, including Medicaid, the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), the Women, Infants, and Children (WIC) program, and childcare. While many services provided in field offices could be accessed via other channels, such as websites or phone, certain programs required in-person interviews, evaluations, or written signatures for enrollment and benefits.

The pandemic posed unique challenges to this traditional model of providing benefits, necessitating immediate and innovative approaches to enable HHS agencies to adapt to changing conditions.

Agencies operate with increased flexibility

As COVID-19 spread, caseloads rose, and HHS agencies faced staff shortages and new challenges due to social distancing and remote operations. To ensure continued access to healthcare and human service programs, federal agencies gave states increased flexibility in how they operated.

One of the first COVID-19 relief packages, the Families First Coronavirus Response Act (FFCRA), enabled agencies to provide services in new ways. WIC clinics, for example, quickly innovated and adapted their ways of working to provide services remotely, extending the certification periods beyond the existing regulatory limit, providing food instruments in larger batches at a time, mailing and remotely loading Electronic Benefit Transfer (EBT) cards, and offering telephone appointments for nutrition counseling and breastfeeding support.

Providers, for their part, transitioned to providing services via phone, email, Zoom, Facetime, and WhatsApp. In states that could not easily ramp up the necessary technological infrastructure, WIC clinics implemented curbside services that reduced in-person contact while continuing to meet the needs of constituents.

For those applying for SNAP, the U.S. Department of Agriculture (USDA) waived the requirements for in-person interviews and written signatures on applications and also provided a six-month extension for recertification. The USDA also expanded case processing by phone, allowing caseworkers to support SNAP applications remotely. Before the pandemic, only two states allowed SNAP participants to use their benefits to purchase eligible food items at participating stores online; today, nearly every state offers this option.

Greater flexibility leads to higher effectiveness

The increased flexibility under the FFCFRA has benefited hundreds of thousands of families. In fact, WIC participation has grown by more than 10 percent in Kentucky, North Carolina, South Carolina, and California since February 2020, resulting in long-term health benefits for children.

Being able to process cases by phone has simplified the eligibility process, making caseworkers more efficient. In a survey of state TANF administrators by the American Public Human Services Association (APHSA), direct service providers said not requiring constituents to sign forms in person and allowing meetings to occur via phone improved their relationships with TANF constituents. The respondents felt that continuing these practices could have long-term benefits.

What’s ahead for HHS agencies

While federal oversight agencies have made certain allowances to help states serve their constituents during the pandemic, state agencies must prepare for many of them to come to an end. Temporary workarounds implemented during the pandemic must be replaced by technology and infrastructure that can support more permanent solutions.

In designing future ways of working, state agencies should consider the benefits they have seen in terms of increased efficiency and constituents’ ability to adapt to changes, including new technologies. State agencies should also consider building the technology needed to provide more self-service functionality to beneficiaries, allowing them to access services when it’s convenient for them. The development of mobile apps, chat bots, and other tools to support constituents—which also enable field office workers to spend their time on other value-added activities—can improve customer satisfaction as well as employee morale.

And, as with all significant changes, organizational change management will be important to help both constituents and state HHS agencies adapt to these new ways of working, ensuring success long after the post-pandemic timeframe.