One Stop for Health & Nutrition

1. One Stop for Health & Nutrition June 2014 www.transformcalfresh.org

2. Alliance to Transform CalFresh • Members: • Founding: 2011, to transform CalFresh participation by 2016 • Approach: • Data driven • Consumer focused • “Statewideness” • Alignment, wherever possible onestophealthnutrition.org June 2014

3. ATC Goal for California: 75% CalFresh Participation by 2016 • Strategy #1: Maximize ACA and dual-enroll families – most low-income families are eligible for both! • Strategy #2: Reduce churn, to keep eligible people connected to food. • Strategy #3: Deliver same day customer service, to make sure all eligible families get the food they need and qualify for asap. onestophealthnutrition.org June 2014

4. The ACA Opportunity for CalFresh “How can California be the best at signing people up for healthcoverage and the worst at signing those same people up for food assistance?” onestophealthnutrition.org June 2014

5. The ACA Opportunity for CalFresh • More People eligible for Medi-Cal as of Jan 2014 (up to 138% FPL), so now most low-income people under 65 are income-eligible for both MC and CF. • More Customer Service (e.g., call center networks between counties). • More Outreach, promotion, and application assistance. onestophealthnutrition.org June 2014

6. Why One Stop for Health & Nutrition? • Less red tape for families who are seeking help if can tell story once (i.e., apply, verify, interview for CF, etc). • Greater chance families will get (and keep) both supports as long as eligible and in need. • Greater enrollment in CF and MC boosts federal stimulus in local economy (e.g. grocery stores) and relieves pressure on local charities. onestophealthnutrition.org June 2014

7. Why One Stop for Health & Nutrition? • Less work for counties to dually enroll in one stop (once can re-engineer process and re-train workers to integrate intake and case mgmt...) • Can leverage Express Lane: enroll in CF and “express” onto MC (see ACWDL 14-06 here) • Plus, State budget increases gross income eligibility for CF to 200% (net still 100%), so more working families with high expenses will get CF (and health) • Less burden on other county emergency services onestophealthnutrition.org June 2014

8. What are the Opportunities for your County? 1. New goals: • More (X) eligible people who are participating in Medi-Cal also participating in CalFresh • More (Y) eligible people who are participating in CalFresh also participating in Medi-Cal • Overall, more (Z) eligible people in need of food participating in CalFresh onestophealthnutrition.org June 2014

9. County Opportunities, cont’d 2. New strategies: • Integrated intake so families get both CF & MC in “one stop” (and case management), especially with a) Express Lane from CF to MC and b) new gross income test to 200% for CF • Targeted in-reach to health: Assistance to MC enrollees targeted as eligible for CF, and vice-versa (and other programs like school meals and WIC) • Integrated outreach: New combined outreach projects with CBOs for CF and health for harder-to-reach groups 3. New plans: • Plus, can provide updated, data-driven “County Participation Plan” for CalFresh to CDSS and Legislature. onestophealthnutrition.org June 2014

10. Data You Can Use: Set Your Goal onestophealthnutrition.org June 2014

11. Data You Can Use: Track Your Progress • Your County’s Dual Enrollment Rates & Total Participation Numbers from CDSS’s new Data Dashboard for CalFresh onestophealthnutrition.org June 2014

12. Context • Talk to your county about this data and what the best, most current data they have for MC/CF enrollment show is happening in your county. • CDSS Data Dashboard is still waiting on best MC data since many MC apps still “pending.” • Rates of dual enrollment may well drop in 1Q 2014, as people surge onto Medi-Cal, some ACA challenges continue at all levels, and counties need time to catch up with CF and truly integrate intake. onestophealthnutrition.org June 2014

13. Action Steps – Every County • Set a specific goal with/for your county based on your baseline to maximize dual enrollment in MC and CF -- either adopt the CBPP rates or calculate a specific number to add to CF from MC. • Identify strategies already in use and to add – for example, in-reach to MC lists, with a simplified CF app; Express Lane to MC at CF intake, per ACWDL 14-06; integrated outreach for both. • Track data for progress -- in both dual enrollment and overall participation -- focusing on trend by end of year, to allow for ACA roll-out and new data collection. onestophealthnutrition.org June 2014

14. ATC Action Steps – State Level • Tracking the Dual Enrollment Data statewide, quarterly – ATC & All • Supporting new Integrated Application from Covered CA to CF/Counties – CHHS Agency proposal coming to California Health Exchange Board before August 2014 deadline (to build by December 2015 deadline) • Promoting on-going Express Lane from CF to MC by counties – ATC working with DHCS, CDSS, and CWDA to track use • Advocating for Reverse Express Lane from MC to CF – CDSS proposal to USDA pending • Aligning reporting of MC and CF – SB 1002 pending in legislature (WCLP & CFPA, co-sponsors) • Advocating for federal & state policy alignment (e.g., verifications, telephonic signature for CF, interview for CF) – ongoing... onestophealthnutrition.org June 2014

15. ATC Toolkit for County Advocates • Website for all tools: onestophealthnutrition.org • “The ACA Opportunity for CalFresh” Fact Sheet • “County Leaders and CalFresh: Three Steps ” Fact Sheet • CDSS Data Dashboard Quarterly Updates • “How to use Dashboard” guide • Blog with updates • Links to resources (DHCS’s ACWDL on Express Lane, SDHC’s Outreach Report) onestophealthnutrition.org June 2014

16. County Advocates at Work • Alameda – Allison Pratt, Alameda County Community Food Bank • Los Angeles – YolieAnguiano & Alexis Fernandez, California Food Policy Advocates • San Francisco – Teri Olle, SF-Marin Food Bank • San Diego – Amanda Schultz, San Diego Hunger Coalition onestophealthnutrition.org June 2014

17. Setting Goals for CalFresh Participation in Alameda County • Strong desire among leadership at Social Services Agency and political support • SSA is making dual enrollment a priority • Linking with current initiatives to generate excitement and support for new goals • County Supervisor Wilma Chan’s “New War on Poverty” • Workgroup includes community organizations and SSA leadership onestophealthnutrition.org June 2014

18. Pursuing an In-reach Strategy in Alameda County • Food Bank has 11 year history of applying varied outreach strategies • For our in-reach strategy, we partnered with SSA to design and send a mailer to 58,000 households receiving MediCal, but not CalFresh • 4% return, double the normal benchmark for success • High number of applications with 90% approval rate onestophealthnutrition.org June 2014

19. Looking Ahead...In Alameda County • More in-reach; we’ve found this strategy to be very cost-effective compared to our other large campaigns. • Current campaign includes 80,000 MediCal households and 10,000 households ageing out of WIC • Mailing will be dropped in batches to control flow • Other way to reach this population include mapping and focusing on certain neighborhoods, residences and businesses. • Can we send a simplified application instead? onestophealthnutrition.org June 2014

20. Coalition of Advocates Identified Priority Strategies to Increase Dual Enrollment in Los Angeles County Nutrition for LA Families Coalition’s Priorities for Dual Enrollment: • “In-reach” to programs with similar eligibility requirements • Improve the electronic referral process from CalHEERs (Covered California) onestophealthnutrition.org June 2014

21. In-reach in LA County DPSS electronic data management system identifies residents that are likely CalFresh based on income information provided for other programs For example, Medi-Cal only households with no share-of-cost CalFresh solicitation Letter sent to inform them of potential CalFresh eligibility Letter highlights potential CalFresh benefit amount onestophealthnutrition.org June 2014

22. Referrals from Covered CA for CalFresh to LA County DPSS Current Process • Send informative CalFresh mailer to those individuals who requested a referral to CalFresh • Mailer highlights CalFresh enrollment options (e.g. online) Advocates’ Request • DPSS seamlessly initiates a pre-populated application for CalFresh and sends to individuals who requested referral to CalFresh onestophealthnutrition.org June 2014

23. Ongoing Advocacy in LA County • As county continues to promote health care enrollment, keep DPSS engaged in implementing additional in-reach strategies & solidifying a process for CalFresh referrals. • Start a dialogue with the Board of Supervisors to gain support for increased CalFresh participation and maximized dual enrollment. Questions? Contact YolieAnguiano at 213.482.8200 ext. 202 or yolanda@cfpa.net Alexis Fernandez at 510.433.1122 ext. 111 or alexis@cfpa.net onestophealthnutrition.org June 2014

24. New Strategy in San Francisco County Outbound recruitment of targeted individuals “Reach out to individual people instead of waiting for them to come to us.” Target: • Medi-Cal • 9,000 clients under 130% FPL and not on CalFresh • Free School Meals: • 11,000students on Free School Meals are not enrolled in CalFresh but are eligible onestophealthnutrition.org June 2014

25. Current Budget Prospects in San Francisco County Mayor’s proposed $2.1 million for FY 14-15 Mayor’s Budget (+ FY13-14 approved supplemental budget) will fund: • Two Outreach Teams of Eligibility Workers • Focus on Medi-Cal recipients, school children, and community-based enrollment (such as successful “CalFresh in a Day”) • First dedicated outreach staff in a decade • Each team = 8 EWs and 1 supervisor Food Security Task Force’s requested $195 thousand in “Add Backs” would fund: • CBO Outreach and Application Assistance at community venues and to targeted individuals onestophealthnutrition.org June 2014

26. Advocate Priorities in San Diego County • Implementation of AB 191: San Diego County HHSA proactively created work-arounds to implement AB191, raising the gross income test to 200% FPL for households with Medi-Cal recipients (note new state budget now broadens to all at 200% FPL) • Express Lane Enrollment: San Diego County HHSA is working to ensure that Express Lane Enrollment is being implemented, maximizing dual enrollment in CalFresh and Medi-Cal.  HHSA is currently in the process of updating county program guide materials and will be providing continued staff training opportunities. onestophealthnutrition.org June 2014

27. Links • One Stop for Health & Nutrition Toolkit www.onestophealthnutrition.org • CDSS Data Dashboard for CalFresh http://www.cdsscounties.ca.gov/foodstamps onestophealthnutrition.org June 2014

28. Contacts • Kim McCoy Wade kim@mccoywade.org • Allison Pratt apratt@accfb.org • Yolie Anguiano yolanda@cfpa.net • Alexis Fernandez alexis@cfpa.net • Teri Olle tolle@sfmfoodbank.org • Amanda Schultz amanda@hungeraction.net onestophealthnutrition.org June 2014

29. Coming Soon... More ATC Webinars & Toolkits on Key Strategies to Transform CalFresh Participation • #2: Reducing “Churn” by Eligible People • #3: Providing Same Day Service onestophealthnutrition.org June 2014

30. Q & A onestophealthnutrition.org June 2014

31. The Alliance would like to thank its funders: onestophealthnutrition.org June 2014