How Can Lessons from Medicaid Help Connect People to Unemployment Insurance?
Millions of people are losing jobs due to the coronavirus pandemic and seeking financial assistance through Unemployment Insurance (UI) programs. While UI can provide an important source of temporary assistance for many people losing jobs, there have been reports of major challenges accessing UI benefits. Although many of these challenges stem from the inability of outdated systems to handle the large influx of applications, people may also face other challenges accessing benefits, such as lack of awareness of eligibility and difficulty completing the application and enrollment process, including providing required documentation. Over time, states have significantly streamlined Medicaid and the Children’s Health Insurance Program (CHIP) application and enrollment processes to overcome many similar challenges to connect eligible people to health insurance coverage. As such, previous experience enrolling individuals into Medicaid and CHIP can provide lessons learned that could help inform efforts to connect people to UI. This brief summarizes some key lessons learned and discusses how states could potentially apply these lessons to UI.
UI is a federal-state system that helps many people who have lost their jobs by temporarily replacing part of their wages while they seek work. States administer the program, within broad federal guidelines under oversight provided by the Department of Labor. To qualify for UI, a person must have lost a job through no fault of his or her own; be able to work, available to work, and actively seeking work; and have earned at least a certain amount of money during a base period prior to becoming unemployed. Within these broad requirements, states have substantial flexibility to establish eligibility criteria and benefit levels. The Coronavirus Aid, Relief, and Economic Security Act (CARES) expanded UI eligibility and benefits. It provides a $600 weekly federal supplement (available through July 31) to state unemployment benefits and extends the period for receiving unemployment benefits by up to 13 weeks. The Act also extends benefits to many types of workers (e.g., self-employed) who are not eligible for unemployment benefits under state laws.
Over half (55%) of working adults have lost a job or income due to the coronavirus pandemic, and a record 33 million people filed for UI between mid-March and April 25, 2020. However, reports describe UI application processing systems lacking capacity to process the recent surge in UI applications, leading to crashed websites and jammed phone lines, as well as delays in updates to UI systems to reflect the expanded eligibility and benefits provided under the CARES Act. Beyond systems-related problems, individuals may face other challenges accessing UI. For example, individuals may not know they are eligible for UI, particularly if they are not aware of the eligibility expansions under the CARES Act. Individuals also may have difficulty completing the UI application and providing necessary documentation, and there may be high demand for enrollment assistance since many people may be applying for UI for the first time and most will be applying from home due to social distancing policies. A recent survey finds that for every ten people who said they successfully filed for UI during the previous for weeks, three to four additional people tried to apply but could not get through the system to make a claim and two additional people did not try to apply because it was too difficult to do so.
Lessons from Medicaid and CHIP
States have taken an array of actions to help connect eligible people to Medicaid and CHIP coverage that may help inform efforts to connect people to UI. After the passage of CHIP, many states streamlined enrollment processes and conducted outreach and enrollment campaigns to promote enrollment of eligible children. The Affordable Care Act expanded coverage and built on previous state experience with CHIP by establishing streamlined and modernized enrollment processes across all states. Further, some states are taking additional steps to streamline Medicaid and CHIP enrollment in response to COVID-19.
Outreach and Enrollment Assistance
Previous Medicaid and CHIP experience showed that outreach and enrollment assistance were instrumental for making people aware of coverage options and helping them apply. Following implementation of the ACA, federal and state mass marketing campaigns helped raise awareness of coverage options. In addition, one-on-one assistance provided through trusted individuals was key to helping eligible individuals enroll. The federal government and states funded navigators and enrollment assistors to help individuals enroll. Many of these navigators and assisters were associated with community-based organizations. Utilizing trusted individuals within the community to provide outreach and enrollment assistance was particularly important for connecting with harder-to-reach populations and those who need more assistance, including individuals with limited English proficiency.
Outreach and enrollment assistance could be similarly helpful to connect eligible people to UI. This experience suggests that broad marketing campaigns could help raise awareness of expanded UI assistance. Further, it points to the importance of increasing the availability of assistance as demand for UI grows, especially phone-based or online assistance since most people will be applying from home. It also suggests that states may want to explore how they can work with community-based organizations to share information about eligibility for UI and provide enrollment assistance.
Streamlined Enrollment Processes
The ACA established streamlined eligibility and enrollment processes across all states. For example, it eliminated certain requirements, such as face-to-face interviews and asset tests for most groups. It also required states to provide multiple application options, including online, phone, mail, or in-person, and to use available data to verify information when possible. States have additional options to facilitate enrollment, including shortening and simplifying applications, relying on self-attestation of eligibility criteria when possible, and providing presumptive eligibility to individuals while the state completes processing of their application. Some states are taking additional steps to facilitate enrollment of eligible people in response to the COVID-19 outbreak, including further shortening applications, allowing for self-attestation of additional eligibility criteria, and expanding use of presumptive eligibility.
UI programs could draw on these state experiences by simplifying application and eligibility determination processes. UI programs typically require applicants to file claims with documents showing income eligibility (e.g., having a minimum amount of earnings for a number of weeks employed prior to filing) as well as non-monetary eligibility (including the reason for separating from work, availability for work, immigration documents, and/or forms for some jobs where the employers are exempt from paying into the UI program). Some states require a one-week waiting period to receive benefits, meaning that the second week claimed is the first week of payment. After being determined eligible for benefits, individuals will file continuing claims generally every 1-2 weeks, depending on the state, to document that the individual is still searching for work, among other requirements. Previous Medicaid and CHIP experience suggests that states could help facilitate access to UI by reducing these requirements. For example, a number of states have waived the one-week waiting period for benefits and waived or relaxed work search requirements. States could also explore options to shorten and simplify the application for benefits and expand use of self-attestation of eligibility criteria. States also could explore similar presumptive eligibility policies as Medicaid and CHIP to make an initial determination of eligibility and begin paying benefits based on limited information while they work through backlogs to complete verification and review of claims.
Coordination or Integration with Other Programs
All state systems coordinate enrollment in Medicaid, CHIP, and the Marketplace coverage, and many states coordinate Medicaid and CHIP enrollment with non-health programs. In half of states, individuals can use a single application to apply for Medicaid and other programs, such as food or cash assistance, and most of these states process eligibility determinations for these programs through a single system. In states that do not have an integrated application or system, eligibility workers can still refer people to apply for other programs. This integration and coordination helps facilitate access to across programs for eligible individuals.
UI programs could coordinate or integrate enrollment with other programs. Most state UI programs coordinate with other workforce programs, such as job training or placement agencies, but the extent to which UI is coordinated with other assistance programs is unclear. Broader coordination across programs and agencies could facilitate access to UI as well as other assistance programs. For example, states could take action to ensure revenue agencies can share 1099 tax filing information with UI programs to facilitate processing of applications for independent contractors and self-employed workers, who became newly eligible under the CARES Act. Coordination between UI and Medicaid, as well as the Affordable Care Act marketplaces, could be particularly helpful in facilitating access to coverage since many people losing job-based insurance will be eligible under those programs based on their UI benefits.
Nearly all states have upgraded or replaced their Medicaid eligibility systems to implement the new processes established under the ACA. The ACA provided states enhanced federal funding to support eligibility system upgrades. It took many states years to upgrade or build new systems, and many are still refining and improving them. Medicaid and CHIP system upgrades have increasingly enabled states to use automated enrollment processes that rely on electronic data matches with other data sources, allowing eligible individuals to connect to coverage quickly and easily and reducing administrative burdens on states. Most states report that system upgrades and modernized processes have contributed to improvements in eligibility and enrollment operations compared to before the ACA.
System upgrades could help address the significant challenges many people are facing accessing UI benefits, especially since a number of states are still relying on outdated systems, but it will require significant time and investment to implement upgrades. In the interim, some states are gating access to systems, for example, by only allowing applicants to file on certain days based on the first letter of their last name. Waiving or reducing requirements to document work search activities may also reduce stress on systems. Some states have also redirected resources and staff to process applications. State UI programs have received federal grants to upgrade systems, but not a sustained federal match for costs.
UI offers an important source of temporary assistance to help people losing jobs as a result of the COVID-19 outbreak. The CARES Act expanded UI benefits to enhance this support. However, many people are facing significant challenges accessing UI benefits. Many of these challenges reflect limitations of outdated systems. However, people may face other challenges, including lack of awareness of eligibility for benefits and difficulty completing application and enrollment processes. Lessons learned from Medicaid and CHIP can help inform state efforts to address these challenges.