Contents

Overview Introduction Why Do a Testing Project in Your State? Getting the Facts Learn How Your State Determines Who is Eligible for the Benefit Learn What the Barriers Might Be in Your State Mounting Your Testing Program Recruit Testers Prepare Your Testers and Volunteers Interview Testers, Document their Experiences and their Stories Charting Your Results Charting Your Results Writing Your Report Moving into Action/Media Summary Appendices ICAN Flyers Hunger Pains: Oregon Food Stamp Program Fails to Deliver

NWFCO and its affiliates have used testing projects to expose barriers to access to public programs like the Food Stamps Program and the State Children's Health Insurance Program (SCHIP). By documenting these barriers, we have been able to give grassroots groups a tool they can use to organize and open the programs to many more people. Testing projects can be used to document barriers to any public benefit program. Some examples of possible programs you could investigate with a testing project include: ● Food Stamps ● Public health coverage programs, including Medicaid, SCHIP, or state health coverage programs ● “Charity care” policies at public or non-profit hospitals ● Interpretation and translation services at hospitals ● Low-Income Home Energy Assistance Program (LIHEAP) This kit explains, step-by-step, how to test your state’s application process for a public benefit program and how to use what you learn from your test. The project includes seven steps, each outlined in this kit: 1. Learn about the eligibility requirements in your state and about the barriers that prevent eligible people from receiving the benefit in your state 2. Recruit testers and volunteers 3. Train your team 4. Perform the test 5. Analyze the results 6. Write your report 7. Present your results to the media This kit includes stories and model materials from two successful testing campaigns. One was a testing project that NWFCO performed with the Idaho Community Action Network (ICAN) of the State Children's Health Insurance Program (SCHIP) in Idaho in 1999. The second was a testing project that NWFCO performed with Oregon Action of the Food Stamps program in Oregon in 2000. Both testing projects resulted in campaigns that won big changes to the programs that were tested.

Why Do a Testing Project in Your State?
Community organizations can expose barriers to access to public benefits programs for people in each state and open the program to many more people. People who are eligible for programs like Food Stamps and SCHIP, low-income families and particularly immigrant families, can be easily intimidated by state caseworkers and prevented from succeeding in their applications. Community organizations can help these people to be heard. ♦ This project can be a victory for the families you work with, providing access to critical benefits. ♦ Organizations benefit by building membership and constituencies on these issues. ♦ This should always be a winning campaign. Programs like Food Stamps and SCHIP have funding already and support from state legislatures. ♦ Many of the barriers to coverage are “illegal” practices, so efforts to eliminate these barriers are supported by the Federal government and its agencies. ♦ Public exposure of these problems has proven to get fast action by state agencies. ♦ Testing projects can be used to win changes in the practices at particular local offices that are not following State or Federal rules, and they can also be leveraged to win state-wide changes in program policies and rules that impact all offices in the state.

Learn How Your State Determines Who Is Eligible for the Benefit
Eligibility for public benefits is based on income measured as a percentage of the Federal Poverty Level (FPL). Each program covers individuals or families up to a certain FPL. You’ll need to find out that income requirement. A chart that shows income at various percentages of FPL looks like this:

2009 Federal Poverty Guidelines Number of family members 1 2 3 4 5 6 7 8 For each additional person add

100% FPL $10,830 $14,570 $18,310 $22,050 $25,790 $29,530 $33,270 $37,010

185% FPL $20,036 $26,955 $33,874 $40,793 $47,712 $54,631 $61,550 $68,469

200% FPL $21,660 $29,140 $36,620 $44,100 $51,580 $59,060 $66,540 $74,020

250% FPL $27,075 $36,425 $45,775 $55,125 $64,475 $73,825 $83,175 $92,525

$3,740

$6,919

$7,480

$9,350

*1/23/09 guidelines. Guidelines are revised annually; you should check to be sure that these numbers are still accurate. Guidelines for Alaska and Hawaii are slightly different. Some states allow applicants to deduct some expenses, like day care for children or dependent adults, from their income before considering income eligibility. Some states count the value of a family’s assets, like a car or bank account, in the income eligibility test.

Immigrant Eligibility for Public Benefits
Public benefits programs have different rules about how citizenship status impacts eligibility. It is important to research how citizenship status impacts eligibility for the program you are testing in your state before you begin recruiting testers. Undocumented Immigrants Undocumented immigrants do not qualify for most federally funded programs.1 Some programs, like the Low-Income Home Energy Assistance Program, may be available to households that include undocumented immigrants if one person in the household is a citizen or “legal resident,” but penalize those households in the way they calculate household income. Non-citizen Immigrants with Legal Status Eligibility for immigrants with legal status who are not yet citizens changes with each program and each state. One issue for legal permanent residents is the “five-year bar.” Lawful permanent residents and some other categories of immigrants with legal immigration status who have arrived in the U.S. after August 22, 1996 are not allowed to receive some federally-funded benefits for five years after they secure their immigration status. Naturalized Citizens and Children of Immigrants All citizens who meet the income eligibility requirements qualify for public benefits, including immigrants who have become citizens through the naturalization process and U.S.-born children of immigrants. A child born in the United States is always a citizen. If a child is a citizen, it does not matter whether other members of the child’s family are citizens when applying for a benefit that covers the child, like SCHIP. Only the child has to show proof of citizenship, if asked. Only the child applying can be required to provide a social security number. The federal government has forbidden states to ask for that information about family members, even parents. Programs that Cover Immigrants Some states have created programs that are paid for with state funds to cover immigrants who do not qualify for federally-funded programs because of their status. Congress also changed the rules for the SCHIP program in 2009 to allow states to choose to cover children who would otherwise be excluded by the five-year bar. You will need to check your state's rules as well as the federal rules to figure out eligibility. This information is provided in much more detail at the following website: www.nilc.org There are a few exceptions. For example, undocumented immigrants are eligible for emergency Medicaid if they qualify under the income and other eligibility rules for their state Medicaid program.
1

This website has an article explaining the issue, Overview of Immigrant Eligibility for Federal Programs, by Tanya Broder and Jonathan Blazer, May 2009, as well as a chart that explains which programs immigrants with each category of status are eligible for.

Learn What the Barriers Might Be in Your State
Interview low-income advocates, caseworkers, and people who have applied for the benefit in your state to learn what barriers exist in your state that prevent eligible people from getting the benefit. These are the things you’ll want to test for. Some questions you might ask are: ● Do caseworkers offer information about the program voluntarily when people ask for help for their families? ● Are applicants discriminated against based on race or because they are immigrants? Are immigrant testers required to submit extra documents? Are they threatened or intimidated about their immigration status? ● Are language services really provided to limited English proficiency applicants? Federal law requires that states communicate with applicants for federally-funded programs, orally and in writing, in a language understood by the applicant. ● Are there procedural barriers that prevent people from completing the application process? Do caseworkers set interview appointments for times when working people can’t go to meetings? Are they unwilling or unable to do interviews over the phone or in places closer to the applicant’s home than the state office? ● Do caseworkers understand and follow the Federal or State rules for eligibility? Do caseworkers demand social security numbers for household members and documentation about household members who will not be receiving the benefit? ● Do caseworkers in different offices follow the same rules and treat applicants alike? ● When an application is rejected, what criteria are used? Are there criteria that allow caseworkers to use their own discretion? ● Are caseworkers respectful or intimidating to applicants? ● How many meetings with a caseworker does an applicant have to attend before a decision is made?

Recruit Testers
We suggest that you pick a minimum of 3 places in the state to include in your testing project. Include at least one rural office and one urban office. Choosing offices in different areas of the state allows you to show that the problems you encounter are part of a statewide pattern, not just a localized problem. Comparing the experiences of your testers in several offices also allows you to point out situations in which local offices are being arbitrary in their policies and decisions. We also suggest that you recruit testers from a variety of backgrounds and races to test for discrimination. It’s important to recruit enough families to be able to show that their treatment is a significant pattern of treatment by the state offices. Some families might not qualify, especially if your state has very complicated requirements, and others might drop out for other reasons. Ways to recruit testers: ♦ Sit in the waiting rooms of free health clinics and Indian Health Centers and talk to people ♦ Spread the word through the network of families and friends of your organization’s low-income members ♦ Check food bank lines, ask at local churches that provide services to low-income people, and inform legal aid offices that you’re looking for volunteers ♦ Distribute flyers in low-income neighborhoods ♦ If your organization does door-to-door recruitment, ask people to participate as you canvass in low-income neighborhoods ♦ Ask farmworker unions and migrant councils to help recruit among their membership

It’s a good idea to make up a worksheet for your recruiters to use to help them figure out if a person will be eligible for the program, and to gather basic information for your project about the child and family. Here are is an example of a recruiting survey that was used in the SCHIP testing project in Idaho. You can adapt it using eligibility criteria for the program you will be testing.

Sample Recruiting Form
Name of person helping you fill out this form: ______________Phone: ___________ Are you in: (Please circle) city 1 city 2 city 3

Your Name: _________________________________ Phone: ______________________________ Address: _________________________________________________________ Do you Need Translator? Language: Yes _____ No _____

Spanish___________ Vietnamese________ Cambodian_________ (Add the most common languages in your area) Other______________

Are you? Male _____ Female _____

White_____ Hispanic/Latino____ Black _____ Native Am. ____ Other_____ Single ______ Married ______ Divorced ______ Other_____

What grade level did you finish in school? Did not graduate from high school____________ Graduated from high school_________________ Attended college__________________________ Graduated from college____________________ Other__________________________________

Name of child

Age

Now Insured?

Insured Six Months Ago?

Citizen or “qualified alien” (A qualified alien is a legal permanent resident who arrived in the US before August 22, 1996.)

Not a citizen or “qualified alien”

What is your Gross Monthly Income Level? What is your income source? (These are the relevant income levels for the Idaho SCHIP program in 1999. Replace them with the income levels for your state's program today.) ______ Under $1,000 _____ Employment ______ $1,001 - $1,450 _____ TANF or welfare ______ $1,451 - $1,850 _____ Soc. Security ______ $1,851 - $2,200 _____ Disability ______ $2,201 - $2,570 _____ Other ______ Over $2,570

Additional comments:

Prepare Your Testers and Volunteers
Have an eligible family run through the application process in each of the locations that you plan to test before you set up your testing plan. In the Idaho SCHIP testing project, the original plan was to have all of the testers in one location go in to the office and apply, one after the other, and then be immediately interviewed about the experience by volunteers. Unfortunately, the application process at the Idaho Department of Health and Welfare was not as simple as they expected. Each of the testers was handed an application and given an appointment to return later and apply. The organizers then had to arrange to interview each of the applicants after their appointments, which were spread out over several weeks. It’s important to be flexible and able to adapt to whatever system you find. If you send in an advance tester, to see generally how the process works, you’ll be able to plan and have a better idea of what resources you’ll need to complete the test. Find out if: ♦ the office will take applicants off the street and allow them to apply on the spot; ♦ the office will set appointments for interviews when people walk in; ♦ the office will set appointments over the phone; ♦ applicants are required to go to the office to apply or can order an application and send it back without going to an office; ♦ applicants have to make multiple visits to the office to complete the application; ♦ the office schedules many appointments for each day. Some states will provide applications to people who call for them and allow applicants to send in completed applications. Some don’t require any interview, either face-to-face or over the phone. That makes applying much easier for applicants, but you will want to test how the office staffs treat applicants, so ask your testers to go in to an office to pick up an application.

Training
Before the test begins you could have a training session for both the testing families and the volunteers who will be interviewing them to collect the results of the test. The following training plan is based on the training ICAN did for its testers in the SCHIP testing project, based on the questions they planned to ask.

Sample CHIP Research Training for Testers
Based on training given in Idaho February, l999 Approximate time: 1.5 hours (Have enough copies of the recruitment forms and the getting the application role-play for everyone. Have two copies of the appointment role-play for you and organizer only) Ask people to fill out recruitment form while they are waiting to begin and be sure to collect them. Welcome Define CHIP (10 minutes) Discuss what participants know about the CHIP program. Prepare a poster with the key facts about CHIP and your state’s program and hang it so everyone can follow along with your explanation and refer to it during the program. Prepare a handout with the same information to give to the testers after the training. Explain benefits, eligibility requirements, and purpose of the CHIP program. Explain application process for your state. Explain purpose of testing projects, examples of past testing (10 minutes) The following is a sample explanation, prepared for the Idaho testing project. We want to help you get CHIP benefits, so we want to help you through the process, AND we want to make it easier for others too, so we're asking your help in documenting what your experience is when applying. We've tried to get as many people as possible to help with this from 3 different parts of the state: Lewiston, Nampa/Caldwell, and Burley. We want to document if people are having difficulties accessing CHIP, and if certain groups of people have more difficulty than other groups; that is, if they are being discriminated against. I believe everyone here is eligible for CHIP and during the next week you'll be applying for benefits. In order to document what is preventing people from getting CHIP

benefits, we're going to ask you to answer a few short questions immediately after you pick up the application form for CHIP and after your appointment with the caseworker. We want you to specifically describe whether the caseworker talked with you about CHIP, and whether his or her comments or actions were positive, or negative. Has anyone had any experience with a public institution (like DH&W - not in applying for CHIP necessarily) that was positive? Can you say what made it so? Negative? Can you describe what made it so? We want to do the same thing here, remember what was positive and negative, and we are depending on you to remember details and to tell us afterward. We don't want you to take notes or tape record, or change anything about the way you would act if you were not in this role of observing. Think for a minute what you might do that would change the possibility of getting benefits (example: lie, not show up for the appointment, tell the caseworker we're watching him or her). We don't want you to change your behavior in anyway - just be yourself. We simply want you to observe what happens as you get an application and during your appointment. We don't believe that this should not in any way affect whether or not you get benefits. This kind of observation has been done by other groups, like this one, to make sure that government programs and laws preventing discrimination are working for people. In l989 there was a big study in Chicago to see if black people were discriminated against in applying for public housing. A group like Idaho Community Action Network got complaints that people were being denied housing, and they thought it was due to their race. So the organization sent people to look at apartments who were similar in income and education and gender but were different races. They sent a black person to apply first, then a white person, and they interviewed each afterwards and they found that blacks were being discriminated against and because of this 'research', practices in renting apartments changed. This technique of finding people who are similar in all areas except race been used also to see if there is discrimination in lending practices of banks. It hasn't been used much in welfare and other benefits. So you're part of a new and important study here in Idaho. We're asking you to tell us about yourselves in a lot of detail so that we can find out if people who have a lot of similarities are being treated differently if their only difference is race. We don't need for the two to go to the same office or at the same time because, unlike an apartment that might be rented, CHIP benefits should be accessible for all and there is no time constraint. So, we're going to be looking at these issues of possible discrimination over the next week. Any questions so far? Research Steps (5 minutes: Write steps up on chalkboard if possible) Explain each step of the project, including directions about when and where testers should be, and how long each step should take. Does anyone have any questions? Review questions (5 minutes)

Ask testers to summarize for you what you’ve discussed so far. Prepare a poster that spells out the key points you want to emphasize, especially that they should not ask for CHIP by name when they ask for assistance. Review the questions you’ll be asking the testers when they report on each stage of the test. For example: We are going to now go over the main questions we are going to ask you after you have picked up your application. By knowing them in advance, you might be able to pay attention to the situation. 1. Did the caseworker tell you how to apply for CHIP specifically? We want to see if they offer to tell you about CHIP when you pick up the application - we don't want you to have to ask for CHIP. 2. Did the caseworker act in a positive way or make positive comments to you? 3. Did the caseworker act in a negative way or make negative comments to you? Does that seem doable? Any questions? Role Play (30 minutes total (20 to model and analyze, 10 to practice 1:1)) Model Good Secretary and Bad Secretary and Bad Caseworker examples and facilitate post role-play discussion after each. Discussion format for good secretary: ask people to identify positive actions/comments like offering a translator, offering information about how long the process will take, and using the term CHIP. Discussion format for bad secretary: Ask people to identify negative actions/ comments like: didn’t offer any extra/helpful information, told person when to come for an appointment without asking if that would work, didn't say the word "CHIP" Discussion format for bad caseworker: Ask people to identify negative actions/ comments like: got up and walked away to talk with colleague, discounted entire application, didn't set another appointment. Then break people into pairs telling them to practice just good and bad secretary and feel free to adapt their characters - but be realistic, then talk about it with one another. Each person should practice asking for the application in this exact way. We don't want people ever to ask for CHIP when they go in for an application. Ask one pair to perform their role-play before the group, and ask them and the group to comment on what went well, etc, in their play.

Summarize, writing points on chalkboard. Repeat the main questions you’ll be asking in the interview, and remind testers that they do not need to act at all, but just be themselves. Closing Q&A (10 minutes) Any questions? Are you ready? Go over logistics. End (10 minutes) Take more time to complete recruitment forms and then collect forms Hand out copies of your “What is CHIP?” summary. Sample Getting the Application Role-Plays Developed for CHIP Research Training Idaho February, l999 Good secretary Client: Hi, can you help me? Nobody in my family has health insurance. Good secretary: Yes, first you need to fill out an application for Medicaid its good for the Children's Health Insurance Plan also, then you need to have an appointment with a case worker. Do you need help filling out this form? We have translators. Client: No thanks, but can I take it home with me? Good secretary: Yes and let's set an appointment, can you come in next Friday? Client: No, I can't, I work then, but I could come in Tuesday or Wednesday? Good secretary: OK, how about Tuesday at 10 am? The appointment will take about an hour. Be sure to bring all the documents listed here, including your children's birth certificates too. Bad secretary Client: Hi, can you help me? Nobody in my family has health insurance. Bad secretary: Yes, first you need to fill out this application. Client: Do I need to fill it out now? Bad secretary: No.

Client: What happens once I fill it out? Bad secretary: Then you meet with a caseworker. Client: Can I make an appointment? Bad secretary: Yes, you need an appointment, next Friday 10 a.m. Client: Sorry, but I can't come in that day because I work then, but I could come in Tuesday or Wednesday? Bad secretary: OK, Tuesday at 10 am. Be sure to bring all the documents listed here, including your birth certificate and your children's birth certificates too. Bad Caseworker Bad Caseworker: OK, what are you here for? Client: Nobody in my family has health insurance and I'd like help. Bad Caseworker: Let me see your application. (looks at it quickly, gets up walks away talks to another imaginary caseworker about their lunch date, comes back). You've filled this out all wrong (tears the application in half and throws it away). You need to start all over again. Here's another form. Client: Can you tell me what was wrong? Bad Caseworker: You didn't have the right documents. Your children's birth certificates showed different dates. You'll have to go to the hospital and get it corrected. Client: But what about the application? What was wrong with it? Can I get insurance for my kids? Bad Caseworker: Come back when your documents are corrected. Next Person?

Training Volunteers
Training for volunteers who interview testers and complete questionnaires can be similar to tester training in many ways. You could begin with the informational sessions that begin the tester training sample above: Welcome Define CHIP (10 minutes) Explain purpose of testing projects, examples of past testing (10 minutes) Research Steps (5 minutes: Write steps up on chalkboard if possible) Review Questionnaires (10 min) Review the questions on the questionnaire and discuss the importance of the information they ask for. Explain how the demographic information can be used to show discrimination against particular groups. Review the barriers you expect to encounter and explain how the questions on the questionnaire willshow those barriers in practice. Discuss Confidentiality Issues (10 min) Some of the questions on the questionnaires will make testers uncomfortable, like the questions about immigration status. Ask volunteers which questions they think might cause testers to be uncomfortable or lose trust in your organization. Discuss those issues and how to approach them without making testers uncomfortable. Remind volunteers that all information collected in the test must be kept confidential. Your group will want to identify families that are comfortable taking public roles in the campaign; discuss how volunteers can explain those roles without frightening publicityshy testers. Teach Listening Skills (10 min) Filling in the spaces on the questionnaire is important, but gathering stories is equally important. Review listening skills and remind volunteers that they need to record as much of the testers’ experiences as they can. Role Play (30 minutes total (20 to model and analyze, 10 to practice 1:1)) Model good interview skills and have the group discuss the role play. Have the group break into pairs and practice. Ask one or two pairs to perform their role play for the group and discuss. Closing Q&A (5 minutes) Any questions? Are you ready? Go over logistics.

Interview Testers, Document their Experiences and their Stories
As each family finishes each step of the application process, have volunteers interview them and record their experiences. The questionnaires volunteers used in the Oregon Food Stamp project follow this section. Try to include questions that discuss all of the issues you wanted to test with your project. As you interview families you might learn about issues you hadn’t known existed. Collect “horror stories” of particularly bad treatment and try to document them. You’ll want to include them in your final report and your press information. Some of the questions on the following questionnaires are very specific. Remind your volunteers that other information, especially stories, is very important. You’ll want to have people’s stories in their own words for your report. Ask volunteers to write down stories as people tell them, as much as they can, and to explain answers like “other.”

Oregon Action Food Stamp Testing Project
Response Sheet Number 1: First Visit to Food Stamps office Instructions: Complete this response sheet after your first visit to the food stamp office. Please fill out the form completely and do not leave any answers blank. If you need help, please ask. Name: ____________________________ Ethnicity: Number of children

______________ Phone: ______________ Number of adults in household: ________ in household: _______________ If anyone if your household works for wages, answer the following questions: First job: Second job: Third job: Hourly wage: __________ Hours per week: Hourly wage: _________ Hours per week: Hourly wage: __________ Hours per week: _________ Hours per month: _____ _________ Hours per month: _____ _________ Hours per month: _____ Do the adults in your household have health insurance? Yes No

Do the children in your household have health insurance? Yes No

Date you applied for food stamps: __________________________ Today's date: ____________ Location you applied for food stamps: ______________________________________________ What language do you prefer to speak: ______________________________________________

Oregon Action staff person name: __________________________________________________

1) Did the person helping you encourage you to complete and return the first page of the application immediately? 2) Was it explained to you that you needed to return for an interview with a completed application and supporting documents at a later time? 3) Were you told to return during a mass intake time (i.e. between 7:00 a.m. or 9:00 a.m.) or a specific appointment time? 4) Was the interview time offered convenient for your schedule? 5) [Skip if answer to #4 is Yes.] inconvenient for you? 6) Why was the time

Yes No Yes No

Intake 
Appointment

Yes No Work School Other Yes No Yes No

[Skip if answer to #4 is Yes.] Were you provided with an alternative time that was convenient for your schedule?

7) [Skip if answer to #4 is Yes.] Did the person helping you offer to send a food stamps worker to your home to interview you or hold the interview over the phone? 8) Were you told that you needed to fill out the entire application and bring the required documents before returning to the office for your interview? 9) Were you told that if you were unable to locate the required documents that you could instead provide the name of someone, like a landlord or

Yes No

Yes No

an employer, who could confirm your statements? 10) Did the person helping you ask if you had any questions? Were you provided with a phone number or another way to contact a food stamps worker if you needed help while filing out the application? Were you asked if you needed help buying food immediately or if you were in a crisis situation? Did the food stamps worker read all sections of the application you turned in while you were waiting?

Yes No Yes No

11)

12)

Yes No Yes No

13)

14)

Were the directional signs in the office clear Yes and did you understand where to apply for food No stamps at the office? Did you tell the person helping you that you were applying only for Food Stamps and not any other programs? Non-English Speakers Only: Were you directed to a food stamp worker who spoke your preferred language during your visit? Non-English Speakers Only: [Skip if answer to #13 was No.] How long did you wait for someone to help you in your preferred language?

15)

Yes No Yes No < 15 min. 15 – 30 30 - 1
hr. > 1 hr. another day

16)

17)

18)

Non-English Speakers Only: [Skip if answer to #13 was No.] Were you provided with an application in your preferred language?

Yes No

19)

How long did you wait before you received an application? Please rate the helpfulness of the person who gave you an application. A rating of 1 is the best rating and means the person was very helpful. A rating of 4 is the worst rating and means the person was not helpful. What was the name of the person who helped you? _________________ Did you know that you could have received an application by mail?

20)

< 15 min. 15 - 30 > 30 min. 1 2 3 4

21)

22)

Yes No

Other questions: 23) How did you know which food stamps office to go to?

24)

Did anything particularly negative or positive happen during your visit that you would like to comment on?

Oregon Action Food Stamp Testing Project
Response Sheet Number 2: After the food stamp interview Instructions: Complete this response sheet after your interview at the food stamp office. Please fill out the form completely and do not leave any answers blank. If you need help, please ask. Name: _______________________________________________

Phone: ______________ Date of your food stamps interview: ________________________ Today's date: _________ Oregon Action staff person name: __________________________________________________ Questions about the food stamp application: ♦ Did you fill out the entire application form? ♦ [Skip if answer to #1 is Yes.] Why didn't you fill out the entire form?

Yes No Directions unclear Lacked required
information

Did not have time Other
____________________ ♦ Did you understand that there were parts of the form that you did not need to complete in order to apply for food stamps? ♦ Please rate the clarity or understandability of the

Yes No

1 = completely
understandable

application. A rating of 1 = the best. A rating of 4 = worst.

2 = basically
understandable

3 = difficult to
understand

4 = very difficult to
understand ♦ Please estimate how long it took you to fill out the application:

less than 1 hour between 1 and 2 hours between 2 and 3 hours more than 3 hours

Questions about the food stamp interview:

25)

What time did you arrive at the Food Stamps office? What time did your interview begin? What time did your interview end? Were you interviewed on the day you were told to return? Non-English speakers only: Were you interviewed by someone who spoke your language or were you provided with a translator? Non-English speakers only: How long did you wait for someone to help you in your preferred language?

26)

27)

28)

Yes No Yes No < 15 15 – 30 > 1

29)

30)

min. 30 1 hr. hr.

had to return on a
different day 31) Were you required to sign the self-sufficiency plan? Were you required to sign the Jobs and Jobs Plus Rights and Responsibilities document? Were you required to sign the "Cooperating with Child Support Enforcement..." document? Were you required to provide proof of citizenship? Was the grievance procedure explained to you? Were you told that you or your family might be eligible for other programs, like health care or cash assistance?

Yes No Yes No Yes No Yes No Yes No Yes No

32)

33)

34)

35)

36)

37)

If there were errors on your application, did the food stamp worker help you correct them? If you were unable to provide a required document were you informed that you could provide the name of someone, like an employer or a landlord, who could confirm you statement? Were you asked if you had any questions? Did you tell the person helping

Yes No Yes No

38)

39)

Yes No Yes

40)

you that you were only applying for food stamps? 41) Were you told when you would learn if you were eligible for food stamps? Outside of the food stamps office, have you ever seen a poster or heard a radio or TV ad describing the food stamp program? How would you rate the treatment you received during your interview? A rating of 1 = excellent. A rating of 4 = very poor. How would you rate the patience of the person interviewing you? A rating of 1 = extremely patient. A rating of 4 = not patient at all. What was the name of your interviewer?

No Yes No Yes No

42)

43)

1 = excellent 2 = adequate 3 = poor 4 = very poor 1 = extremely patient 2 = somewhat patient 3 = not very patient 4 = impatient

44)

45)

Other questions: ♦ Do you feel you were treated with respect at the food stamp office? ♦ Did the person helping you make any particularly positive or negative comments during your interview?

♦ Did anything particularly negative or positive happen during your visit that you would like to comment on?

Charting Your Results
As you interview families, it can be helpful to enter the information you collect into a chart. Important information to include in your charts: ♦ Each step of the application process ♦ Each family’s experience with each issue you have decided to focus on in your study ♦ Notes about horror stories A good chart will show you at a glance which steps still have to be completed in the applications. That can save organizing time and you’ll be able to tell how much of your project is complete and how much time you still need to devote to it. Collecting results for all families about one issue in one spot will make it easier to generalize about experiences as you plan what to focus on in your report.

Two sample charts follow; you can adapt them to suit your project. Some testers will have experiences you didn’t expect. Leave space in your chart to add those experiences.

Sample Charts to Organize Questionnaire Information
# of kids Monthly Income Race Town Offered CHIP? Which documents were you asked to show? SS# for Kids at appt. Does the staff treat people fairly? Can’t say yet Comments Next Step How long did you wait? How long did the appointment take? 10 minute wait for appt., 50min appt.

Name of adult tester

Jane

6

$1,4511,850

Black

Nampa

No

Wasn’t told to bring in all paperwork

Name

Did you go to 1st Appointment ? Yes

What was the next step? Intervi ew.

Did the next step happen? Comment s Yes

Which documents were you asked to show? Marriage License and Paternity form.

Anna

Were birth certificates requested for people other than the kids and for whom? Yes, they wanted birth certificates for everyone that was in the household

Have you received CHIP/ Medicaid for your kids? Yes

If you were disqualified, what are your next steps to get covered?

Comments/ Stories

She had to send away to Mexico to get marriage license.

Writing Your Report
Prepare a report that describes the experience of your testers when they applied. One way to organize your information is to choose several common barriers testers faced in the application process. For example, in evaluating the ICAN testing project, organizers chose six issues: lack of access to translation services, the failure to publicize CHIP availability, lack of privacy for applicants, the length and complication of the application form, discrimination, and the difficulties to working parents of scheduling mandatory interviews during the workday. In the Oregon food stamps project, organizers chose seven issues: an inflexible and inconsistent interview process; inadequate access to language services for non-English speakers; a long and confusing application; inadequate and discourteous service; food stamps offices that were difficult to contact; a failure to provide families in crisis with immediate service; and a failure of offices to follow up with families, forcing them to repeatedly contact the offices to obtain food stamps. In your report, explain how you conducted the test, and who your testers were. Then focus on each of these barriers, explain how the barrier affects applicant families in general, and provide examples of individuals’ experiences confronting the barrier. Suggest how each of the barriers could be eliminated. These suggestions are very important. Be sure to make them a part of all of the information you distribute. Prepare one-page fact sheets about each of your issues, explaining the problem and proposing your solutions. Try to make these summaries simple and eye-catching. The report that NWFCO and Oregon Action prepared after the food stamp testing project, and the one-page summaries that NWFCO and ICAN prepared after the SCHIP project are attached as examples.

Moving into Action/Media
Ask some of your testers and their families to speak about their experiences at your press conference. Before the conference, help them to prepare short statements about their experiences. Listen as they practice their statements and role-play a press conference, asking questions reporters are likely to ask them. Invite organizations you work with to join you in your actions and statements to the media.

Summary
What you will have accomplished when you complete this project: 1. Built a membership base of members who have worked on the issue, recruited members to work as testers, trained them to perform the test, and prepared them to act as spokespersons to the press about the issue. Documented problems in your state that prevent people from receiving benefits. Produced written material about your project and access to the benefit program, including fact sheets and a report. Publicized your actions through the media and “removed the barriers” for people in your state.

2. 3. 4.

I DAH O COMMUN I T Y ACT I ON N E T WORK

Children’s He alth Insurance Progra m
All Applicants S hould be Tre d the ate Sa W y me a
Many of our members are eligible for CHIP. We asked them to write down their experiences with the Department of Health and Welfare when they tried to applyfor the program. W found that many people were treated differently Most peoe . ple did not have positive experiences with the Department‘s w orkers. O Latino members experienced the most difficult ur time getting Medicaid/CHIP .

O person had their application torn up bya Department ne of Health and Welfare worker. Another w pressured to withdraw her application by a as caseworker. Another was given an appointment when she was unable to come in because of work. W hen she complained, the caseworker stated that she had to take what she could get. No other alternative was offered. Still others have been turned down or discourag from aped plying, although their children were eligible for Medicaid/ CHIP.

I DAH O C OMMUN I TY AC T ION N E TWORK
1311W st Jeffer e son Boise, ID 83702 Phone: 208-385-9146

Unfortunately we keep collecting these horror stories. In order , to address this problem, the Department must develop a clear procedure for taking Medicaid/ CHIP applications. There must be a complaint system for investigating people’s complaints about how they are treated bythe Department of Health and W elfare. There must be careful training of Department workers, to ensure that theyare up-to-date about the current Medicaid/ CHIP rules and treat all people with dignity and respect.

I DAH O COMMUN I T Y ACT I ON N E T WORK

Children’s He alth Insurance Progra m
Onlychildren who are apply for CHIP should be asked for ing

Priv cy a

their citizenship status and social security numbers. Parents may not want to disclose this information or may not have their social security number available. Asking for this information fromparents is not required and a child’s Medicaid eligibility maynot be based upon whether a parent provides it.

Some states have included statements on the application forms that protect privacy:

“Citizenship information for those age 19 and over is optional.” Connecticut “Parents apply for KidCare only for their children do not ing need to provide proof of legal immigration status for themselves.” Illinois “If you are applying for Medicaid for a child, y are not reou quired to provide your own social security number (SSN) in order for the child to receive Medicaid, but we must have the child’s SSN in order for the child to receive Medicaid.” Model HCFA application.

I DAH O C OMMUN I TY AC T ION N E TWORK
1311W st Jeffer e son Boise, ID 83702 Phone: 20 8-385-9146

I DAH O COMMUN I T Y ACT I ON N E T WORK

Children’s He alth Insurance Progra m
Many w orking families whose children are eligible for Medi-

Publicity: A New Ba Your by Ba by Campaign

caid/ CHIP don’t know about the programor believe that they are not eligible. W need a strong publicitycampaign to get e the w out, similar to the Department of Health and W ord elfare’s highly successful “Baby Your Baby” Campaign in 199192. The BabyYour Baby Campaign got the word out using many different media: It used tele vision and public service announcements in English and Spanish, brochures explaining health programs. A series of information sheets on a variety of health topics, billboards, posters and tables at community events that publicized the program. Many people learned about needed health programs through the publicity campaign which played a key role in dramatically lowing Idaho’s infant mortality rate.

I DAH O C OMMUN I TY AC T ION N E TWORK
1311W st Jeffer e son Boise, ID 83702 Phone: 20 8-385-9146

Publicity can have the same effect in low ering the uninsurance rate among Idaho’s children. W want a new Baby Your baby e Campaign for CHIP!!

I DAH O COMMUN I T Y ACT I ON N E T WORK

Children’s He alth Insurance Progra m
S imple Applica tion Form and Proce ss
Idaho’s Medicaid/CHIP application form is seventeen pages long and very difficult for some parents to complete. Idaho can rewrite its Medicaid application to be much shorter. The Health Care Financing Administration (HCFA the federal ) agency that oversees Medicaid, has designed a tw page o model application form. Over forty states have shortened their applications to four pages or less. Many are just two pages and easy to complete.

Idaho also needs to develop an easy application process. Many people report having to visit the Department of Health and W elfare offices two, three, even four times to be able to submit a complete application and find out if they can enroll their children on CHIP/ Medicaid.

People should be able to find out whether they are eligible for
I DAH O C OMMUN I TY AC T ION N E TWORK
1311W st Jeffer e son Boise, ID 83702 Phone: 208-385-9146

services quickly Right now people have to wait for two to . , three weeks to find out whether their children are enrolled on CHIP. Children shouldn’t have to wait to get this coverage. The Department should process these applications immediately so children can get health coverage right away .

I DAH O COMMUN I T Y ACT I ON N E T WORK

Children’s He alth Insurance Progra m
Acce to ss Translation Se rvice s
Idaho’s Department of Health and Welfare is required by law to communicate w Medicaid/CHIP applicants in a language unith derstood bythe applicant, including English and Spanish.

The Department should ensure that:

All CHIP materials, applications, fly ers, brochures and other documents should be available in Spanish.

Its toll-free number has Spanish speaking workers available at all times to respond to the questions bySpanish speaking families.

It has hired bi-lingual outreach workers to work in Hispanic communities in Idaho to enroll Medicaid/ CHIP eligible children.

I DAH O C OMMUN I TY AC T ION N E TWORK
1311W st Jeffer e son Boise, ID 83702 Phone: 20 8-385-9146

T rained translators are available at all offices during working hours to ensure that families applying for services fully understand the process and that their concerns are heard.

I DAH O COMMUN I T Y ACT I ON N E T WORK

Children’s He alth Insurance Progra m
W orking families have a difficult time applying for CHIP. The Department’s offices are not open after working hours, and it

Making it Easie to r Apply for Me dica id/ CHIP

won’t take applications by telephone or mail. This restrictions prevent manyparents from signing their children up for CHIP.

Idaho should allow Medicaid/ CHIP applications to be processed at more sites outside of Department of Health and W elfare (out-stationing). Idaho is required to allow pregnant women and children to apply for Medicaid/ CHIP at locations other than the Medicaid office. These places include community health centers, migrant health centers, health care programs for homeless people and health clinics operated by Indian tribes. Additional out-stationing can take place in other settings, including schools, early childhood programs, WIC clinics, familyresource centers, one-stop career centers and churches.

I DAH O C OMMUN I TY AC T ION N E TWORK
1311W st Jeffer e son Boise, ID 83702 Phone: 20 8-385-9146

The Department can also allow w orking parents to submit their applications by mail or bytelephone. Thirty-four states allow mail-in applications and six of these will interview families over the telephone.

Hunger Pains: Oregon Food Stamp Program Fails to Deliver
National Breaking Barriers Series: No. 2

By Carson Strege-Flora Oregon Action Northwest Federation of Community Organizations May 2000

Table of Contents
● Executive Summary ... ……………………………………………………..page ● Introduction ………. ……………………………………………………….page ● Key Findings ………. ………………………………………………………page ● Barriers to Enrollment ……….…………………………………………..…page 1. Applicants in crisis are not provided with required expedited service…page 2. AFS interview process is inflexible and inconsistent…..……………….page 3. AFS provides inadequate services for limited English speakers..………page 4. Applicants must repeatedly contact AFS to obtain food stamps………..page 5. AFS uses a long and confusing application …………………………….page 6. AFS provides inadequate and discourteous service to applicants.………page 7. AFS offices are difficult to contact……………………….. …………….page V. Conclusion……….…………………………………………………………..page Endnotes.……….……………………………………………………………page Appendix 1: Appendix 2: Letter from USDA to Oregon AFS Division Idaho’s simplified application

Executive Summary
Tim Riddle works part-time but doesn’t earn enough to live on. Tim and his six-year-old son, Chris, live at a homeless shelter in Medford, Oregon. As money grew short in late January, Tim realized he would not be able to provide enough food for his son and went to the welfare office to apply for food stamps. Despite federal requirements to do so, Tim was not screened for emergency food stamps and was told he needed to wait a month for help. “There’s nothing scarier for a father than not knowing where his child’s next meal is coming from.” – Tim Riddle. Unfortunately, stories like Tim Riddle’s are all too common in Oregon. According to the United States Department of Agriculture (USDA), Oregon tops the list of states with the highest percentage of people experiencing hunger.i The USDA estimates that more than one-eighth of Oregon households are “food insecure,” meaning that these households do not always have assured access to enough food to fully meet their basic needs. About half of these households experience painful feelings of hunger.ii The food stamp program is Oregon’s largest and most important program in the fight against hunger, particularly for children. About 40 percent of food stamp recipients in Oregon are children.iii Benefits are modest, but food stamps can mean the difference between hunger and a healthy diet for families. In an average month, about 100,000 households receive food stamps in Oregon.iv Despite the benefits food stamps offer families, participation in Oregon’s food stamp program is declining. Since 1996, participation has plummeted by 20 percent.v Yet, Oregon’s food bank network reported a 16 percent increase in demand for emergency food boxes between 1998 and 1999.vi Additionally, data from the USDA indicate that the number of hungry people in Oregon may be at a three-year-high.vii USDA data find that the number of food insecure households in Oregon has increased from 146,591 in 1996 to 194,594 in 1998, an increase of eight percent in just three years.viii
The purpose of this study is to identify policies and practices that delay or impede applicants from obtaining food stamps. Oregon Action identified 25 low-income Oregon residents in the winter of 2000 who wanted to apply for food stamps and who agreed to participate in two interviews. Participants were interviewed in accordance with a protocol developed for this study after they had obtained an application at an Oregon public assistance office and after they had completed the required food stamp interview. This study tracked applicants through the enrollment process but, due to time constraints and the lengthy enrollment process, it does not track which applicants were ultimately enrolled in the food stamps program and instead focuses on the barriers that prevent applicants from applying for food stamps. A future report will examine if applicants are being wrongly denied for food stamps. This report outlines seven barriers that obstruct applicants during the application process, including some that appear to be in violation of federal and state law. Oregon’s Adult and Family Services (AFS)

Division, which administers the food stamp program, has the power to eliminate all the barriers identified in this report.

Barriers to accessing food stamps in Oregon • • • • • • • AFS does not provide families in crisis with immediate service as required by law. AFS’ interview process is inflexible and inconsistent. AFS provides inadequate services for Non-English speakers. Applicants must doggedly pursue and repeatedly contact AFS to obtain food stamps. AFS uses a long and confusing application. AFS provides inadequate and discourteous service. AFS offices are difficult to contact, particularly hindering working applicants from applying.

Some key findings of the report
• Only 46 percent of applicants were instructed to complete the emergency services screening tool used by AFS. If AFS does not use its emergency services screening tool, applicants in crisis situations are left with no ability to purchase food. At some offices, applicants must arrive between 7:00 a.m. and 9:00 a.m. to sign-up for interviews. If interview slots are taken, applicants must return the next day; requests for appointments are generally denied. Applicants with morning obligations are shutout of the process. Applicants waited an average of 6.5 days for their AFS interview. Applicants request food stamps because they need food. Making them wait a week to have their required interview unnecessarily elongates the time they must wait for food. Non-English speakers waited four times longer than English speakers to receive applications in their languages. Applicants should not receive substandard service simply because they do not speak English. Forty-four percent of applicants rated the understandability of the AFS application as “difficult to understand” or “very difficult to understand.” A confusing application can discourage applicants from applying for the program. Several applicants contacted the office more than six times during the application period. Making applicants repeatedly contact the office is an inefficient way to provide services.

Solutions

Simplify and accelerate the application process • • • • • • • • • • • • • • • Encourage applicants to file application forms on the same day of initial contact. Inform applicants about their right to file an incomplete application to begin the process. Streamline the interview process so that clients wait no more than 2 days for an interview. Simplify the 16-page application by using the Idaho application as a model (see appendix). Provide applicants with a clear list of documentation required. Provide all clients with the option of a specific interview time. Inform eligible applicants of their right to a home or phone interview. Provide translators in a timely manner to all applicants who speak limited English. Do not use translators who are not fully fluent in both English and another language. Train front desk staff to fully explain the food stamp process and engage with clients. Provide more out-stationed AFS workers to enroll applicants in their neighborhoods. Provide evening office hours for working clients. Improve phone system so clients can access the information they need. Provide clients with sufficient information so that they do not have to repeatedly contact the office. Allow applicants to apply at the AFS office closest to their home or work.

Provide expedited services for applicants in crisis • • • Inform clients about how the expedited food service process works. Train staff on how to identify clients needing expedited service. Develop and use a satisfactory screening tool to identify people in need of emergency assistance.

Treat applicants with dignity and respect • • • • • Train all workers in basic customer service skills. Hire an independent research group to survey clients about the treatment they receive. Provide clients with the required information about the grievance and appeal procedures. Use directional signs in the office. Inform applicants about other programs available to them.

Develop an effective outreach program to educate potential applicants • • Maintain a statewide toll-free food stamp hotline for applicants. Develop outreach campaigns that include neighborhood-based educational activities.

Introduction

Over the past year, members of Oregon Action have described alarming problems when applying for food stamps. Many applicants experienced long delays at the Adult and Family Services (AFS) Division offices where food stamps are processed. Others reported that they felt discouraged and mistreated by AFS workers. Some detailed incidents at AFS offices that appeared to be in violation of food stamp law. Many Oregon Action members felt that AFS offices were more focused on creating barriers to the food stamp program than helping them enroll.

The food stamp program is Oregon’s largest and most important program in the fight against hunger, particularly for children. About 40 percent of food stamp recipients in Oregon are children.ix Benefits are modest. In Oregon, the average per person benefit is $70 per month, but food stamps can mean the difference between hunger and a healthy diet for families.x In an average month, about 100,000 households receive food stamps in Oregon.xi Despite the benefits food stamps offer families, participation in Oregon’s food stamp program is declining. Since 1996, participation has plummeted by 20 percent.xii Yet, Oregon’s food bank network reported a 16 percent increase in demand for emergency food boxes between 1998 and 1999.xiii Additionally, data from the USDA indicates that the number of hungry people in Oregon may be at a three-year-high.xiv USDA data find that the number of food insecure households in Oregon has increased from 146,591 in 1996 to 194,594 in 1998, an increase of eight percent in just three years.xv Because the decline in food stamp participation is occurring at the same time that Oregon’s hunger rates are increasing, it is very unlikely that people are leaving food stamps because they are enjoying the benefits of the expanding economy and finding high wage employment. The explanation that food stamp participation is declining because Oregonians no longer need food stamps is inadequate. To understand why the food stamp program is under-utilized, Oregon Action and the Northwest Federation of Community Organizations interviewed 25 food stamps applicants about their experiences when applying for food stamps. We examined the enrollment policies and practices at seven AFS local branch offices in Portland and Medford, Oregon in order to identify policies and practices that hinder applicants from applying for food stamps.

Figure 1: Oregon food stamp participation compared to hungry households.xvi

500,000 Oregon households 400,000 300,000 200,000 100,000 0 Hungry households Food stamp participants

Figure 2: Food stamp participation compared to food insecure households.xvii 250000
Oregon Households

200000 150000 100000 50000 0 1996 1997 1998 1999

Food Insecure Food Stamp Participation

Key Findings This report found the following barriers at Adult and Family Services offices in Medford and Portland. These barriers unnecessarily delay and impede applicants during the food stamp application process. Barrier 1 AFS does not provide families in crisis with immediate service as required by law.
Fifty-six percent of applicants were not instructed to complete the emergency screening tool used by AFS. Some homeless applicants were not provided expedited services. Other applicants determined eligible for expedited service waited two or more weeks to get food stamps.

Barrier 2 AFS interview process is inflexible and inconsistent. AFS provided only a quarter of applicants with specific interview times; others attended during first come, first serve interview sessions. Interview times during first come, first serve sessions fill early and applicants must return each day to take another number. Barrier 3 AFS provides inadequate services for limited English speakers.
Limited English speaking applicants waited four times longer than English speakers to obtain applications in their language. AFS does not always provide adequate translator service.

Barrier 4 Applicants must doggedly pursue and repeatedly contact AFS to obtain food stamps.
To get help, applicants repeatedly contacted AFS offices, often without success. AFS phone systems are deficient and applicants were generally unable to contact workers. Many applicants reported that when they did leave messages, workers did not return their calls.

Barrier 5

AFS uses a long and confusing application.

AFS requires applicants to complete a 16-page, cumbersome general public assistance application form. The application does not specify which documents are required for food stamps. Applicants often have to make several trips to the office to provide the necessary documentation. Barrier 6 AFS provides inadequate and discourteous service.
AFS does not provide applicants with basic, required information about the enrollment process, including appeal and grievance procedures. Applicants reported that caseworkers made inappropriate comments about their looks, lifestyle, and life choices.

Barrier 7 AFS offices are difficult to contact, hindering working applicants from applying. Most AFS offices offer client services only between 8:00 a.m. and 5:00 p.m., making it difficult for a day shift working

applicant to apply. At some offices, applicants must arrive between 7:00 a.m. and 9:00 a.m. to sign-up for an interview.xviii There is no enrollment hotline phone number.

Barrier 1: AFS does not provide families in crisis with immediate service as required by law.
Findings: • Only 46 percent of applicants were instructed to complete the expedited service-screening tool used by AFS.xix • Only 12 percent of applicants were asked about their current situation or need for emergency assistance by front desk workers. • Of the three homeless applicants, only one was determined eligible for expedited service. The other two homeless families waited three to four weeks for their food stamp benefits. • Only one applicant was told that she could provide income verification in ways other than a written document. The general lack of urgency and sluggishness evident in AFS branch offices particularly harms those with emergency food needs. Expedited processing means local offices must provide food stamps to qualified individuals within seven days rather than the standard 30 days and is a critical component of the food stamp program. Expedited service reduces the time applicants in crisis must wait for their food stamps. Eligible applicants have almost no income or assets and are at serious risk of not being able to access food. When AFS does not screen families for expedited service, eligible families must unnecessarily endure additional days without food. AFS’ inadequate expedited food stamp process may violate federal law. Under federal law, every applicant must be screened for expedited service. The USDA requires all states to design application procedures that identify households eligible for expedited food stamp processing at the time assistance is requested.xx None of the offices in Medford or Oregon consistently screened applicants for expedited service eligibility. Three homeless families that should have been immediately identified as potentially eligible for expedited service were required to go through the standard process, including providing all required verification. Federal law requires that families eligible for expedited service need only initially provide proof of identity and residency. Income and other verification can occur later.xxi In a separate study, the USDA identified serious problems with AFS’ expedited food stamp process and required AFS to take corrective action but applicants continue to experience problems.xxii Pull quotes for sidebar: “I made it clear that I was in an emergency situation but nothing was done.” – Name withheld, Broadway AFS office in Portland. “They told me I had to wait seven days before I could turn in my application and have my interview. I’m a diabetic and need food now.” – Barby Campbell, West Main AFS office in Medford

“I told them I needed emergency assistance. The front desk person told me to come back almost three weeks later for an appointment.” – Name withheld, West Main AFS office in Medford.

Barrier 2: AFS interview process is inflexible and inconsistent.
Findings: • Seventy-five percent of the employed applicants who requested alternative interview times because of job conflicts were denied an alternative interview time. • All of the unemployed applicants who requested alternative interview times because of educational, training or job search conflicts, childcare problems, or transportation problems were denied an alternative interview time. • Only one applicant was provided with the option of a home or telephone interview. • Applicants waited an average of 6.5 days before they were interviewed by AFS. • Twenty percent of applicants waited ten days or more for their required interview. • Eight percent of applicants were provided with an application but not told that they needed to return for an interview. • Applicants who were told to return for an interview during a general intake time waited an average of 70 minutes before their interview began. One applicant waited two hours and twenty minutes. • On average, interviews lasted 40 minutes, but some were as short as 15 minutes and others took over 90 minutes. The AFS prolonged interview process ignores the serious needs of food stamp applicants by making them wait for unnecessarily long periods of time. Some AFS offices make clients return only during a specified two-hour period for their interviews. If the interview slots fill up for that day, applicants are sent home and required to return another day. For applicants who are working, time spent at the welfare office means missing pay and endangering the financial stability of their families. For applicants who are in training or who are searching for work, long waits at AFS offices interferes with their ability to become self-sufficient. AFS’ interview process may violate state law and federal directives. In its December 1998 review of three Portland area AFS offices, the USDA found that the first come, first system could hinder applicants and suggested several corrective actions. It does not appear that any of these corrective actions had been taken by February 2000.xxiii The AFS practice of denying applicants’ requests for alternative interview times and not offering applicants off-site or telephone interview options contradicts the AFS goal of helping people obtain and maintain employment. Not providing clients with the option of non-office interviews also violates AFS policy.xxiv Pull quotes for sidebar:

“I had to take time off work for my 2:00 p.m. appointment but wasn’t seen until 2:40. I missed more work. For people on food stamps, every hour of work counts.” – Sarah Anderson, SE Powell AFS Office in Portland. “My kids missed breakfast and the first two hours of school because the only time they gave me for an interview was in the early morning,” – Dannette Gill, Albina AFS office in Portland.

Barrier 3: AFS provides inadequate service for limited English speakers
Findings: ♦ Limited English speakers waited four times longer than English speakers to receive applications. ♦ An AFS worker with limited Spanish interviewed a speaker of Spanish. The worker was not able to understand that the applicant was in a crisis situation. ♦ A speaker of an African dialect had to locate and bring his own translator to the AFS office to obtain services. Applicants who do not speak English deserve the same level of service as applicants who speak English. Limited English speakers who applied for food stamps at AFS offices had to wait significantly longer for help simply because they spoke another language. Limited English applicants were generally more fearful about applying for food stamps than English speakers. The additional barriers they faced at every level of the food stamp application process discouraged them further. AFS’ deficient services for limited English speakers may violate federal law. The Civil Rights Act of 1964 protects limited English speakers rights to access public assistance services and requires offices to meet the needs of limited English speakers in a timely manner. Local offices must provide a translator who is proficient in English and the applicant’s language to aid a limited English speaker.xxv The St. John’s AFS office in Portland was unable to provide a Spanish translator, the West Main AFS office in Medford provided an inadequate Spanish translator, and the Albina AFS office in Portland required an Oromo speaker to locate his own translator. Federal law also requires states to have application forms and client notices available in languages that people speak in the community.xxvi Client notices and applications in other languages were not available at all offices, nor were there signs about how to obtain non-English materials. Pull quotes for sidebar:
“I talked with their Spanish speaking worker when I got my application. I tried to explain that I needed food stamps right away, but she was not a native Spanish speaker and seemed to not understand me.” – Gloria Cruz Rodas, West Main AFS office in Medford. [Gloria went to the office on 2/8/2000. She was given an interview for 2/23/00 where it was determined she needed expedited service. She should have received her food stamps by 2/15.]

“It’s frustrating that it takes so long and that you have to sit there and wait while you are hungry.” – Name withheld, Oromo speaker, Albina AFS Office in Portland.

Barrier 4: Applicants must doggedly pursue and repeatedly contact AFS to obtain food stamps.
Findings: • Fifty-six percent of applicants were not encouraged to file their application on the same day they contacted the office. • Applicants contacted the office an average of three times during the application period. • Several applicants contacted the office more than six times during the application period. It is critical that food stamp applicants file their application as soon as they receive it. Thirty days after an application is filed, food stamp offices must deliver food stamps to eligible households. For families in a crisis situation, food stamp offices must deliver food stamps to eligible families in seven days. In addition, food stamp benefits are pro-rated from the date of application. If applicants are not told to file their applications immediately, applicants’ food stamps are delayed and the amount of benefits received is smaller. AFS offices require that applicants visit the office at least twice, unnecessarily extending the food stamp enrollment process. In Oregon, applicants must first obtain a food stamp application and then return at a later date to the AFS office for the required interview. However, many applicants had to repeatedly contact the office for information or clarification about their situation. Often, applicants had to make additional contacts with the office because they did not understand which documents to provide. More often, applicants contacted the office because they had received no response from the AFS office. These repeated contacts, especially when an in-person contact was made, significantly extended the food stamp enrollment process. AFS practices may violate federal law.
The USDA requires states to encourage applicants to file an application form on the same day the household first contacts the office seeking assistance.xxvii The USDA notes that it is important that applicants be informed that they do not need to complete the entire application in order to file it on the same day of initial contact.xxviii In addition, USDA officials have noted that procedures requiring food stamp applicants to return a second day creates barriers to participation.xxix

Pull quotes for side bar: “It took me five calls to figure out which office I needed to go to.” – Michael Kelly, Albina AFS office in Portland. “My husband and four children are homeless and have no money. AFS made us wait so long to get food stamps. It was horrible. I

kept telling them I was in an emergency situation. I was down there every other day for three weeks and I called every day. I left messages, but no one ever returned my calls. They just kept putting me off. I kept telling them my kids were hungry, but they did nothing. After we got our food stamps, they told me my they accidentally mailed my file to Roseburg. [Roseburg is four hours south of Portland.] I was afraid they were going to cut me off completely because I was going to miss an appointment in Roseburg. After more calls, they finally mailed my file back to the Portland office.” – Audrey Spivey, Metro AFS office in Portland.

Barrier 5: AFS uses an unnecessarily long and confusing application.
Findings: ♦ Forty-four percent of applicants rated the understandability of the 16-page AFS application as “difficult to understand” or “very difficult to understand.” ♦ AFS uses a combined application to gather eligibility information for all assistance programs. However, 87 percent of applicants were not told about other programs available to them. ♦ Only 30 percent of households with uninsured children were told about the Children’s Health Insurance Program or Medicaid. ♦ Ninety-two percent of applicants were not offered any assistance in obtaining necessary verification. ♦ Sixty-eight percent of applicants did not understand that parts of the application were not applicable to food stamps. If applicants are intimidated by the length of the application form, they may not apply for the food stamps that they need. Households applying for food stamps often get their first sense of the program when they see the application form. A long and complicated application form that uses confusing language and requires applicants to produce a long list of documents may discourage prospective applicants. Using a short application that provides a brief list of the required verification documents would reduce the amount time applicants spend on the application and sends a positive message about the availability of food stamps. AFS’ application may violate state and federal law. The USDA has urged all states to simplify their application forms because it believes a simpler application will eliminate many of the barriers keeping families from food stamps.xxx Certainly if AFS is not going to use the information collected by the combined application to inform applicants of other programs, the long application serves only to lengthen the food stamp process. In addition, the application does not appear to meet USDA requirements in a number of ways, including providing appropriate lists and descriptions of documents required. The application also does not list required information about the agency’s obligation to help applicants locate documents.xxxi The large number of applicants who reported difficulty understanding

the application also indicates that the application does not meet Oregon state law requiring applications to be in plain language.xxxii Pull quotes for sidebar: “I had to ride my bike back and forth from my home and to the office three times to get them all the documents they wanted. I lost a day’s pay because I missed a full day at work. ” – Name withheld, West Main AFS office in Medford. “I told them I had no money and couldn’t pay my rent or my Oregon Health Plan bills. They told me that this was where you come for food stamps, not for other stuff and that I should borrow money from a friend.” – Michael Kelly, Albina AFS office in Portland.

Barrier 6: AFS provides inadequate and discourteous service to applicants.
Findings: • Forty-four percent of participants felt they were not treated respectfully. • Only 20 percent of the applicants were told or saw information about the grievance procedure. 5. About a third of applicants reported that they did not understand where to apply for food stamps because the directional signs were unclear. • Applicants rated the helpfulness of the front desk staff on a scale of one to four, with one being the best rating. Applicants gave the front desk staff an average rating of three or “not very helpful.” • Eighty-eight percent of applicants were not asked if they had questions about the process. 6. Eighty percent of applicants were not given a telephone number or another way to obtain help. 7. Most AFS offices did not post USDA-required information about the food stamp process. Applicants who don’t understand the food stamp enrollment process and are not provided with a way to access help are more likely to be discouraged and miss out on vital food stamp benefits. Applicants who are not told about their right to file their application on the same day an application is obtained unnecessarily elongates the time applicants must wait for food stamp benefits to begin. xxxiii Unfairly denied applicants may never get the food stamps they deserve if they do not understand how to appeal a decision. Applicants who are treated rudely are much more likely to give up before they finish the application process. AFS’ inadequate service may violate federal and state law. Oregon state law requires AFS to provide information about the grievance procedure to applicants.xxxiv In addition, federal law requires states to post signs explaining the application process and the right to file an application on the day of initial contact.xxxv A 1999 AFS study of Portland offices found that the

lack of good directional signs cannot be a barrier to enrollment, but this problem has yet to be fully corrected.xxxvi Pull quotes for sidebar: “I told my caseworker that I couldn’t get a job right now because of my injury. She told me that she was “hurting all the time too” but managed.” – Dannette Gill, Albina AFS office in Portland. “During my interview, my worker was very distracted and kept gossiping with another worker about the people on welfare. Then they both looked at me for a minute but my worker said, ‘Don’t worry, she doesn’t know who we are talking about.’ Then she told me that I stunk of cigarettes.” – Bobbie (last name withheld), Albina AFS office in Portland. “The front desk people waited an hour before they started calling numbers. They were talking on the phone with friends. I know everything they did the night before.” – Name withheld, Albina AFS office in Portland.

Barrier 7: AFS offices are difficult to contact, particularly hindering working applicants from applying.
Findings: • At some offices, applicants are told they can only submit applications and sign-up for interviews during 7:00 a.m. and 9:00 a.m. • No offices are open during evening hours for day-shift workers. • No statewide, toll-free informational number is maintained. • Applicants who used the voice mail system reported difficulty and frustration. • None of the applicants who went to the wrong office were provided with the phone numbers, and in some cases addresses, of the correct office. • No AFS workers offered to forward applicants’ completed applications when they were submitted to the wrong office. Day-shift workers lose pay when applying for food stamps, causing more financial instability for their families. None of the eight offices reviewed in this report offered evening hours for working clients to apply for food stamps. Some offices are also closed for lunch, making it impossible for applicants working the day-shift to apply without missing work. Applicants who can’t get help become frustrated and may give up before completing the food stamp application process. Applicants who arrive at the wrong office and are not assisted are unnecessarily required to spend more time in the application process. AFS’ failure to adopt user-friendly practices may violate state and federal law. The USDA requires AFS offices that receive application forms from outside of their service area to mail the application form to the correct office on the same day that the application form

is submitted.xxxvii AFS’ policy manual requires branch office workers to assist applicants who come to the wrong branch.xxxviii This did not occur when applicants went to the wrong offices with completed applications. Additionally, after its review in December 1998, the USDA instructed Portland branches to remain open in the evenings at least one evening per month, when possible.xxxix Short story for sidebar: “I went to the St. John’s AFS office on February 11 to request a food stamp application. When I got there, they just handed me the application and didn’t tell me anything. I took it back to St. John’s a few days later. The caseworker at St. Johns told me that I needed to go to the SDS office because that’s where I get my disability benefits. When I got to the SDS office they told me they couldn’t use the application I filled out for St. John’s. They gave me another 16 page application to complete.” – Keith Jackson, SDS office in Portland.

Conclusion
This report demonstrates that serious barriers in Oregon’s food stamp program impede applicants from accessing food stamps. These barriers include an unnecessarily lengthy application process, inadequate customer service for clients, and an inconsistent expedited service process. Adult and Families Services appears to treat clients’ requests for food stamps as inconsequential and without urgency. These barriers are particularly disturbing in a state with a growing percentage of hungry people and a declining percentage of people using food stamps. Some of the barriers identified in this report appear to violate state and federal law. Others are simply bad policies. AFS should immediately develop an action plan that includes participation from community groups. The action plan should include, at a minimum, the following: Simplify and accelerate the application process • • • • • • • • • • • • • • • Encourage applicants to file application forms on the same day of initial contact. Inform applicants about their right to file an incomplete application to begin the process. Streamline the interview process so that clients wait no more than 2 days for an interview. Simplify the 16-page application by using the Idaho application as a model (see appendix). Provide applicants with a clear list of documentation required. Provide all clients with the option of a specific interview time. Inform eligible applicants of their right to a home or phone interview. Provide translators in a timely manner to all applicants who speak limited English. Do not use translators who are not fully fluent in both English and another language. Train front desk staff to fully explain the food stamp process and engage with clients. Provide more out-stationed AFS workers to enroll applicants in their neighborhoods. Provide evening office hours for working clients. Improve phone system so clients can access the information they need. Provide clients with sufficient information so that they do not have to repeatedly contact the office. Allow applicants to apply at the AFS office closest to their home or work.

Provide expedited services for applicants in crisis • • • Inform clients about how the expedited food service process works. Train staff on how to identify clients needing expedited service. Develop and use a satisfactory screening tool to identify people in need of emergency assistance.

Treat applicants with dignity and respect • • • Train all workers in basic customer service skills. Hire an independent research group to survey clients about the treatment they receive. Provide clients with the required information about the grievance and appeal procedures.

• •

Use directional signs in the office. Inform applicants about other programs available to them.

Develop an effective outreach program to educate potential applicants • • Maintain a statewide toll-free food stamp hotline for applicants. Develop outreach campaigns that include neighborhood-based educational activities.

Research Methods
Hunger Pains: Oregon food stamp program fails to deliver is based on data collected during February and March of 2000 by Oregon Action and the Northwest Federation of Community Organizations. The objective of this study is to identify policies and practices that delay or impede applicants from obtaining food stamps in Oregon. Data were gathered from 25 food stamp applicants identified by Oregon Action. Ten of the study participants were white, ten were black, and five were Hispanic. Five participants spoke limited or no English. Forty percent of the study participants were working and 70 percent of the applicants had children. Applicants applied at three offices in Medford and four offices in Portland. Researcher intervention in the application process was limited to providing rides to AFS offices. In one case, a bilingual researcher intervened to help a Spanish-speaking applicant when no Spanish-speaking AFS workers were available to help. Applicants were interviewed twice in accordance with the protocol developed for this project. The first interview occurred after the applicant obtained an application. The second interview occurred after the required interview at AFS. Applicants also shared the experiences in narrative form during their interviews with researchers. Some applicants requested that their names be withheld from the report. In addition, researchers looked for posted and written information at each AFS office visited by an applicant.

Endnotes

i

Mark Nord, Kyle Jemison, Gary Bickel, Prevalence of Food Insecurity and Hunger, by State, 19961998, Food and Rural Economics Division, Economic Research Service, U.S. Department of Agriculture, 1999, p. 3. ii Ibid. The USDA classifies a household as hungry if the food intake for the adults in the household has been reduced to an extent that it implies that adults have repeatedly experienced the physical sensation of hunger. Household Food Security in the United State in 1995: Summary Report of the Food Security Measurement Project, USDA, September 1997, p. v. iii Michael Leachman, Oregon Center for Public Policy, telephone conversation, April 3, 2000. iv Food Research and Action Council, Oregon Food Profile 1999. www.frac.org. v United State General Accounting Office, Food Stamp Program: Various Factors Have Led to Decline in Participation, July 1999, p. 33. Because of eligibility restrictions created by welfare reform in 1996, the number of able-bodied adults with no children has declined by 46 percent. Leachman, April 3, 2000. vi Michael Leachman, HowMany Hungry Oregonians? Measuring Food Insecurity and Hunger, Oregon Center for Public Policy, November, 1999, p. 1. vii Nord, Prevalence of Food Insecurity, p. 17. These data were calculated using Oregon Current Population Survey Food Security Supplements of September 1996, April 1997, and August 1998. Annual prevalence of estimates of food insecurity and hunger for states have significant margins of error because of the limited number of households surveyed in each state. viii Ibid. ix Leachman, telephone conversation, April 3, 2000. x Ibid. xi Food Research and Action Council, Oregon Food Profile 1999. www.frac.org. xii United States General Accounting Office, Food Stamp Program: Various Factors Have Led to Decline in Participation, July 1999, p. 33. Because of eligibility restrictions created by welfare reform in 1996, the number of able-bodied adults with no children has declined by 46 percent. Leachman, April 3, 2000. xiii Michael Leachman, HowMany Hungry Oregonians? Measuring Food Insecurity and Hunger, Oregon Center for Public Policy, November, 1999, p. 1. xiv Nord, Prevalence of Food Insecurity, p. 17. These data were calculated using Oregon Current Population Survey Food Security Supplements of September 1996, April 1997, and August 1998. Annual prevalence of estimates of food insecurity and hunger for states have significant margins of error because of the limited number of households surveyed in each state. xv Ibid. xvi 400,000 hungry household estimate for 1998 from Leachman, How Many Hungry Oregonians, p. 10. Food stamp participation data for July 1998 from Oregon public assistance data charts, www.afs.hr.state.or.us/papage.html, p. 36. xvii Food insecure data from Nord, Prevalence of Food Insecurity, p. 17. These data were calculated by the USDA using Oregon Current Population Survey Food Security Supplements of September 1996, April 1997, and August 1998. Annual prevalence of estimates of food insecurity and hunger for states have significant margins of error because of the limited number of households surveyed in each state. Food stamp participation data for July 1996-1999 from Oregon public assistance data charts, www.afs.hr.state.or.us/papage.html, p. 36. xviii Many offices tell applicants to arrive an hour before AFS offices open for client services because interviews are scheduled on a first come, first serve basis. xix The first two pages of the application is the tool AFS uses to screen people for expedited service. xx 7 CFR 273.2 xxi Ibid. xxii . Letter from Dennis Stewart, Western Regional Director, Food Stamp Program, to Jim Neely, Deputy Administrator, Adult and Family Services Division, received January 14, 1999 re: Portland area AFS branch office review. xxiii Stewart, letter received by AFS January 14, 1999. xxiv The AFS Family Services Manual directs local offices to provide applicants with the option of home or telephone interviews if the adult family member is elderly, disabled, faces transportation problems, or other hardships exist. These hardships can include illness, bad weather, conflicting work hours, or other reasons. xxv 7 CFR 272.4(b)(3).

xxvi

7 CFR 272.4(b)(2),(3). 7 CFR 273(c)(2)(i). xxviii 65 Federal Register 10864. xxix United State General Accounting Office, Food Stamp Program: Various Factors Have Led to Decline in Participation, July 1999, p. 14. xxx Letter from Dan Glickman, U.S. Department of Agriculture, to all state Governors, dated July 12, 1999, re: the Clinton Food Stamp Initiative. xxxi For requirements see 7 CFR 273.2. xxxii ORS 411.967 requires all written material published by AFS for potential or current public assistance clients to be written in plain, understandable language and gives specific instructions about how AFS must comply with these standards xxxiii 7 CFR 273.2. xxxiv ORS 411.977. xxxv 7 CFR 273.2. xxxvi Adult and Family Services District 2, “Shopper Study”, 1999. xxxvii 7 CFR 273.2(c). xxxviii AFS Family Services Manual, Food Stamp Program, Section B, p. 9. xxxix Stewart, letter received by AFS January 14, 1999.
xxvii