State Leaders' Lessons about Human Services Reforms, Innovations

By Cemere James

A new report from the Work Support Strategies initiative describes what leadership looks like among state health and human services officials implementing large-scale systems reform. Observations of Leaders Driving Changes in State Government, authored by Urban Institute, offers practical, concrete lessons based on interviews with leaders and staff in WSS states. This includes committing to and communicating a clear vision for serving clients, creating an environment in which that commitment is shared across teams and departments, and promoting shared accountability for meeting objectives and making progress on measureable goals.

The WSS initiative—a multi-state demonstration led by CLASP in partnership with Urban Institute, the Center on Budget and Policy Priorities (CBPP), and other national organizations—offers six leading-edge states the support needed to integrate and streamline delivery of work support benefits (SNAP, Medicaid, and child care assistance). The goal is to eliminate barriers that prevent working families from getting and keeping the full range of benefits for which they are eligible. With technical assistance (TA) and grant funding, WSS states (Colorado, Idaho, Illinois, North Carolina, Rhode Island, and South Carolina) are working to improve management practices, enhance technology, and align eligibility policies for consistency across programs. As the report shows, leaders are taking on the challenges of updating technological systems, cutting down backlogs, and reducing delays in processing to increase access to work support programs through:

  • Business process or operations changes that ensure families receive benefits more promptly, including increasing same-day service;
  • Eliminating bureaucratic processes that cause “churn,” which refers to families being pushed off benefits even though they are still eligible;
  • Implementing new enrollment opportunities for families, such as online and telephone applications, waiting room kiosks, and one-stop service delivery; and
  • Actively cross-enrolling families in health and human services programs by using the information already available in a client’s file.

The Urban Institute report counters the widespread myth that public sector officials cannot innovate because the environment is too difficult or because they are “just bureaucrats” who lack change leadership skills. The report describes openly and honestly the challenges state leaders face; furthermore, it also echoes last summer’s WSS Program Integration Forum (where senior officials shared experiences in their own words) by illustrating the skills, energy, thoughtfulness, and optimism these leaders bring to improving government effectiveness and responsiveness. Robert D. Reischauer, former director of the Congressional Budget Office and president emeritus of Urban Institute, remarked in his role as forum respondent: “I came away with a tremendous positive feeling of what is happening [in the states] and what is possible. Even in a policy environment that is extremely inhospitable, positive and significant change is possible.”

As WSS states continue to implement healthcare reform, expand Medicaid, and redesign their child care subsidy programs, the other 44 states should draw on these lessons to improve their own services. Further, federal partners and national thought leaders should take notice of public programs’ effectiveness and what it takes to help leaders succeed. WSS states will continue to share hard-earned lessons on service delivery reforms and health and human services integration materials in the coming year.

Click here to learn more about Work Supports Strategies (WSS).