Advocacy in the Dark: A Pennsylvania Case Study on Advocating to Improve Technology that Drives Eligibility Decisions

By Louise Hayes

Hundreds of thousands of Pennsylvanians risk losing their Medicaid coverage every year due, in part, to computer systems that are not accessible to the public. In fact, many government decisions are made by automated computer programs. For example, computer programming formulas may determine how many hours of home care services individuals will receive, or whether someone who has been arrested may be released while they await trial. 

Technology that automates different processes aims to save time for caseworkers and people who count on public programs like Medicaid. But this innovation can significantly reduce the transparency of government operations. Further, glitches in the system can cause people with low incomes to be wrongly denied enrollment or dropped from critical public supports. How can outside advocates seek improvements in a system whose outcomes they see, but whose processes are obscure? 

This paper describes how Pennsylvania advocates tackled one manifestation of this problem: a very low rate of automated Medicaid renewals. Advocates can use the strategies we found effective to lift barriers facing people enrolled in other public programs. This project was funded through the Advancing Strategies to Align Programs (ASAP) national project to boost participation in Medicaid and the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps). 

This brief was written as part of the Advancing Strategies to Align Programs (ASAP) project, which worked with state advocates to improve the policy and operational components of public benefit programs.