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Paul Sableman via Flickr

Removing the stigma of Medicaid and food stamps in Philly

“There is a large misconception,” said the city’s benefits coordinator about how the system actually works.

After graduating from Dickinson College in the mid aughts, Graham O’Neill found himself unemployed and in need of health care. He had a bachelor’s degree at the time, and it took him four applications and the help of a social worker before he was able to be approved to receive Medicaid.

All along, he’d just been filling out the form wrong.

Today, O’Neill is the benefits access coordinator in the Philadelphia Mayor’s Office of Community Empowerment and Opportunity where he oversees efforts to help low-income residents receive benefits — rather than having thousands of Philadelphians leave millions of dollars on the table every year.

And because he’s been through it, he knows how difficult the process can be to navigate and, he says, that “there is a large misconception” of how public assistance really works.

“There’s this common conception that ‘welfare’ is kind of this omnibus program,” he said, using air quotes. “And you go and you apply for ‘welfare’ and tell them what your needs are and then this ‘welfare’ just fixes your needs. But in reality, it’s tons of different programs.”

Public assistance in Philly

Philadelphia has the highest poverty rate of the top 10 largest cities in America. That means a high percentage of residents are receiving, or are at least eligible for, public benefits, and the most popular of those are SNAP and Medicaid.

Nearly half a million Philadelphians use the Supplemental Nutrition Assistance Program — AKA food stamps — and more than that have access to Medicaid for health care assistance. But there are more than a dozen other local, state and federal benefits for which Philadelphia residents qualify, ranging from help paying utilities to assistance with housing to a decrease in taxes.

But in Philly, one out of every four eligible residents isn’t getting the SNAP benefit for which they qualify. Compared to the rest of the state, Philadelphia has a lower SNAP participation rate, with just 73 percent of those qualified enrolled.

In Philadelphia, enrollment in Medicaid increased by almost 30,000 people after expansion was adopted by the Gov. Tom Wolf administration. Enrollment in Philadelphia — though still lower than it could be — went from 522,700 in 2014 to 550,300 in 2015.

But the process of actually applying for and receiving these benefits is an onerous one. There’s no just walking into a waiting room somewhere and picking up a check.

“It’s a very difficult system to navigate,” O’Neill said, adding: “No one really wants to be enrolled in these benefits.”

Those seeking benefits who don’t use the services of a place like BenePhilly (more on that soon) may have to work with three or four different agencies. Each requires the applicant to submit a lengthy application, provide documentation as detailed as “every expense in the last 30 days,” submit and mail their applications to the correct place, wait for a response, submit more documents, sometimes go through an interview process and then wait to find out if they’re approved.

At any step in the process, administrative snags can happen, which O’Neill says is the most common problem. Paperwork gets lost. Someone doesn’t receive the letter they were supposed to. Someone is mistakenly denied because a caseworker read their forms wrong. Happens all the time.

For someone seeking health care or help purchasing food, it can literally mean life or death.

“It’s such a convoluted process,” O’Neill said, “that it’s kind of hard to even explain it front to back because there are so many touch points on there that could go wrong.”

The home screen of the COMPASS system that people can use to sign up for benefits directly through the state.

The home screen of the COMPASS system that people can use to sign up for benefits directly through the state.

What has made the process a bit easier in the last year or so was Wolf’s decision to eliminate “the asset test” from acquiring food stamps. Under former Gov. Tom Corbett, the process to receive food stamps was tied to people’s bank accounts and car ownership, so if a person had more than $5,500 in assets, they’d be ineligible, even if they had no income.

How BenePhilly works

But beyond the statewide changes to each program individually, the city of Philadelphia has attempted to streamline the process so it’s easier for low-income residents to take full advantage of every benefit available to them.

Since July 2014, BenePhilly centers across the city (there are eight) have helped clients submit more than 12,000 applications resulting in more than 4,000 confirmed enrollments in benefits the residents hadn’t been receiving before they went to BenePhilly for help. In addition to their eight centers, BenePhilly also operates five centers embedded in community organizations and a mobile unit that people can use to sign up.

BenePhilly, managed by the Benefits Data Trust through a block grant, offers free services to people who come into the centers or call their hotline so that rather than going through several processes for different benefits, they’re able to do it all in one place.

“It’s making it so that people that are applying for benefits are armed in the best possible way to receive that benefit,” O’Neill said. “We do that through documentation support because that’s where a lot of people stumble.”

If you go into a BenePhilly center (they encourage anyone to do so), you’ll first go through a screening process about your income, household size and what benefits you already receive so the person staffing the center can figure out which benefits you qualify for.

Then, BenePhilly submits the applications for the client and the waiting game begins to see if the person was approved for the benefit. If they weren’t, BenePhilly helps them tailor their application in another way so they have a better chance of being approved.

There can still be problems, even when going through the streamlined process. Undocumented immigrants still have little access to public benefits and non-U.S. citizens have to produce a green card to qualify for things like SNAP and Medicaid.

And even when BenePhilly is involved, administrative problems still can happen. But at least in those cases a professional can tell a client that they weren’t denied because of something they did, but rather because of something beyond their control.

‘Shared Prosperity’

The strategy that guides BenePhilly’s efforts to enroll the thousands of people in Philadelphia who qualify for benefits but aren’t enrolling in them is called “Shared Prosperity.” Improving benefits access is just one of the goals of the plan adopted in 2013 under Mayor Michael Nutter as a comprehensive strategy to decrease poverty.

The best way to get more people enrolled? Outreach and explanation.

Benefits Data Trust, which operates BenePhilly, holds community workshops to answer questions and make sure people understand the significant barriers — but also the possibilities. O’Neill said he and his colleagues frequently encounter people who at one point in their life didn’t qualify for benefits and they never tried again. 

Beyond the practical benefits, O’Neill said there’s also a “welfare stigma” that often has to be addressed. Some people have a lot of pride in not seeking help from the government. Others are under the impression that if they opt in for a benefit, they’re taking away that benefit from someone else.

The opposite is almost true in the case of a benefit like SNAP, he said, explaining that if a state can’t demonstrate that all the people that are likely eligible are participating, then there’s a chance the state could lose benefits the next year.

And the best way to help people get over the “welfare stigma?” O’Neill tells his own story.

“I had to get food stamps and Medicaid not relatively long ago,” he tells them. “And it was there when I needed it. And me getting the benefit didn’t take it away from anyone else.”

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