Although many people leaving welfare under the 1996 federal welfare reform legislation retained eligibility for such programs as Medicaid, the State Children's Health Insurance Program (SCHIP) and Food Stamps, studies suggested that from one-half to two-thirds of people leaving welfare were losing these benefits.

The Robert Wood Johnson Foundation (RWJF) designed Supporting Families After Welfare Reform: Access to Medicaid, SCHIP and Food Stamps to remove administrative obstacles that prevent low-income families from securing health and Food Stamp benefits. In January 2000, RWJF's Board of Directors authorized $5.9 million for the program.

Key Results
RWJF issued grants to seven states and counties to diagnose problems within their eligibility systems, and later to 11 states and counties to implement strategies to reduce barriers to receipt of services. The Southern Institute on Children and Families served as the national program office and provided technical assistance throughout the program.

When the program ended in 2004, 10 teams from public agencies in the program's implementation sites had participated in collaborative problem solving. (An additional team from the Washington grantee of the RWJF national program Covering Kids & Families participated in the collaborative.)

Using the Breakthrough Series Collaborative approach — structured team-based learning and problem-solving experiences developed by the Institute for Healthcare Improvement (IHI) — participants devised strategies to help families secure and retain benefits, then they returned home and pilot-tested, refined and in many cases institutionalized their strategies. Strategies included:

• Simplifying client forms and notices.
• Sending or calling families with reminders regarding required verifications.
• Reorganizing workflow to reduce staff burdens.
• Reprogramming computer systems to reduce mistakes.

In April 2002, staff from the national program office attended the Breakthrough Series Collaborative College run by IHI. The Supporting Families sites subsequently participated in sessions conducted by the Southern Institute, which led to field experiments and small-scale tests to:

• Test strategies to simplify eligibility rules.
• Eliminate duplication.
• Improve workflow.
• Improve communication among staff from different programs.
• Solicit accurate and timely information from recipients.

Evaluation
Carolyn Needleman, Ph.D., of Bryn Mawr College conducted a mid-term program evaluation. She found that despite the budget cuts all states were facing at the time, collaborative problem solving enabled agencies to move forward with small, workable improvements to their administrative systems.