Early Insights from the ACCESS Initiative: Summary and Commentary

Image credits: American Public Human Services Association 1300 17th Street North, Suite 340, Arlington, VA 22209 (202) 682-0100 www.APHSA.org @APHSA1

The Aligned Customer-Centered Ecosystem of Services & Supports (ACCESS) initiative is a two-year project led by the American Public Human Services Association (APHSA) in collaboration with the National Association of State Workforce Agencies (NASWA). Its goal is to create a roadmap for modernizing and aligning efforts across human-focused programs  to improve customer-centered program design and delivery. In the early stages, professionals across these sectors emphasized the need for alignment to boost workforce capacity, streamline processes, and enhance service delivery. Through the initiative, key collaborators have identified current and future opportunities, as well as potential challenges, to achieving better alignment within their agencies. The 2021 Executive Order 14058, aimed at improving federal customer experience and service delivery, has significantly advanced alignment across health and human services and labor programs. The 2023 Executive Order 14110, focusing on the safe and trustworthy use of AI, is expected to further these goals by integrating AI tools into innovation strategies while upholding customer experience, safety, and rights.

The TipCo Perspective

The team at TipCo Automated Systems brings over 60 years of public sector experience in improving access to essential services like SNAP and Medicaid. Co-Founder Greg Tipping will share his insights on enhancing human-focused programs throughout the report.

Early Themes and Insights

The ACCESS project team at APHSA and NASWA has found some early themes and insights of achieving alignment through their research work.

Program Design, Administration, and Service Delivery Models

The way assistance programs are designed and managed can greatly affect how well they can work together. Programs run by the same agency, like SNAP and TANF, usually have fewer issues working together than those run by different agencies or different parts of the same agency. This is also true for programs managed at the state level compared to those handled at the county or local level.

In human-focused programs run by the government, how a program is designed affects its decision-making, resource allocation, policy creation, and flexibility. decisions are made, resources are used, policies are created, and how flexible they are all depend on how each program is designed. The ACCESS initiative found that when different agencies at the county, state, and federal levels work together in a coordinated way, the teamwork improves between human-focused programs, leading to smoother and more connected services for people.

Achieving operational alignment isn’t just about merging agencies, programs, or systems. Although centralized models can help, true alignment requires a complex approach that involves strong leadership and proactive actions at all levels. Success depends on combining leadership support with practical steps to fully integrate and make programs work together effectively.

The TipCo Perspective

Government agencies have been trying for years to break down silos of information to better serve our communities. This initiative and the recognition of the power of AI is a leap forward in that mission.

Funding Models and Resourcing Streams

Access to cross-program funding is crucial for building workforce capacity, launching special projects, and modernizing technology. However, if funding is insufficient, it can lead to a cycle where agencies struggle to meet requirements, which in turn reduces future funding. Additionally, differences in how and when programs receive funding can affect their ability to combine resources, impacting overall alignment efforts.

Understanding current funding and resources is necessary for optimizing support in human-focused programs. Funding models and levels not only affect agency capacity but also influence federal requirements and agency flexibility. State agency leaders have told the ACCESS project team that funding structures greatly impact their ability to align operations, especially when it comes to technology innovations. Program leaders struggle with funding environments that create major barriers to alignment. An ACCESS survey revealed that resource constraints, alongside technology limitations, are the biggest obstacles to alignment, and these two issues are intricately connected.

The TipCo Perspective

The partnership between the federal, state, and county programs is crucial. Federal and state programs need strong policy and guidance, but the counties need flexibility to create and operate programs tailored to meet their communities’ unique needs.

Funding via Siloed resource streams

Programs and agencies often receive funding through isolated streams, which limits options for financing technology and innovation projects. These projects typically rely on special grants rather than standard administrative or benefit funding because they’re seen as modernizations rather than essential functions. State agency leaders use various strategies to navigate this challenging funding environment to support initiatives like data security, system interoperability, and user accessibility across human-focused programs.

·      Special Grant Funding: Agencies often depend on grants specifically for technology upgrades and innovations. These grants are essential for funding projects aimed at modernization and improving service delivery, beyond just maintaining basic program functions.

·      Advance Planning Document (APD) Process: APDs are used for distributing costs across multiple federal programs for shared state services. Managed by State Systems Offices (SSOs), the APD process is a formal procedure that helps states secure federal approval and funding for technology projects. This process ensures compliance with federal regulations and varies based on the risk level of the IT project, with fewer requirements for lower-risk projects and more oversight for higher-risk ones.

·      Administrative and Benefit Funding Models: These funding models mainly cover operational and direct service costs but sometimes allow for technological improvements. Their use is often restricted by strict federal guidelines.

·      Waivers and Demonstrations: States use waivers or demonstration projects to flexibly allocate funds, enabling innovative uses for technology enhancements that support broader program goals.

·      Federal and State Collaborative Funding: Technology projects are sometimes funded by a mix of federal, state, and philanthropic sources, enabling larger investments in system improvements.

·      Pre-Implementation Checklists: United States Department of Labor-required checklists help states manage Unemployment Insurance IT projects. These tools support resource allocation and compliance, enabling essential technology upgrades for more efficient service delivery across human-focused programs.

The TipCo Perspective

Every year new and more complex policies come out, requiring the states to modify their case-management rules engines—which is complex, error-prone, and expensive for the states. We need only look at the challenges that the unwinding of benefits post pandemic posed to the states to see why this is an issue. Most participants who successfully renewed their Medicaid coverage found the process quick and easy online, though some faced barriers like paperwork issues and long processing times. Disenrolled individuals reported confusion about their eligibility and encountered communication challenges, leading to out-of-pocket costs for necessary care. The unwinding emphasized the critical importance of Medicaid, with many participants expressing that losing coverage would have devastating health and financial consequences.

Technical Infrastructure

A survey by APHSA and NASWA found that technology limitations, including outdated systems, varying eligibility and enrollment systems, different vendors and procurement practices, and inconsistent regulatory requirements, are major barriers to alignment for health, human services, and labor professionals. These issues affect systems interoperability, data sharing, and process coordination, impacting both customer and employee experiences.

The technological infrastructure for health, human services, and labor programs varies widely across states and agencies. According to the ACCESS project survey, 68 percent of respondents identified technology limitations as a major challenge, making it the top obstacle to alignment along with funding limitations.

State leaders in the ACCESS project highlighted the close connection between policy and technology: Complex policies require sophisticated systems, while simpler policies are easier for older systems to manage. Differences in cross-program policies lead to significant variations in how systems collect, protect, and store data, determine eligibility, calculate benefits, and handle ongoing requirements like job search proof and benefit recertification.

Procurement practices vary depending on whether states have centralized or departmental  procurement agencies. ACCESS research highlights the complexities and variations in procuring and using IT systems for health, human services, and labor programs, including systems for applications, eligibility, enrollment, contact centers, document processing, data management, and case management.

Future Efforts

Some agencies are advancing alignment through a mix of formal and informal practices. Formal alignment occurs through organizational-level collaboration, such as regular inter-agency meetings. More commonly, informal collaboration at the staff level—through strong relationships and daily interactions—promotes coordination and problem-solving. High-level leadership and gubernatorial support are crucial for sustaining alignment efforts and encouraging innovative practices across human-focused . Agency personnel highlighted that system modernization is necessary not only for technological upgrades but also for rethinking and reshaping service delivery to the public.

The TipCo Perspective

The technology we have at our fingertips today makes this initiative finally attainable in a meaningful way.