Flickr image courtesy of user Moppet65535

Until this year a Michigan resident looking to register for government assistance would have encountered the longest form in the entire country. 42 pages of scarcely legible type and tiny boxes covered more than 1,000 questions, including reasonable inquiries like family size alongside more invasive and confusing questions like conception dates for each child.

If they successfully navigated the massive form, residents deemed eligible for support were then subject to often confusing access points for different programs. Information, resources and services were scattered across websites, offices, and different departments within the state. The complex layout created a barrier for those in need; the system was overwhelming for anyone, but could essentially be a brick wall for someone struggling with literacy, or juggling multiple minimum wage jobs, someone balancing daily care for their family or dealing with chronicle health concerns.

In 2016, the Michigan Department of Health and Human Services (MDHHS), with support from the Health Fund, kicked off a series of projects aimed at transforming the way they deliver public assistance. They focused on three main components; updating the form that determines eligibility, transforming the way they deliver support programs, and empowering staff to become problem-solvers rather than paperwork navigators.

Project Re:form – Plain language and Friendly Design

Aside from the intimidating length of the application, the original form featured small, difficult to read text. Text that was rife with complicated health terms and uncommon phrases further spurred confusion among native and non-native English speakers alike. Reading levels throughout the document varied widely.

Daily questions poured in from community members struggling to complete the form, leaving employees overworked and wondering if they were really helping people. Assistance for healthcare, food, childcare, and emergency relief services went unclaimed, leaving vast federal funds unutilized each year.

With the help of the design firm Civilla, MDHHS tackled both the design and the content of the form. Using plain language, they were able to ask fewer questions while still gathering all necessary information. Plain language avoids jargon and includes a range of methods, from writing in shorter sentences to breaking up text with bullet points and subheadings, all to create a document that is clear and logical to its intended audience. MDHHS was able to cut the form by more than half, trimming it from 42 pages to just 18. The new form is more inviting and, most notably, easier to read and understand.

The new form, which was tested in Wayne and Eaton counties, will allow staff to go beyond helping people figure out the eligibility paperwork. MDHHS had estimated that a reduction in processing time of just 5 minutes per application could allow the Department to more effectively use 82,000 casework hours each year. The hope is that they’ll be able to spend that time better understanding and helping residents, connecting them to the resources that can improve their health and economic futures.

Integrated Service Delivery Portal – A holistic approach to resource navigation

The redesigned form makes it easier for people to determine their eligibility for assistance, but the next step was to streamline access to resources and services and make them available over a wider range of devices. Nearly 80% of residents have access to a cell phone even if they do not have, or have limited access to computers. With that in mind, MDHHS decided to tackle their web platform, creating the Integrated Service Delivery portal called MI Bridges, that transitions seamlessly to mobile phones. The portal also centralizes a range of support programs and information that was previously scattered around the digital and real worlds.

Three years in the making, the final web interface will take holistic approach with a design focused around positive outcomes. The portal will guide residents through a needs assessment and connect them with support to directly address those needs. Additionally, it will take an in-depth look at underlying causes that often go overlooked during the cursory application process. By providing residents with more in-depth care, the state seeks to reduce the potential of future crisis situations and help set families up for lasting success.

MDHHS launched a pilot program in September 2017, testing the system in Muskegon county. The next phase will start this year, with the rollout of the ISD Portal across the entire state of Michigan this Spring.

From Innovation to Impact: Putting People First

In Michigan, almost 17% of households live below the Federal Poverty Line, nearly 2% more than the national average. And, according to the Michigan Association of United Ways, an additional 24% of households struggle to afford basic necessities like food, housing, child care, transportation and healthcare. With the difficult application process and the complicated landscape of support resources, people were kept at the margins of the system instead of at the center of it.

The system overhaul has been designed, tested and tweaked with the ultimate goal of bringing people into the fold instead of locking them out. By redesigning the paper and technology infrastructure, MDHHS will be able to meaningfully help more people in need, and reduce the burden on staff while empowering them to make a bigger difference.

The next steps are about improving and expanding. With support from the Health Fund and other partnerships, MDHHS will work to gauge residents’ experience with the new form and portal, and further tweak each component to work even better for people. And the public can expect to see this changes within the year. Armed with smarter, more efficient tools, the State of Michigan will be prepared to better the needs of our most vulnerable neighbors while also empowering residents to feel comfortable accessing available resources — putting us on a path toward a healthier state for all.

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