Nutrition Security Plan San Diego County Health and Human Services Agency San Diego, CA

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1 Nutrition Security Plan San Diego County Health and Human Services Agency San Diego, CA General Description This Raise the Local Voice profile is one of a series from APHSA addressing specific policies and recommendations that support the four outcome impact areas identified under our members Pathways initiative. This profile illustrates the outcome of Healthier Families, Adults, and Communities. The County of San Diego s Board of Supervisors launched an ambitious and forward-looking plan in April 2009 called the Nutrition Security Plan. This plan set the goal of adding 50,000 kids and seniors to the CalFresh (SNAP) program enrollment by June This plan also set forth three major strategies: 1. Promote nutrition and health improvement and make this integral to branding of the CalFresh (SNAP) program; 2. Strengthen outreach, in-reach and education about the program; 3. Enhance eligibility and enrollment through a wide range of systems improvements. This plan effectively put the CalFresh (SNAP) program out front as a major priority for the county, particularly in light of difficult economic circumstances for many families and historical challenges getting eligible families to participate. Broadcasting that this program is a nutrition program has proven an effective way to reach families and remove some of the stigma that has long been associated with this program. Outcome Goals and Measures What are the outcome goals and measures you are using to guide your efforts? The primary outcomes measure is: Increase the number of child and senior participants from March 2009 to 2012 by 50,000. A number of other milestones/measures are being monitored to assess progress for all three strategies promoting nutrition and health improvement; strengthening outreach and in-reach; and enhancing eligibility and enrollment. To promote nutrition and health improvement, the agency s success is reflected by: Won a $16 million award in ARRA funding for chronic disease prevention from the Centers for Disease Control and Prevention to address childhood obesity and promote local farmers markets, the largest ARRA award for this purpose. Conducted 4 free learning seminars in partnership with the Lakeside Community Collaborative to provide nutrition tips and information. The American Public Human Services Association is a bipartisan, nonprofit membership organization representing state and local human services agencies through their top-level leadership. APHSA s mission is to pursue excellence in health and human services by supporting state and local agencies, informing policymakers, and working with our partners to drive innovative, integrated, and efficient solutions in policy and practice.

2 To strengthen outreach and in-reach, the agency s success is reflected by: Provided over 2,000 individuals/families/worksites with blasts on nutrition information. Provided 336 community partners with instructions on utilizing an online geographic information system mapping tool to assist targeted outreach to local farmers markets and food retailers that accept CalFresh/EBT. Provided CalFresh (SNAP) outreach to 20 elementary schools and application assistance to 13 through community partners. To enhance eligibility and enrollment, the agency s success is reflected by: Received over 19,000 CalFresh (SNAP) and Medi-Cal (Medicaid) applications since implementation of online systems that allow for submission of electronic applications directly to the county. More than 5,000 CalFresh (SNAP) applications were submitted through ten community partners conducting application assistance. Implemented more than nine major program and business changes including waiving the face-to-face interview and asset limit, restoring eligibility the month following discontinuance due to an incomplete or no quarterly report, submission of electronic applications, an Inter-County Transfer process, same-day interviews, case imaging, an ACCESS Customer Service Call Center and new task-based business processes. How are you specifically measuring progress toward this outcome? CalFresh (SNAP) participation numbers are being tracked through the automated welfare system, CalWIN. Other progress measures in implementing the plan are being tracked by program staff and reported on routinely to the Board of Supervisors, to the Social Services Advisory Board and community, and internally to staff across HHSA. Program Coordination and Integration How are you working with multiple programs (rules and requirements, funds) to coordinate them, build collaborative activities around them, or integrate them? The Nutrition Security Plan is a highly collaborative effort between Public Health Services staff and our CalFresh (SNAP) program staff, outreach staff in the regions, and community partners. By elevating the health and nutrition aspects of CalFresh (SNAP), the county has successfully leveraged additional staff resources. What are the primary barriers you face in doing so, and how are you addressing them? Primary barriers are listed below. We are addressing/mitigating these barriers as best as we can through the strategic partnership in which we are engaged under this Nutrition Security Plan. State and federal program regulations are too complicated and create barriers to efficient processing. Inadequate state and federal funding for administering the program limit resources/staffing to process the increased number of applications. An outdated state program manual and issuance of state material through All-County Letters and All-County Information Notices creates confusion and difficulty in identifying current regulations. 2 Nutrition Security Plan, San Diego County, CA: A Raise the Local Voice Profile

3 Results What positive results are you experiencing from doing so, both in terms of lower costs and improved outcomes? What are your current outcomes and outcomes trends? Significant enrollment gains have been achieved since adoption of the Nutrition Security Plan in March As of May 2011, 50,599 additional children and seniors have been enrolled in CalFresh (SNAP), which means we have already surpassed our 2012 goal of 50,000, almost a year ahead of schedule. A wide array of gains or results have also been realized across each of the 3 strategies. For example: Toward promoting nutrition and health improvement, the People s Produce Certified Farmers Market in south eastern San Diego opened on Friday, December 3, 2010, making fresh and locally grown produce accessible to the community. This was a collaborative effort between HHSA, Project New Village, International Rescue Committee, Fresh Funds and University of California San Diego. This is the third market in the county that currently offers Fresh Fund, referring to a program that provides matching dollars for people with WIC, SSI and Electronic Benefit Transfer (EBT) in encourage the purchase of purchase farmers market produce each month. Toward strengthening outreach, in-reach and education, the San Diego Unified School District Board of Education unanimously adopted a strategic plan to promote CalFresh (SNAP). The plan was a joint effort involving the County, the school district and community-based organizations, and calls for these agencies to work together to provide application assistance and to publicize the program as a means to support healthy eating. Through the Thrive San Diego initiative, a partnership between HHSA, United Way, IRS, and local universities to enhance the County s Earned Income Tax Credit campaign, CalFresh (SNAP) on-line application assistance and pre-screening is offered at 12 service sites. Toward enhancing eligibility and enrollment, self-sufficiency clients now have the ability to apply for CalFresh (SNAP) and Medi-Cal (Medicaid) over the phone 24 hours a day, seven days a week, through collaboration with ACCESS Line. With the use of this technology, clients receive information and are efficiently referred to appropriate social, health and behavioral services. In addition, funding through a grant from the Alliance Healthcare Foundation allows for online application (called One-e-App ) for healthcare and nutrition assistance CalFresh/ SNAP benefits in cooperation with community partners. Applicants can complete core information once and apply for multiple services, and submit electronic CalFresh (SNAP) applications. Both of these initiatives have contributed to significant enrollment gains in CalFresh (SNAP) and other assistance programs. Why do you think this is the case? Please respond to this question from three perspectives: Improving incentives and removing disincentives that positively impact the decisions and actions of those you serve. The Nutrition Security Plan re-orients the CalFresh program by shifting its emphasis from a public assistance program to nutrition assistance and health program, thereby helping to de-stigmatize the program. This rebranding of the program and emphasis on outreach and education has done a lot to encourage (incentivize) participation of families in need and has proven an important way to get positive health messages out to the community, particularly the importance of healthy eating to the reduction of chronic disease. Enabling more effective and holistic client-level practices and service innovations. The Nutrition Security Plan effectively integrates public assistance and public health efforts in the County of San Diego. This promotes more effective use of public resources in that, for example, public health nurses facilitate clients access to CalFresh (SNAP), and conversely, eligibility staff carries important health and nutrition messages when assisting clients apply for CalFresh (SNAP). This is just one example of the synergies created. 3 Nutrition Security Plan, San Diego County, CA: A Raise the Local Voice Profile

4 The Nutrition Security Plan is one of the best examples at HHSA of integrated service delivery and holistic client-level practices that make for much better use of limited public dollars. In-reach efforts such as on-line trainings about the CalFresh (SNAP) program have expanded employee awareness about CalFresh (SNAP) among all Agency staff who now know how to refer their clients to CalFresh (SNAP) when appropriate. Improving system efficiency and capacity (e.g., staffing, technology, logistics). Improving system efficiency and capacity is the heart of the strategy to enhance eligibility and enrollment. Through a wide range of process improvements and enhanced technology, HHSA continues to streamline the eligibility process and expand the ways in which clients can access services. Stories and Anecdotes To illustrate and reinforce your responses above, please share what you can about specific, real-world experiences of those you serve and those with whom you collaborate. Here are some stories collected from our partners: San Diego Food Bank Single senior household I met him at an enrollment clinic that we organized at a low-income property in Poway. He is a senior citizen and living off his SSA of $963. His rent $500. He came fully prepared with all his paperwork to the event (e.g., SSA award letter, ID, rent, etc.). The following day I submitted the application electronically through using Cisco. The application was approved in less than a month. Client is receiving $53 in CalFresh (SNAP) benefits. Two-person household I met at the same enrollment clinic. She was not sure if they would be eligible because her household receives SSI but she thought to get informed and make sure. After talking to her, it was discovered that her 20-year-old daughter was disabled and on SSI of $845. This single parent has dedicated herself to taking care of her daughter and for that reason has not been able to work. After prescreening and learning she was eligible she was thrilled to sign up. She received application assistance that same day and because she had brought copies of her verifications, the application was ready to be submitted to the county the next day. She was approved in less than two weeks for $190 in CalFresh (SNAP) benefits San Diego Mrs. Davis had been referred by ACCESS to call 211 for the purpose of completing a phone application for CalFresh (SNAP). Mrs. Davis recently lost her job and due to financial hardship her household of five were staying with family. While they could provide a place to stay they weren t in the position to put food on the table for five more. At the time of her call she had already received her final paycheck so our phone center provided emergency, ongoing, and commodity food referrals to her so that the family could access food resources immediately and set a follow-up appointment for her application. During the follow-up assessment I was able to complete an application for the family on 1/21/11 and now Mrs. Davis family of five is receiving CalFresh (SNAP) benefits in the amount of $497/month for her family. San Diego Hunger Coalition Community partners are able to provide assistance at many different locations throughout the county. An elderly couple was at a food distribution picking up their senior supplemental food package. The husband disabled and home bound (a Cuban refugee) and the wife worked cleaning houses and collecting recycling, but still went hungry. They were unaware of CalFresh (SNAP) benefits. They are now receiving over $200 per month thanks to the work of the community partner and HHSA. 4 Nutrition Security Plan, San Diego County, CA: A Raise the Local Voice Profile

5 An elderly client was denied for being over the net income limit. The community-based organization that assisted with the application was able to contact the liaison at the HHSA office to request a re-assessment of the case. The liaison checked the case and fixed the error. The elderly client, also a cancer survivor, was awarded $178 per month in benefits. An organization working in rural San Diego (over an hour s drive from the closest HHSA office) sent this I had four applicants this week that needed help. I ed our HHSA liaison about each, and within 48 hours she had each problem resolved, with appointments set. Just wanted you to know I m getting great service and we all appreciate it. Recommendations From your experience, what related policy, program, or funding changes at the federal level would best serve to streamline, simplify, or integrate separate policies and programs? Standardize regulations for all States rather than individual States requesting waivers Increase certification periods from 12 to 24 months Increase the gross income limit Allow averaging of student work hours Waive interviews at recertification for elderly/disabled (except those with earned income) Allow administration through a single agency rather than two (CDSS & CDPH) Provide funding sooner rather than waiting until the last quarter From your experience, how long would it take for these changes to take hold at the local level and either lower costs or improve outcomes? The Nutrition Security Plan was approved by the Board in Spring of 2009 as a three-year plan to improve CalFresh (SNAP) participation, with the focus on children and seniors since these represent more vulnerable populations. A little more than two years into the implementation of the plan, the County has achieved 97.8 percent of its enrollment goal (48,878 of 50,000). This is strong evidence of the success of an aggressive three-pronged strategy that addresses the root causes of enrollment barriers the stigma associated with the program, the lack of strong outreach and positive messaging, and system inefficiencies that made the application process unnecessarily burdensome. The positive impact of this plan has been realized earlier than expected in large part due to the aggressive and comprehensive nature of the plan itself. 5 Nutrition Security Plan, San Diego County, CA: A Raise the Local Voice Profile

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