Key research findings from GetCalFresh’s work with SSI recipients include insight into wariness around benefits applications, particular difficulties for people with disabilities, how income relates to health consequences, and the important role that helpers play.
For decades, people who receive Supplemental Security Income (SSI)—low income seniors and people with disabilities—have been unable to receive SNAP food benefits in California. Last year, this policy was reversed and an estimated 400,000 people became eligible for food assistance as of June 1, 2019.
The California Department of Social Services (CDSS) partnered with Code for America to evaluate how SSI participants could apply for food assistance online. We launched a four month research initiative to understand their experience and the people who help them, including how they apply for benefits, make ends meet, and generally use technology.
Code for America practices human-centered design, where product improvements and new features are informed by continuous research. Our approach seeks to understand the experiences, expectations, and needs of users. With the expansion of CalFresh benefits to SSI recipients, we designed a research plan that sought to understand the life experiences and attitudes of low income seniors and adults with disabilities.
But since we couldn’t speak to all 400,000 newly eligible SSI recipients, our first step was to plan our research across groups based on important characteristics. Our quantitative research team analyzed several datasets, looking at factors like age, disability, and location.
We expected that about 71% of the newly eligible population would have a disability, and that roughly 47% would be age 65 or older. Among SSI recipients for whom there is data (about half), 48% have a representative payee, someone who helps them receive and spend their money. We also saw that almost half of those with a disability had a cognitive or vision disability. This data suggested that a sizeable share of newly eligible individuals would receive help from someone else in completing their application.
At the same time, we spoke to half a dozen subject matter experts who work with or advocate for SSI recipients. These two activities helped us build a picture of the preliminary user groups we conducted research with:
- Low income seniors (with an emphasis on women of color over age 65)
- Adults with disabilities (split between physical, cognitive, and sensory disabilities)
- Helpers of the two main groups
Finally, our data analysis suggested that the highest populations of eligible SSI recipients would be concentrated in Los Angeles and Southern California, Sacramento, and counties in the San Francisco Bay Area.
We planned our research in phases that roughly corresponded to these user groups. During each phase we collected information through different qualitative methods such as observational research, intercepts in the community, focus groups, and longer interviews. After each phase we synthesized what we heard into research insights. Then we analyzed the gap between what we learned and what we still needed to know, and began the cycle again.
What we learned
SSI recipients are experienced benefits clients, and wary of the process of applying for and maintaining them.
In group sessions, interviews, and in our community intercepts we heard again and again about the firsthand and long-term experiences people on SSI have had with government benefits and programs. The application and enrollment processes, as well as what is required to maintain benefits, is often described in negative terms, particularly for SSI and housing vouchers. Even after successfully navigating these programs, participants were often confused about why things had happened as well as the program’s rules and regulations, and renewal processes. These experiences color their expectations about a new benefit, often manifested as a series of rapid fire questions, like, “Are they going to take it [CalFresh funds] out of my SSI payment?” or “When will I have to renew, and go through the process all over again?” This insight highlights a need for more information up front so SSI recipients can figure out for themselves if a benefit will help them, or be too much trouble.
“Are you serious? And you can still keep your income? They won’t change your income?”
Helpers play a critical role to support applicants, and stand to benefit from the client receiving more aid
We discussed with research participants the help they receive and often encouraged those who had a part-time or full-time helper to bring their helper along to our interviews. Helpers overall play a bigger role for SSI recipients than other GetCalFresh users. The type or level of support can vary from daily help with dressing, bathing, and cooking to occasional support like shopping, going to doctor’s appointments, or organizing bills.
Helpers are often family and friends who give so much money, time, and energy that they often need support and care themselves. Some helpers are paid for their time through the in-home supportive services program (IHSS), while many others care for loved ones without financial compensation. This insight allowed us see that helpers are highly motivated to make sure the person they are supporting has the best chance of getting the biggest benefit.
Common hassles in application processes are magnified for those with disabilities
Resources and services, however modest, may be available—but are not accessible. They take effort and energy to obtain. People with different disabilities may become fatigued or struggle to get places, harming access to services. People with cognitive disabilities, for example, tend to need more help than others to understand, apply for, and manage benefits, as different requirements in the benefits process may cause them anxiety, frustration, and exhaustion. Access issues for those with disabilities are further aggravated in smaller towns and more rural areas as resources there are fewer and farther apart. Beyond accessible applications, SSI recipients with disabilities need an enrollment experience that is easy and low-stress, so they can complete the process without undue reliance on others.
Without enough money for food, people get what they can and suffer the health consequences.
Californians on SSI receive less than $1,000 per month, and live in the fourth most expensive state in the country (source). The most fortunate have low-income housing or vouchers, but many pay far more than 50% of their income in rent, leaving them with little to no extra money for higher quality food, modest toiletries, or over-the-counter medical items. Due to a variety of medical issues, many SSI recipients we spoke to tried to obtain healthy food, but felt it was unattainable because of cost, transportation, or their inability to cook or prepare it. Eating whatever is available or skipping meals is unfortunately the norm, which results is a variety of unhealthy trade-offs, such as blood sugar crashes or cycles of illness. SSI recipients need as much nourishing food as they can get.
What we’re doing now
As a result of the insights from our research, we identified two immediate improvements we could make to the GetCalFresh experience for this population.
Improvement 1: Customized Welcome for SSI Recipients
We know that SSI recipients have experience with government benefits and want to know what to expect in this new process. To address this, we designed a landing page that lists answers to the most common questions we heard in the field. We think this will help SSI recipients apply instead of calling an office, doing a Google search, or asking a friend for more information before even starting an application. We have also added more detailed information to the “How CalFresh works” screen at the beginning of the application. We found that participants have specific expectations around interviews and recertification based on their experience, so they feel comforted by additional explanatory information.
Improvement 2: Activating Helpers
Because so many SSI recipients have help, and those helpers are motivated to make sure the SSI recipient under their care receives the maximum financial support, we designed several screens to allow applicants to identify their helpers and the level of support they provide, so we can activate and formally bring them into the CalFresh process. Our new screens allow a client to designate someone to be an authorized representative, to get their own EBT card to buy groceries for the client, or to be able to speak to someone at the county on the client’s behalf. When the client fills out the helper screens, GetCalFresh uses the answers to populate forms that then are sent to the county. As we find out more about how this support system improves client outcomes, we are looking for more ways to activate helper support in GetCalFresh.org.
In May and June of 2019, GetCalFresh received 86,863 applications from SSI recipients. There are still improvements we want to make around usability, and we think we can make the experience even better for applicants. But we also have plans to evaluate the application process now that it is live. Combining our broad qualitative research on the SSI experience with data-driven insights will give us a clearer picture of how SSI recipients are doing across the state in applying for, enrolling in, and using their CalFresh benefits.
Stay tuned for a full report this fall.
Want to get more in the weeds? View our research updates in our Field Notes blog.
This post was co-authored by Nicole Rappin with help from Caitlin Docker, Eric Giannella, Gwen Rino, and Ruthie Reisner. Special thanks to our SSI research team including Nicole Rappin, Julie Sutherland, Taranamol Kaur, Cesar Paredes, and Melissa Cliver.