Appendix C. Local Administrator Interview Guide

OMB Approval No. 0584-####

Expiration Date: XX/XX/XX

Appendix C. Local Administrator Interview Guide

This information is being collected to assist the Food and Nutrition Service (FNS) in understanding Supplemental Nutrition Assistance Program (SNAP) and Medicaid coordination. This is a voluntary collection and FNS will use the information to aid in the administration of SNAP. This collection does request personally identifiable information under the Privacy Act of 1974. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-[xxxx]. The time required to complete this information collection is estimated to average 55 minutes (.9167 hours) per response, including responding to recruitment outreach, participating in interviews, and reviewing and providing feedback on process maps. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, 5th Floor, Alexandria, VA 22306 ATTN: PRA (0584-xxxx). Do not return any completed materials to this address.

Local Administrator Interview Protocol

Background

To start, we would like to ask for some background information about you, your role, and an organizational overview.

1. What is your current job title or position?

2. How long have you been in this position?

3. What are your primary responsibilities?

4. Please provide an overview of the office/agency and the programs administered through this office/agency.

   1. Do SNAP and Medicaid share eligibility staff in this office or are eligibility staff separate for each program?

      1. Does the State have a process for training eligibility staff on both Medicaid and SNAP?

   2. Are eligibility staff responsible for all aspects of a case or are different staff responsible for processing new applications and recertifications?

Policy Background

Now we’re going to ask a series of questions about coordination activities between SNAP and Medicaid. We are particularly interested in MAGI Medicaid participants. When we use the word “coordination” we’d encourage you to think of that term broadly – it could encompass anything from policies, to procedures, to IT solutions to communication strategies that a state might use to coordinate between two programs. We are particularly interested in activities that have been shown to improve efficiency, customer service, accuracy, and/or program access. Next, I’d like to get your perspective on some of the Federal and State policies that have shaped [State]’s ability to coordinate SNAP and Medicaid programs.

1. What, if any, Federal policies have impacted your State’s ability to coordinate SNAP and Medicaid? How?

1. [SNAP staff]: Potential policies to probe on:

1. SNAP verification requirements

2. Interview requirements

3. Application and recertification time standards

4. Certification periods differing from Medicaid

2. [Medicaid staff] Potential policies to probe on:

1. ACA administrative simplification rules (e.g., common application, timeliness standards, electronic data sources to verify eligibility, reasonable compatibility standards, ex parte renewals)

2. What, if any, State policies have impacted [State]’s ability to coordinate SNAP and Medicaid services? How

1. [SNAP staff] Potential policies to probe on:

   1. Joint application and processing with Medicaid

   2. Income and resource alignment with Medicaid

2. [Medicaid staff] Potential policies to probe on:

   1. Medicaid expansion

   2. State-based exchange decisions

   3. Population specific decisions

   4. MAGI vs non-MAGI renewal timing

3. What waivers that your state has received approval for have impacted coordination between SNAP and Medicaid? Were these waivers barriers or facilitators to coordinating SNAP and Medicaid? Probe on:

1. Extended certification period waiver

2. Adjustment to interview requirements (e.g., waiver face-to-face interviews)

3. Adjusted verification requirements waiver

4. Waive Period Reporting

5. CMS waiver opportunities, including E14 waivers

3. What, if any, local policies impact your office’s ability to coordinate SNAP and Medicaid?

Data Systems

Next, I have a few questions about your State’s eligibility and enrollment data system.

1. We understand you have a [insert type of eligibility system]. How, if at all, does having a [insert type of eligibility system] impact your office’s ability to coordinate SNAP and MAGI Medicaid participants?

Application, Eligibility Determination and Redetermination Process

Next, I have questions about the application, determination, and renewal process in your State for participants applying for and renewing both SNAP and Medicaid.

1. What are the most frequently used modes for individuals to apply for [SNAP or MAGI Medicaid] in [State]? For example, online application, in person, and by phone/call centers.

1. Is this the same for individuals applying for both programs?

2. What are the most frequently used points of entry for individuals to apply for [SNAP or MAGI Medicaid] in [State]? For example, local offices, community partners, qualified healthcare providers, food banks.

1. Is this the same for individuals applying for both programs?

3. According to your State website, your State offers [combined application, separate application, both] for SNAP and MAGI Medicaid participants. Can you confirm this is correct?

   1. Is this the same application for non-MAGI Medicaid participants?

4. Can you identify the most notable features of your application process that facilitate outreach and enrollment of individuals who are eligible for both Medicaid and SNAP?

1. What features of your online application facilitate outreach and enrollment of individuals who are eligible for both SNAP and Medicaid? What about your paper application?

2. What impact, if any, does this have on program administration? What about the beneficiary experience?

3. What are the benefits? Challenges?

5. Does [State] use electronic verification processes and systems to facilitate streamlined eligibility determination for MAGI Medicaid participants? If yes, is this coordinated at the time of application or at another time?

   1. Are electronic verifications always accurate? How do you ensure accuracy?

   2. Is the electronic verification process different for non-MAGI participants?

6. Can you provide an overview of the renewal process for SNAP and MAGI Medicaid participants?

   1. How streamlined is the process for individuals eligible for both MAGI Medicaid and SNAP? What strategies has your State implemented to align the SNAP and MAGI Medicaid renewal process?

   2. Probe on:

1. Aligning Medicaid renewals during SNAP recertification (probe on what this will look like after the unwinding period ends and regular operations resume)

2. Auto or ex parte renewals

3. Synchronized certification period

4. Streamlined Medicaid enrollment

5. Express lane eligibility

1. What has been the impact of these coordination efforts (e.g., increased retention rates, identification of those eligible but not enrolled, decreased churn, reduced staff workload and beneficiary burden)? Have these efforts impacted some populations more than others (e.g., rural participants, elderly, etc.)

2. Are notices/communications to participants coordinated across both SNAP and Medicaid? If so, what are the impacts of the coordinated messaging?

1. Does the State agency provide guidance on implementing strategies? How did State agency staff communicate any changes to local agencies?

2. What types of assistance do eligibility workers provide to applicants applying for both SNAP and Medicaid?

1. Does the State agency provide guidance for assisting applicants applying for both SNAP and Medicaid?

Lessons Learned and Promising Practices

To close, we would like to learn about any additional lessons that you have learned from coordinating SNAP and Medicaid processes.

1. What lessons have you learned coordinating SNAP and MAGI Medicaid?

1. Are there promising practices or lessons learned from coordinating SNAP and non-MAGI Medicaid participants?

2. Have there been any unintended consequences of coordinating SNAP and MAGI Medicaid? What about non-MAGI Medicaid?

3. What changes, if any, would you make to Federal policies to improve the coordination of SNAP and Medicaid (e.g., aligning eligibility or verification rules, time allowed for response to notices)?

4. What changes, if any, would you make to State policies to improve the coordination of SNAP and Medicaid?

5. How could FNS or State agencies help support successful coordination of SNAP and Medicaid in other States?

6. Is there anything we did not ask about that you think is important for us to know?

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