Technology and the social safety net

Q&A with Martha Donnelly, a Deloitte Human Services Transformation leader

The social safety net has long been a fragile system of interconnected programs and services. The COVID-19 pandemic exposed this fragility as human services like Medicaid and the Children’s Health Insurance Program (CHIP), nutrition benefits, unemployment insurance, child care, disaster aid and temporary cash assistance became front and center for Americans seeking help—many of whom had never tried to access these benefits before.

Modern technology has played an important role in expanding access to these services. Since the public health emergency began in 2020, government leaders have been focused on strengthening that access by improving data and systems integration, enhancing online options, and automating manual tasks so that public servants can spend more time helping families understand and receive the services for which they are eligible.

And that work didn’t stop with the official ending of the COVID-19 Public Health Emergency (PHE) one year ago. As states began the “unwinding”—redetermining eligibility for those receiving Medicaid and CHIP for the first time in three years—many leaders identified and closed gaps in their health care ecosystems. In fact, according to the U.S. Department of Health and Human Services (HHS), states have now enabled access to health insurance to millions more Americans than before the pandemic.

As the unwinding process ends, it’s a good time to assess what we have learned about America’s system of human services over the past four years and what more can be done to maintain states’ social safety net for the future.

We sat down for a conversation with Martha Donnelly, a Deloitte leader who advises human services professionals on the administration of benefits to the people they serve. Martha began her career as a state case manager in 1984 and spent more than 30 years working with people and families to support their food, health care, work, and other social service needs.

Q. It might be hard for one to argue, especially after a global pandemic, that the programs making up the American social safety net are not essential public services. But why is it critical that leaders embrace technology and enhance these programs with modern technology?

Martha Donnelly: As consumers, we’ve been using computers for a long time now. But I can tell you, it’s not that long ago that government agencies were using pen and paper.

Every day, we expect a lot from our government, especially social workers in communities all across the country. For them, technology has enabled them to be even more effective at achieving the mission that matters most—giving people a hand up.

Years ago, as a case manager, I would arrive at my office at 8 a.m., and there would be a line of people wrapped around the block waiting to apply for help with food, health care, rent. Many of them would be standing in line with small children too young to be in school. The weather might be freezing, raining, burning hot. It didn’t matter.

By the time I checked in, I would have 10 people already waiting for an initial interview. The other caseworkers and I kept snacks at our desks because most people didn’t have money for the vending machine or to take the bus home and return later for an appointment. This might’ve been their only day off. And after speaking to me, they might have had to go to their old employer and get a separation notice, to their landlord for a statement, to the utility company for a recent bill—and come back to the office again.

All of this has changed now because technology has improved access to all these things. Programs are still complicated, and people still need help understanding all the rules and requirements, but people can now apply for benefits from anywhere—at a food bank, on the bus, from their job. They can be interviewed over the phone or online, submit documents using a smartphone, and receive an EBT payment card instead of coupons.

Some say we’ve lost some of the human touch by relying so much on computers, but I doubt you would have heard that years ago from the parents and grandparents waiting in line outside my office.

Q. How did the PHE change the way state government leaders think about and approach their health and human services programs?

Martha Donnelly: In many ways, the emergency created by the pandemic broke down barriers, especially between the federal government and the states. And even between different federal agencies. Nobody had time to mess around.

There was an unprecedented amount of two-way communication and collaboration. There were meetings, surveys, conversations to make sure everyone had the latest information and was exploring the best options for their states. The amount of community outreach was impressive. In one case, Deloitte supported a nonprofit organization helping states figure out how to reach people who might be eligible for SNAP, but were not receiving that benefit. In all my time of public service, I’ve never seen so much cooperation.

And this cooperation was essential because all states were in the same boat. To handle the historic volume of applicants, states needed to innovate with automated data entry, platforms that enabled people to self-serve, and technology that could read documents.

And this wasn’t just for health care. Integrated platforms proved extremely useful with connecting people to other programs. So, if someone was determined to be eligible for Medicaid, chances were good that they also qualified for SNAP (Supplemental Nutrition Assistance Program) or TANF (Temporary Assistance for Needy Families) and vice versa.

The public health emergency also pushed everyone to think about what happens when there’s no school. What happens to kids who depend on free lunch in the school cafeteria? From that crisis came the Pandemic EBT program and now the Summer EBT program, which serves kids during the summer months—the hungriest time of year for some kids. These nutrition programs really got traction once people at all income levels experienced school closures.

Q. The public health emergency officially ended over a year ago. How is the safety net holding up?

Martha Donnelly: The PHE might be over, but nothing is going to change the fact that all people need access to quality health care, even the healthy ones. Managing an emergency like the pandemic, and then somehow returning to normal, was never going to be without some complications.

During the pandemic, government policy allowed people on Medicaid to stay covered, even if their circumstances had changed. This gave states the opportunity to think about how they wanted to enhance their programs for the future. Throughout all of it, the clear message was automate, automate, automate.

Yet, public health programs might be the most important part of the social safety net that still needs attention. That’s because state agencies have spent the past year unwinding the continuous-coverage policy and recertifying people’s eligibility for Medicaid and CHIP. For many Medicaid recipients, this was the first time they had gone through the eligibility verification process—and some didn’t realize they needed to do so until they had lost coverage.

Q. What has made the unwinding process so challenging?

Martha Donnelly: Technology has made managing Health and Human Services programs much, much easier; there’s no doubt about that. However, these programs are complex and large system implementations are complicated. Every state’s eligibility system is different, and they each run Medicaid and CHIP in their own way. What is consistent is that they all require ongoing maintenance, enhancements, upgrades to software and hardware, and database management.

Many states modernized their technology during the public health emergency. They worked with HHS on ways to waive certain eligibility rules, so that they could automatically renew a person’s coverage through something called ex parte. These kinds of waivers used to take years to get approved, but increased communication during the PHE made things more flexible.

Since then, nearly all states have taken advantage of some new federal waivers, which have reduced some of the administrative red tape people encountered in the past. For example, HHS reports that auto-renewal rates increased nationally from about 25% in April 2023 to 47% in December 2023.

So far, the unwinding shows us that the states that used streamlined policies, processes, and technology before the pandemic are the ones that are still able to quickly check and update eligibility renewals. They realized that investing early in things like automation, self-service options, and integrated eligibility systems could help them—and they were right. The modern tools and technology they now have make this mission more straightforward for their workers and the families they serve.

Q. What is the path forward for government leaders trying to build stronger, healthier communities?

Martha Donnelly: First, I am proud of the work we have done here at Deloitte to support states. Service for the public good takes real commitment and hard work; it’s not for the faint of heart. Although I no longer work for a state, I am grateful for the chance to advise and help many state clients make progress with purpose.

State leaders looking to strengthen the social safety net can look at the health of their communities holistically and equitably. There are many social drivers that make healthy people beyond health coverage. Good nutrition habits and access to fresh and wholesome foods. A warm, dry roof over their heads. A safe, well-paying job. Reliable transportation. Access to quality education for themselves and their kids. Emotional support from friends and family. During the pandemic, we all also learned how important it is to have access to services that support our mental health and well-being.

The good news is that all of these things, so tightly connected already, can also be addressed with a whole-of-government approach. The programs and resources to drive this kind of health equity already exist. States just need to connect the resources and, in many cases, the technologies, to make it happen. And we’re here to help them on that journey.

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