Over the last eight months, we've all watched as existing health inequities were exacerbated by the COVID-19 pandemic. We also learned that social determinants of health — conditions in the environments in which people are born, live, learn, work, and play — put people of color and low-income Americans at greater risk of infection than others, and that those communities are more likely to be negatively impacted by the economic fallout of the pandemic. The supports that normally help families meet such challenges are delivered through the collaborative efforts of America’s health and human services infrastructure, including public-sector agencies, philanthropic entities, and community-based organizations.
COVID-19 has turned everything we know about how to deliver these critical services on its head. The way people apply for help, the ways in which the human services workforce carries out essential duties, and even how clients engage in program activities are being redesigned and -imagined. As a result, public agencies and their community partners have had to accelerate the modernization of their business processes to preserve and expand access to the services that undergird an effective health and human services ecosystem.
Even as we carry out this work, however, organizations on the ground must operationalize these changes within a local, state, and federal regulatory framework that is in desperate need of remodeling. Congress and federal agencies have taken emergency actions since the pandemic hit to give more flexibility to service providers. One such agency, the Centers for Medicare & Medicaid Services, relaxed its payment rules so that medical practitioners can be reimbursed for the purchase of remote communications technology. While the change is temporary, it underscores the long-term need to simplify rules and regulations in ways that enable organizations to prioritize outcomes over process. There are similar opportunities across the health and human services sector.
In 2018, the Alliance for Strong Families and Communities and the American Public Human Services Association released the National Imperative Report: Joining Forces to Strengthen Human Services in America, which identified overlapping, conflicting, and outdated regulations as one of the major barriers to successful service delivery. The report recommended that regulators at all levels of government commit to a fundamental review and reform of human services CBO regulation. The pandemic underscores that need.
One example of needed regulatory modernization is the federal Supplemental Nutrition Assistance Program (SNAP). Unlike block grant programs, SNAP, the largest nutrition program in the country, operates within a highly regulated framework, with detailed rules that dictate how various agencies can administer their respective programs. As the pandemic has revealed, such a framework is particularly challenging for service providers to adapt to during a crisis. From March through June, states submitted more than five hundred and sixty waiver requests across seventy-nine different waiver categories related to SNAP. Approval or denial of these waivers repeatedly came just days before, or even after, states were required to implement changes and often required further guidance, clarification, or re-issuance at a later date. The constant state of uncertainty created inefficiencies and sub-optimal outcomes in service delivery at a time when providers should have been empowered to take decisive action to maintain critical services.
The pandemic also reinforces the need to review and modernize regulations to better reflect what is currently working. Rapid scaling of remote benefit processing functions suggests that agencies can reduce their reliance on onerous interviews in the application process and still maintain the integrity of their programs. Similarly, policies that support expansion of online purchasing options can have a major impact in reducing barriers to food access for individuals and communities. There's also a need to evaluate current and proposed SNAP regulations that restrict the strategies states can use to support households facing barriers to employment and to better align the program with other systems to create pathways that lead to greater economic mobility.
The child welfare system, which often relies on in-person visits and interventions, is another system that has been significantly impacted by COVID-19. Early on in the pandemic, it became apparent that the system could not continue to operate normally and that changes were needed to protect the health, safety, and well-being of children, staff, and families. The U.S. Children's Bureau was extremely responsive to these challenges, issuing modifications to allow monthly caseworker visits by video conference and later providing funding flexibility under existing federal law for the purchase of cell phones and equipment for birth parents and foster kids. This kind of flexibility with respect to technology has allowed those in the system to better meet the needs of the children and families they serve and to maximize the efficiency with which interventions are delivered. Given the ever-increasing role of technology in society, these changes should be made permanent.
The pandemic has underscored the need for a more flexible, nimble regulatory environment that enables state and local agencies and CBOs to creatively engage in experimentation and innovation, embrace technology, and improve outcomes for individuals and families in their communities.
The time is ripe for more permanent regulatory modernization in the health and human services space. We urge federal, state, and local policy makers to embrace such a paradigm shift, building on lessons learned from the COVID-19 pandemic and providing the kind of regulatory flexibility that fosters innovation and, ultimately, leads to better outcomes for all.
Ilana Levinson is a senior director for government relations for the Alliance for Strong Families and Communities. Matt Lyons is the director of Policy and Research with the American Public Human Services Association.