SHARE

Link copied to clipboard!

Month: April 2022

Fast facts and the areas in which we work

Posted on by admin

At 17A we are dedicated to making service delivery better for the public and building trust in government. We work with clients across sectors like healthcare, housing, courts, and transit to positively impact diverse and vulnerable communities. We think a big part of understanding these problems is understanding their scope. These questions and answers below provide a great reference point and reminder of the impact government policy has across different communities.

As of June 2021, how many individuals were enrolled in Medicaid? (estimated)

76M+

Source: CMS [1]

What is the Federal Poverty Level (FPL) in the US?

$12.9K for 1 person, $21.9K for family of 3

Source: ASPE [2]

What is the number of people incarcerated in the US on any given day?

2.3M

Source: The Commonwealth Fund [3]

As of 2022, what is the maximum federal reimbursement rate to state Medicaid spending (i.e. Federal Medical Assistance Percentages)

83% (Federal govt. will reimburse the state .83 for each Medicaid $ spent)

Source: Congressional Research Service [4]

As of the latest Census estimation (2019), what percent of families in Ohio live below the Federal Poverty Level (FPL)?

30% (Family defined as household with >2 adults and >1 child)

Source: KFF [5]

As of June 2021, how many individuals were enrolled in the Child Health Insurance Program (CHIP)?

6.9M+

Source: CMS [1]

What is the shortage of affordable housing units in the US?

3.8M

Source: White House [6]

As of 2019, what percent of the nationwide prison population is incarcerated for non-violent offenses?

25%

Source: Time [7]

As of the latest Census estimation (2019), what percent of families live below the Federal Poverty Level (FPL)?

29% (Family defined as household with >2 adults and >1 child)

Source: KFF [5]

As of February 2022, which states have not adopted Medicaid expansion through the Affordable Care Act (ACA)?

TX, FL, GA, MS, AL, SC, NC, TN, KS, WI, WY, SD

Source: KFF [8]

How many people in the US have a family member who is justice-involved?

Nearly 50%

Source: Equal Justice Initiative [9]

What is the number of people that experience homelessness in the US on any given day?

326K

Source: U.S. Department of Housing and Urban Development [10]

What is the US Federal Medical Assistance Percentage (FMAP) minimum?

50%

Source: KFF [11]

As of the latest Census estimation (2019), what percent of families in New York live below the Federal Poverty Level (FPL)?

27% (Family defined as household with >2 adults and >1 child)

Source: KFF [5]

As of 2022, what is the minimum federal reimbursement rate to state Medicaid spending? (i.e. the Federal Medical Assistance Percentages)

50% (Federal govt. will reimburse the state .50 for each Medicaid $ spent)

Source: Congressional Research Service [4]

What is the number of rental units available for Extremely Low Income (ELI) renters (per 100 households)?

35 per 100

Source: National Low Income Housing Coalition [12]

As of 2020, how many Americans are under the supervision of the adult correctional system? (e.g., probation, prison, parole, or jail)

5.5M Americans

Source: Bureau of Justice Statistics [13]

As of February 2022, how many states have adopted Medicaid expansion through the Affordable Care Act (ACA)?

39 (including DC)

Source: KFF [8]

[1] https://www.cms.gov/newsroom/news-alert/cms-releases-latest-enrollment-figures-medicare-medicaid-and-childrens-health-insurance-program-chip

[2] https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines/prior-hhs-poverty-guidelines-federal-register-references/2021-poverty-guidelines

[3] https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/medicaid-role-health-people-involved-justice-system

[4] https://sgp.fas.org/crs/misc/R43847.pdf

[5] https://www.kff.org/other/state-indicator/population-up-to-200-fpl/

[6] https://www.whitehouse.gov/cea/written-materials/2021/09/01/alleviating-supply-constraints-in-the-housing-market/

[7] https://time.com/4596081/incarceration-report/

[8] https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

[9] https://eji.org/news/half-of-americans-have-family-members-who-have-been-incarcerated/

[10] https://www.hud.gov/press/press_releases_media_advisories/HUD_No_22_022

[11] https://www.kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/

[12] https://reports.nlihc.org/gap

[13] https://bjs.ojp.gov/data/key-statistics

Community-minded strategies in local courts – and how these approaches can work for other government agencies

Posted on by admin
Where local courts are today

Local courts play an important, central role in the lives of community residents, offering services beyond hearings that range from fine settlements and housing assistance to vehicle registration and family support. Amongst local government offices, courts see some of the highest foot traffic from community residents, with nearly 66% of Americans interacting with their local court in some form each year[1].

Yet engaging with the local court system is sometimes a daunting process. Despite 75% of court users reporting that they were satisfied with the overall outcome of their court engagement, only 33% were satisfied with the resolution process – citing confusion, inconsistencies, and overall process hardship as the main drivers for dissatisfaction[1].

These facts beg the ultimate question: if millions of residents go to their local court for assistance in dealing with legal disputes or for debt, housing, child custody, or divorce assistance, how can we make the courts work better for them? Some courts have answered this question by employing innovative approaches that can make a big difference in driving stronger community-court interactions and experience in a low budget environment. And, what’s more, these community-minded strategies can be deployed in other local government agencies. 

Promising community-centered strategies in local courts

To design the court of the future that is responsive to all constituent needs, courts must directly hear from constituents to understand their experiences, frustrations, and ideas. Feedback and satisfaction surveys are a great tool to measure and address those experiences while enlisting community involvement in the improvement of the court experience.

Feedback survey design and implementation can be executed excellently by local courts with minimal budget. Below are key considerations which are core to designing and implementing court feedback mechanisms well:

  • Design questions that are simple and easy to access. Survey instructions and questions should be written in plain English and at an accessible reading level to promote participation. Surveys should also be translated to the top-spoken languages in the community. It is important to clearly communicate the purpose of the survey, that it is confidential, and that the feedback recorded will not affect the outcome of any case.
  • Design questions that address social determinants of justice. Much like the social determinants of health, the conditions in which people are born, grow, live and work relate to their court experience and outcomes. Designing the court of the future requires recognition that the public consists of individuals with different needs.
  • Share the survey in digital and paper formats. Surveys should be as easy to access and complete as possible to maximize participation. Surveys can be accessed on cell phones enabled by QR codes placed across the courthouse, allowing visitors to easily record their satisfaction in the web browser of their phones at their own time and convenience. Hard copies should also be available for visitors that prefer pen and paper.
  • Share the survey at all high-traffic touchpoints. Survey access should be available, whether digitally or on paper, at all high-traffic areas, which can include the courthouse entrance, outside courtrooms, bathrooms, the help desk, parking structures, and on any material that visitors leave the courthouse with (e.g., fine payment receipt).
  • Earn buy-in from court stakeholders. Visitors of the courthouse engage with a host of government services to fulfill their needs, such as the Clerk of Courts, Probation Department, and Family Services. Having the support of such administrators is essential to creating a survey that is encompassing of the residents’ court experience and will encourage buy-in of other stakeholders.
  • Organize and analyze the data transparently. Collecting visitor feedback is merely the first step – courts must build trust with the community by transparently reviewing survey responses and deciding what changes might be made to address pain points. Courts can begin doing this by setting up an ongoing process for which survey results are tracked, monitored, and shared. 

Many courts across the U.S. have successfully implemented feedback surveys to enhance their court processes. Changes stemming from community feedback include clear court signage for navigation, a revamp of instructions and procedures for filing orders of protection that is more constituent-friendly, and staff training on best practices for delivering and communicating court services[2].

The court of the future will be centered around the resident experience and needs. There are a host of operational innovations that can create “quick wins” for courts and their constituents as far as improved experience, along with more frontier innovations that can radically transform the user experience in a low budget environment.

  • Visual handout guide to following legal processes
    • Constituents often express confusion around what to expect on the day of a trial, or how to follow legal procedures such as obtaining an Order of Protection or requesting tenant assistance services administered at various local courts.
    • Many courthouse procedures and FAQs can be conveyed in single-page handouts that visually provide step-by-step guidance for processes, such as opening a child custody case or navigating the day of a hearing. These handouts can be tailored to specific processes and be made available at various courthouse touch points (e.g., help desk, waiting areas) and online. Scaled versions of this can include How-To videos available online conducted by courthouse staff that walk residents through various court processes.
  • Clear courthouse navigation for improved wayfinding
    • Courthouses can feel confusing and intimidating, especially for those that arrive at court for the first time. Clear and ample court signage directing residents towards common court destinations, along with pictograms and uniform color palettes that are associated with specific courthouse services, have contributed to overwhelmingly positive results in user access and experience where implemented[3].
  • Court schedule transparency
    • The daily courthouse docket schedule is often opaque; visitors are expected to arrive at the courthouse upon opening and wait in the area until their name is called, with little to no view in how the day’s schedule is progressing. This can create inconveniences around time off work and finding childcare.
    • Progress tracking tools can go a long way in alleviating such inconveniences by providing real-time updates on estimated hearing or service appointment time, allowing constituents to plan to be at the courthouse only for the window that is required. Such tools can be visualized digitally in waiting rooms or connected to alerts & reminders that residents receive as part of any courthouse communications.
  • Pre-trial notification system
    • Constituents often fail to show to court due to confusion around knowing where and when to show, which can lead to further justice involvement.
    • Digital court reminders are a direct way to increase court-community interaction in a low-touch, yet effective manner. Notification system software such as UpTrust and RemindMe allow local court systems to send reminder texts days before a hearing and enable courts to include information on how to prepare and navigate their day at court or access human services (e.g., social workers, court liaisons).

Improving community-court interaction begins with driving court outreach in the community. Constituents often have little connection with judges and court administrators beyond court hearings and services, contributing to an archaic view of the courthouse in the community. Yet there are various ways to reimagine how the court can engage with its community to break down conceived notions of the court and help foster trust among its users:

  • Judicial listening tours throughout the community for court staff to court procedures and outcomes with specific interest groups and members of the community, and bring awareness to new procedures (e.g., new expungement laws)
  • Court-in-the-Neighborhood model that brings the court to the community. Low-level criminal offenses, family and housing disputes, and juvenile delinquency cases are heard at community centers such as churches and schools and incorporate local voices such as residents and community groups in the administration of justice. Such courts are designed to respond to the concerns of individual communities – taking into consideration particular economic and social landscapes – and often involve community service and engagement with local community programs as part of dispute resolution[4].
Community-focused approaches can work for other agencies, too

The above innovations are just a small sample of the initiatives that local courts can take to begin redesigning court processes to be more constituent friendly. More importantly, these innovations can be scaled to other local government agency contexts, such as the DMV, the post office, and public works – creating an ecosystem of local services that are more constituent-oriented. This local service orientation helps to promote and foster community trust and satisfaction, a fundamental pillar to a well-functioning and well-serving government.

[1] https://worldjusticeproject.org/our-work/research-and-data/global-insights-access-justice-2019

[2] https://www.ojp.gov/pdffiles1/bja/197109.pdf

[3] https://www.ojp.gov/ncjrs/virtual-library/abstracts/user-friendly-justice-making-courts-more-accessible-easier

[4] https://www.ojp.gov/pdffiles1/bja/183452.pdf

Day in the Life: Jeff Huang, 17A Lead and Chief Plant Officer

Posted on by admin

Our incredible team at 17A is powered by a range of perspectives and experiences. Through our Day in the Life series we are giving you the opportunity to get to know our core team members. Read below to learn more about our resident Chief Plant Officer / Program Lead, Jeff Huang, and what projects he’s been up to!

What does a typical workday look like for you?

  • My workday depends on the projects I’m on! Sometimes it’s full of meetings, and other times, it’s a mix of self-directed research and data analysis. I’m not a big morning person, so I usually save heavy reading for later in the day when I can.

What’s a meaningful project you’ve worked on during your time here?

  • My favorite project has been working with a regional Medicaid payer better support justice-involved members. I joined 17a to work on ways to better provide / direct social services for a more just and humane world, and this project has been exactly that.

What are your responsibilities as Chief Plant Officer?

  • Taking care of all the office plants! Except right now, I’m on crutches and haven’t been able to make it into the office as much as I would like. So my job right now is making sure our team is taking care of the office plants while I recover.

What prepared you to take on the Chief Plant Officer role?

  • My mom has always loved plants and all things nature. I never used to understand the hype around plants, but I recently got into the process of tending to them and watching them grow, once I had my own. Because of that, my mom and I are always talking plant care; she’s constantly sharing stuff with me and keeping me on my game.

Describe 17A’s culture in 3 words.

  • Open-minded, curious, caring

What is your favorite 17A team tradition?

  • Our in-person retreats!

What do you do for fun outside of work?

  • In my free time, I’m probably doing something basketball- or music-related; right now I’m watching a ton of the NBA playoffs and am also loving being a nerd about samples and music history / influences of the music I love.

Promising models for investing in and scaling equitable housing solutions

Posted on by admin
Why focus on housing?

On any given day in the US, approximately 580,000 people experience homelessness with about 110,000 people of those experiencing chronic homelessness (defined as experiencing homelessness for more than one year or four homelessness events). This issue particularly affects the Black and Latinx communities, with Black people representing 39% of people experiencing homelessness and more than 50% of homeless families with children, despite only representing 13% of the US population. And, homelessness tells only part of the story – on average, nearly one in three renters experience housing insecurity (defined as a household spending spending more than 30% of its income on rent).[1] Multiple factors  contribute to the affordable housing crisis, including shortages of units available and decreasing affordability; for example, estimates of housing availability show that there are only 24 units available for every 100 extremely low-income renters (households making below 30% of the area median income), and on the affordability front one in four renters overall pay at least 50% of their income on housing.

Beyond supply and financial issues, additional barriers push housing security further out of reach for many. For example, with those who are justice-involved, criminal records often prevent renters from passing background checks in public and private housing markets.[2] And more broadly, studies have shown that landlords in private markets have surreptitiously been biased against those using Section 8 vouchers, despite the provisions of the Fair Housing Act.[3]

Big ideas for investing and scaling

Beyond needed increases in federal investments (e.g., increases in housing development and rental assistance[5]), there are two scalable models of private and local efforts working to combat barriers to housing for those experiencing homelessness and housing insecurity.

Models in the private rental market have increased housing supply by working as middlemen between landlords and those seeking rapid rehousing or facing temporary homelessness. For example, HousingFirst Lab dually works with landlords and tenants and locates low-income renters wh need housing and guarantees these tenants’ rents in the case of missed payments.

Beyond providing novel solutions for landlords (e.g., rent guarantees, immediately filling vacancies), this model also actively works to eliminate barriers renters may face throughout the housing process (e.g., eliminating biases in application processes, mediation of tenant-landlord issues, providing rental assistance), crucial for equity in housing solutions.

Additionally, smaller municipalities have piloted research-backed Housing First programs for those who are chronically homelessness. These pilots often operate under the assumption that city resources (e.g., corrections, emergency room visits) can be spent on housing individuals that will prevent the need for future downstream costs.

For example, in Santa Clara’s “Welcome Home” pilot, the city identified and housed the “frequent fliers” of the emergency room and local jail systems with the highest need for services, while providing optional housing and healthcare services. By the end of the evaluation period, 86% of people remained housed, with a significant reduction in psychiatric emergency department usage (with other outcomes harder to measure due to covariates). A similar program in Denver (Denver Supportive Housing Social Impact Bond) successfully housed 77% of participants in stable housing after three years, with ~40% reduction in arrests, ~30% reduction in jail stays, and ~40% reduction in costly emergency department visits—which offset roughly 3/4ths of the original investment from the City of Denver.

What to do next

These pilots have demonstrated the impact of Housing First models; given the necessary investment capital, these social investments lead to decreases in people experiencing homelessness, reducing medical emergencies, and reducing avoidable justice-involvement, particularly for those who typically face the most issues in the rental markets. Though “return-on-investment” is not immediately recouped, these Housing First models are becoming more popular options for funders seeking to support social investments, and who can invest over longer time horizons.

[1] www.cepr.net/report/housing-insecurity-by-race-and-place-during-the-pandemic/

[2] https://endhomelessness.org/homelessness-in-america/what-causes-homelessness/inequality/

[3] https://www.americanprogress.org/article/preventing-removing-barriers-housing-security-people-criminal-convictions/

[4] https://www.nytimes.com/2021/03/15/nyregion/real-estate-lawsuit-section-8-discrimination.html

[5] https://www.nber.org/papers/w29516

[6] https://www.urban.org/urban-wire/one-four-americas-housing-assistance-lottery

States’ roles in improving household health for mothers and babies

Posted on by admin
American moms face grim reality

The statistics on United States (US) maternal health outcomes are grave, and the data reveals stark racial health disparities. As a country, the US is one of the worst wealthy nations in the world in terms of maternal morbidity.[1] Furthermore, poor maternal health outcomes disproportionately impact Black and Indigenous mothers, who are two to three times more likely than white mothers to experience maternal morbidity.[2]

Medicaid is a critical lever for improving these maternal health outcomes – particularly for diverse mothers (see Figure 1) – because of the large number of US births covered by Medicaid.

Figure 1: Kaiser Family Foundation

*Percent of births for each is roughly 2/3rds, per KFF calculations

Which state levers best support Medicaid moms and babies?

The data on US maternal health outcomes has established a clarion call for several states, and these states have pursued evidence-based strategies to improve outcomes.

First, these states have extended Medicaid postpartum coverage to one year, which enables more mothers to receive services, and at critical times. An additional 720,000 mothers (i.e., an approximately 45% increase) would be covered if all remaining states expanded postpartum coverage to one year, the period during which 50% of pregnancy-related deaths occur.[3] This extension would be especially critical for mothers with existing gaps in outcomes (e.g., postpartum depression).[4]

Secondly, these states cover additional benefits that can improve outcomes both by delivering critical care in new ways as well as providing supplementary services to improve current care delivery.  Benefits that create new care models (e.g., doula supports) can more holistically address a myriad of barriers that Medicaid mothers face, including coordination with physicians for appropriate care, among others. Studies have shown doula-supported births reduce C-Sections and increase positive birth experiences.[5] In addition, benefits like covered home visits have been shown to benefit both mother and child via decreased infant emergency room visits and increased breastfeeding rates.[6] Lastly, benefits that augment existing pathways can also target certain access gaps and specific needs outside of clinical settings (e.g., lactation consults for breastfeeding complications).[7]

Which States Are Pulling Promising Levers?

Leading states are taking a holistic view on supporting Medicaid moms and babies and are pulling the promising levers to promote better outcomes. The map and rankings below track current efforts across 50 states (and the District of Columbia) on their use of these levers.

Grading current state action

Figure 2: 17A, Usage of Medicaid maternal health levers
Ideas for where to go next

For covered benefit-related levers, holistic delivery model changes (e.g., home visits, doula supports) are the most promising interventions to improve maternal health disparities and promote better outcomes for Medicaid babies from birth. Additional ideas – broken out by providers, managed care organizations (MCOs), and agencies – are presented below.

  1. Payment model: Find ways to take on more and higher-risk agreements to pay for additional services

  2. Care model: Pilot high-touch, proactive care models (e.g., home visiting, doula supports) with focus on most vulnerable populations; telehealth (clinical and nonclinical) and home visits can be used break down barriers. Data-sharing and risk agreements can be used to get reimbursement; state Medicaid agencies may also reimburse for services provided to mothers with SUD or high-risk pregnancies

  1. Care delivery: Use data to pilot high-touch care delivery with highest risk populations to bring costs down; piece together disparate health care delivery (e.g., traditional ob-gyn follow-ups, lactation consults, doula supports)

    • Pay for levers that work and lobby state for additional reimbursements, especially focused on breaking access barriers; find ways to incorporate whole-family health interventions to bring down costs

  2. Data: Improve data collection (e.g., demographics, clinical goals), for internal tracking and to share with providers to improve outcomes

  1. Coverage and benefits: Increase coverage time periods and reimbursed levers

  2. Payment reform: Additional payment reforms (e.g., value-based care, payment disincentives for C-Sections, etc.)

  3. Data: Support data improvements to empower MCOs, providers to track outcomes

For more information regarding the methodology used you can download here: Methodology – State Medicaid Maternal Health LeversDownload

[1] https://www.commonwealthfund.org/publications/issue-brief-report/2020/dec/maternal-mortality-united-states-primer

[2] https://www.commonwealthfund.org/publications/issue-briefs/2021/oct/severe-maternal-morbidity-united-states-primer

[3] https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries

[4] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5714a1.htm

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/

[6] https://ajph.aphapublications.org/doi/10.2105/AJPH.2013.301361; https://pubmed.ncbi.nlm.nih.gov/24187116/; https://pubmed.ncbi.nlm.nih.gov/30399451/

[7] https://www.cdc.gov/breastfeeding/about-breastfeeding/why-it-matters.html