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[Applause] well as Jen said this is a my fourth summit here and I love coming to summit because it's where we get to hear great stories get to hear about the work that could for America's doing a refresh on that what you all are doing in the brigades and for me what's most inspiring what what you the city and federal and state workers are doing to help better deliver services to your residents on the commercial side of the house we're seeing all this great disruption and innovation that's coming from technology however on on the in government services we're really not seeing that that level of disruption and what that means is we're seeing roadblocks in the way that for people who administers these government service programs we're seeing siloed data and really that trickles down it impacts the residents who need that most in our city's program what we're trying to do is empower local governments to better understand their citizens better deliver those services and really most importantly work to make sure that the benefits of this technology all this innovation is being more balanced and better distributed across the population we're proud to partner with Code for America as they champion the voice of civil servants and bring technology to the forefront and jessica Kahn's a prime example of that just as a senior expert at McKinsey and company in Washington DC office she specializes in state medicaid and social service programs public sector data to end technology she holds an mph from Julian University and bas in government and French language from the University of Texas at Austin previously she held a series of positions directing state Medicaid systems at the Centers for Medicare Centers for Medicare and Medicaid Services in the Obama administration which is where she first became associated with Code for America and their work on the social safety net she's continued to be at her deep involvement CFA his work as she moved to McKinsey she's a great champion of user and the user in all her work and a strong ally in the cause please join me in welcoming us Akhanda stage good morning so it was one said that the moral test of government is how that government treats those at the dawn of life the children those in the twilight of life the elderly and those who are in the shadows of life the needy the sick and the handicapped that's a quote from Hubert Humphrey it's a little long for a tattoo but trust me when I say that it is etched in my soul after 25 years of working for and now with government there are three things I want to talk about today that can positively disrupt the social safety net programs first the model that most of these programs follow is what I call an affirmed eligibility model that means the burden is on the individual the potentially eligible individual and the eligibility workforce to provide and to process information to make that eligibility determination even if it's already known to the system this results in gaps between eligible and enrolled potential inaccuracies and delays and accessing services so an alternative would be to consider proactive benefit determination not unlike Medicare when the Social Security Administration recognizes that you're of age you are automatically eligible for Medicare not unlike the FCC's lifeline program where if it's confirmed that you are enrolled in snap or Medicaid you automatically can be eligible for their discounted phones and Wi-Fi so that you can call the doctor to make appointments call for a job interview or scheduled childcare not unlike a pilot program under the former administration that the US Department of Agriculture in several states did whereby if your family was enrolled in Medicaid your children were pre-qualified as eligible for free and reduced lunch at school if they opted in this model entails predictive analytics you know the kind that tells you since you just streamed the shape of water these are the other kinds of movies that you should watch or everybody else who bought what you bought on a certain ubiquitous site also bought all of these other things but in this case I'm talking about it around Sentinel events I just lost my job I have a catastrophic medical illness I am newly homeless and an expanded reliance on electronically verifiable data around those Sentinel events so I challenge us to run the models to do the diagnostics and to show that the impact of proactive benefit determination is real just a little caveat write this down the IT is going to be the easy part policy is the barrier there but still do it okay number two data sharing between programs is unnecessarily painful even between sibling agencies it's the me to era I don't say sister agencies anymore even between sibling agencies even between programs and local jurisdictions imagine the impact if they were guiding principles for data management between safety net programs such as semantic interoperability is a must you with your new program and your lovely new services you must check how existing services for your same target population define their terms I beg you to reuse the way they do identity management and identifiers instead of creating your own new way of identifying who the people are while programs may be related and how they align to help families and individuals in crisis to be honest they are generally conceived in silos and then later on they decide to cohabitate this means that they have different renewal and recertification timelines they define households and income differently they use data and IT and their business process is completely different guiding principles like the CIOs and the chief data officers in the room it is your job to set the guardrails the rules of the road why should local communities and counties and cities have to spend endless hours on on environmental scans and drowning lawyer fees figuring out what are the data privacy rules that are largely state and federally defined what should a pis be and what should be the transaction standards this is that thin layer across the top that could be defined at that level so that the innovation can happen below guiding principles like establish lean data governance as step number one this never happens but I'm glad I'm still optimistic after all this time who figures so not after you've mapped it all out you built your data warehouse and you built your system and you figured it all out and then you figure out how you're all going to get along no no no no no so you need to figure out who owns the data where is it coming from what's the source of truth when are you going to share it who are the stewards first so why doesn't this happen because people hate conflict it's pure conflict avoidance purely many a project has stalled or fizzled because of data Government's I've seen government agencies create a whole new data infrastructure just to avoid having the conversation about who gets to use which data when so let's put on our adult pants and let's face it down first because this is actually where civic tip can help we can see where our government partners are reinventing the wheel we can see where they're gonna spin down a road that is going to end badly we can help them prioritize and assign the roles where the policy levers are there to be pulled most effectively three user centered design and user centered business processes are often viewed as the counterpoint to compliant design so why like why is it so hard for government to do user centered design when obviously it's native an IT everywhere else because oversight emphasizes compliance the federal government is not going to come audit a state's the social safety net program and say you had ten clicks instead of three on your website it doesn't happen do you know what they audit for accurate and timely determinations compliance with federal rules adherence with federal standards so while compliance still emphasized is emphasized on the federal side and often on the state side with local programs user centered design becomes a nice-to-have not that anybody here will actually admit that everybody here and I'm only nine months fresh out of government I would have told you I'd fall on my sword for user centered design but if you look at the money people if you look at the budgets compliance design is winning so what we need to do is the community is prove the case that user centered design and business processes are more efficient than compliant design alone it is time to shut down the nice to have myth and to bring the benchmarks and make it quantifiable and not warm and fuzzy because warm and fuzzy in front of your legislature doesn't help you as much as saying this actually is going to save me money so bring the benchmarks and let's do it right so proactive benefit determinations guiding principles for data management and social safety net programs and proving that user centered design brings more value than compliance alone those are my three so next we're going to hear some examples locally pretty exciting ways that the social safety net is being reimagined for delivery driven government we have Laura Ramos from get Code for America who's going to share how they're working with pilot states on integrated benefits we have Dave Guarino also from Code for America and Albert Garcia from San Diego's Health and Human Services they're going to talk about improving access to food and then Ashley Myers from digital services from the City and County of San Francisco and Maria Benjamin from the San Francisco mayor's office on Housing and Community Development will talk about using data to address homelessness and housing instability please join me in welcoming them and thank you for listening [Applause] [Music] hi good morning I am here today to talk about how Code for America along with Nava Sevilla and the Center on Budget and Policy Priorities are partnering with States to transform how safety net benefits are delivered for people experiencing food instability inadequate access to health care or difficulty covering their utility bills programs like Snap Medicaid WIC LIHEAP and TANF can make all the difference in getting by we've been working with Michigan Colorado and Alaska to understand their top pain points and identify opportunities to build technology that will measurably improve how people apply enroll and maintain their benefits at the same time we've met with dozens of Health and Human Services leaders across Louisiana Vermont Maryland New Mexico Arizona and New Jersey and also sat alongside their frontline workers to understand the challenges they face in the hopes for more modern and responsive business processes and technologies for people to successfully enroll in safety net programs they must jump through many hoops to apply that's if they even know the programs that are available to them the status quo of benefits integration is a stitched together process that takes more time and has more requirements for clients making them less successful and obtaining the help that they need now states know there's an opportunity to do better with the design and technology they've deployed online applications and self-service portals to ease access to benefits now this is a good start but there's still much room for improvement in some cases people will find their state's online application portals unavailable during nights and weekends sometimes that's the only time people are able to sit down and complete an application or update their case and there are countless states whose self-service portals don't work well on mobile devices the only device some clients have to access the internet in the middle of this are the frontline workers who absorbed in their workload the results of policy changes complicated business processes poor technology decisions and confused clients they're difficult jobs become even more pressing and urgent when they live and work among the people walking into their offices from for benefits now in case you haven't picked up on it the delivery of safety net benefits is complex there's so many pieces to that comprise benefits delivery there's again technology processes even physical spaces like field offices now we're focused on one very specific area how people apply and enroll in benefits and we put the user all of the users at the center of this work now you may have seen news headlines about states like Illinois and Rhode Island struggling to keep up with their caseloads or clients being negatively impacted by the implementation of a new eligibility enrollment system many states have been hampered by technology they procured not working as expected now the reasons for these failures aren't straightforward but the important thing to take away is the amount of rework and burden added to an already strained system now to truly integrate applications and enrollment processes across programs you have to start with the most critical part of an application how many people are in your household different programs treat the same household in many different ways it's not just a simple calculation about who lives together in offices across this country there's still a ton of paper floating around and this paper often represents not just application forms but the tens of thousands of unique pieces of verification data it's the critical proof that clients must provide to demonstrate their eligibility for benefits can you imagine what it's like in the dead of an Alaskan winter when it can take two weeks for a plane to reach remote areas to retrieve and deliver paper applications and documents paper might not crash but it has to arrive promptly where you need it that's a critical moment for a person being able to have access to benefits now there are lots of paper floating like I said there's paper floating around but also states saw a ton of money putting out paper notices and it can take a week for that notice to reach a client's mailbox you can take another wee for those responses to go back to the state and that's if the client can even decipher what is on those notices what clients can't figure out what those notices mean and what they say they end up calling or going into an office for clarification every extra piece of paper that goes out is another seven days added to knowing whether you're going to get those critical benefits or not now after people get on benefits then they have to work to maintain them and we found that some of the most difficult changes for people to report are also the ones that happen most frequently things like job or income changes and clients expect that any change that they submit whether it's something simple like a new phone number or something more significant like a new address will be immediately processed now I think that's pretty reasonable like that's what we think about with most of the tools that we use on a daily basis things like paying your friend back or adding a new address to it you know you're next Amazon order instead a clients reported change isn't real time it actually kicks off a longer assembly line of steps where information goes into a queue and has to be investigated and verified and depending on the case on your state it can actually be easier for your case to be processed more quickly if you can walk into an office as opposed to going online we've seen time and time again that when a state's self-service portal is overly complex and cumbersome people give up they lose confidence and they head straight to that office for example clients have ten days to report a change to their case like a new job or a new family member but in Missouri for example it can take ten business days just to get the pin number that you need to finish the online applicator like registration that's gonna then let you apply and or you know put those changes in it should not be simpler to go into the office than apply online yeah who wants to do that now with all of these examples I think you could get the wrong picture and think that states aren't being creative or innovative and that's that's totally not true Vermont Alaska Colorado Michigan they're all trying to approaches to service delivery and using the tools they have at their disposal in Michigan some offices are experimenting with a tool that lets clients text docum nts into a monitored email box our Colorado State team has joined us in Colorado and prototyping sessions to learn a new way of working and Alaska and Vermont have collaborated with 18f to incorporate agile procurement approaches into their eligibility and enrollment initiatives now as we talk about a modern safety net or reinventing the one that we have I'm not talking about like whiz-bang technology or throwing automation and to everything that you could possibly do every state is also in the process of modernizing their eligibility and enrollment technologies but that's not enough a transform safety net is not just the modernization of systems or technology it requires the modernization of service delivery now we're already embedding the principles of a modern human centered safety net into the state pilots currently underway in Michigan we designed a snap and Medicaid application flow that proved that you can complete an online application in under 10 minutes the learnings from this pilot have been so compelling that Michigan's Department of Health and Human Services and Deloitte have worked together to incorporate some of those learnings into their recent relaunch of their client portal now we've turned our sights into building into a building away for clients and caseworkers to interact with each other using SMS to send and confirm receipt of verification documents in a Colorado we hope to evolve the change reporting process to guide a client to answer only the questions relevant to their life change and to provide more context to the caseworker has to process it in Alaska we're just getting started but we're excited to design for Alaskans at the far reaches of the state who can't reach a field office and struggle to maintain access to the Internet now there are many approaches that could be taken to reimagine the delivery of safety net benefits at Code for America we're taking a Hume centered delivery driven approach you can consider although you must consider all of the users to be important clients case workers and leaders you can't build for one you must build for all now as I mentioned at the beginning we're not doing this alone Code for America Nava Sevilla and CB pp are working are working on long side and with our state partners we selected them for two reasons one we think we found something that we could make a difference together on and to their willingness to try something new Monica Tracey casts Seamus Patrick Wendy herb Nina Blake Meghan sandy and John that are all here today thank you for being great partners and being open to trying a more human centered and agile approach to transforming how your states deliver benefits by early next year we will have delivered products in five states will be able to show the benefit system that this country deserves thank you very much [Applause] hello I'm dig worry no I'm the director of the get CalFresh project at Code for America and we're going to talk about technology but I hope what you take away from this is not really about technology and I'm Albert Garcia in the county of San Diego's CalFresh program manager so to begin with I want to tell you something to happen in the middle of 2012 I was a frontline supervisor I was also the one designated to get complaints and and get customers refer to me when they needed something in on an expedited basis and I remember one time when a mother came to me she was she was in tears she was hyperventilating she had a lot of documents with her and she met with me and she told me she began to apologize and in fact she began to apologize because she knew that that she had a renewal for her CalFresh case and her medical case but she was not able to provide these documents to us in time and I looked at the case and it wasn't late to reestablish your benefits and she thought she was gonna have to go through this arduous process but in this particular instance it was really satisfying to know that I could fix it for her that was in my power and I could do it right there and then so by the time she walked out she had her healthcare benefits again and and I try to listen to her and kind of calm her down because she she was I could tell she was going through something very severe in her life I didn't know exactly what until about six months later when we finally got a letter that she took the time to pend to our office manager where she told us that that day she truly felt that she was heard this he received compassionate service and that we have saved her son's life because he was hospitalized and the intensive care and she found out that her health coverage has lapsed but at the same time I went back to my office and I thought to myself why and how did this happen this is a family that obviously needed their CalFresh and medical benefits had everything they needed at that spot and knew exactly what they needed to provide to keep those services but somehow was not able to easily connect with us and she had to come in actually take time out of her day in this crisis to give us what she needed we knew that we could do better since 2012 we actually underwent a transformation and the way we handle documents and we provide services and not and not least of anything we began to embrace partnerships such as the one that we have with Dave and his team and Code for America yeah so the last four years now we've been working on get CalFresh org which is like a lot of things you've heard about it's just what we think of good modern digital services and the point of it is to make it so that no one faces any barrier between being eligible for the CalFresh or food stamp program in California and then getting involved as Albert mentioned one of the things that is difficult about the process is submitting documents so we make it easy we say okay you can just take pictures of documents on your phone everybody's walking around with a high-resolution scanner in their pocket and we should just make it so that when you take a picture it goes straight to your county and they have it right there and then that stuff is table stakes that should be what we're all doing period but what we also find is when people are applying through get CalFresh not everybody actually uploads documents so that's a problem because we've looked at and we've looked at the outcomes we find people who don't have a much lower likelihood of getting approved so what do we do well we ask them so if they say no I don't have documents to submit right now or I can't we just say why not and ask a simple question and we get some themes like well pretty much I don't have a smartphone or scanner with me or I don't have the documents with me so the message is not now so what we do is now we send a text message the next day if you didn't submit documents remember your application is not done until you do that click here you can do it right here some people say well I just don't know what to submit if you say ID or income so we added guidance we told people for their situation specifically what documents they need to submit and that change in particular led to a 29% increase in the average number of documents made with applications and that's great and some of the information that Dave and his team is able to provide to us is really valuable because it gives us an additional window that we can incorporate into the feedback that we're already collecting from our customers via surveys and some other means but this but this is different it really does provide us something that is different and it allows us to make the changes that we need to make to deliver better services and so that's why this is about the partnership I mean we bring this data back to the county but some of these things like the ones I'm showing here people just don't have the documents or they're homeless and don't have any documents and those are actually not really things we can productize away so they're really policy questions and then the question gets to well who controls CalFresh policy which is probably a very simple question well it's complicated because we have the feds who make the rules they they make the regulations they give that to the states states have options waivers and different means where they can kind of tailor their program to fit the population in their states and in California we the counties 58 of us administer the program and and and we try to do our best to you know follow what the regulation states that we need to do but make it effective efficient and to deliver it and you know in an efficient way so that's the thing when we talk about what the person who's actually trying to get help has to go through they're seeing every level they're seeing a client experience which comes from law and statute at the federal level policy and regulations promulgated by the feds or by the state operations and business process decisions by the counties and it's a composite it's not one thing it's not one unitary actor with control here it's all of those things together one example of this I'll show is a great slide all-county letter this is what the state issues when they're giving guidance to the counties on how to implement something in CalFresh yeah shout out all the county letters so this is an example of where this is them saying okay on demand interviews if you as a county wanted you on demand interviews it seems like a really good idea what you have to do and it says here if you do this it must be countywide and it must be your process by default there's a lot of good reasons why you might want to do this you want to ensure equitable treatment of everybody across the county but the dilemma here is you really have limited options as a county to get feedback or do experiment or try things and it's really high risk because it's kind of all or nothing you either do on a man or you don't so relatively few counties have actually done this and I think what I'm trying to say here is we could do policy in the same way that we do this technology stuff we're talking about what if instead it was saying you should test different implementations and you should report on the two metrics that you're actually looking for which are interview success and operations impacts I don't think that is outside the realm possibility so I mean what you're hearing over and over from people here is the best technologies start small take risk experiment to learn and measure results but but the best policies also start small take risks experiment to learn and we get to measure results yeah you know it if you are at the frontline administering service the best operations start small take risk experiment to learn and measure results because while you're here and you hear us talk about text messaging or really nice user friendly web forms it's not really about those solutions it's about better feedback loops on the problems that you're trying to solve and when you hear this phrase that's what we're talking about when we say delivery driven government it's that constant improvement and constant better understanding of the problems you're trying to solve it really is we have to constantly go through our loop of learning mastering improving learning measuring and improving it never stops when the goal is continuous improvement the work will never be done but it's worth it and through partnerships like the one that we have with Dave & Co for America we know that we can collaborate to really truly effectively deliver services to those who need it most thank you [Applause] boom we're in front of this light yeah yeah here we go hi my name is Ashley Myers I'm a product manager with the San Francisco digital services team and I'm Maria Benjamin from the mayor's office of Housing and Community Development in the beautiful City and County of San Francisco there's a lot of talk right now about how we need to let policy be informed by what works best for implementation and today we're going to tell you a story about what it can look like on a local level when you actually start letting delivery drive policy we built a new digital service to help San Franciscans apply for affordable housing but more importantly today we're going to tell you about one team that totally changed their approach to policy itself and how that continues to grow there isn't enough affordable housing in San Francisco but or across the region our late mayor lee had a goal a housing goal of creating 30,000 new units throughout the city ten thousand of those affordable to low and moderate income households world the good news is were way past meeting that goal the but the bad news is that because of the market there also are is an increase in gentrification in our neighborhoods and evictions throughout the city so the mayor and Board of Supervisors have come up with policies that give housing preferences to those people that are most vulnerable to of losing their affordable housing so in 2015 we when we started this project we needed to implement those changes we needed to get people into those 10,000 new units and we needed to update how we prioritize placement of people into them and we also wanted to redesign the experience of applying for affordable housing which we knew was troubled and Maria is going to tell you about so we built a new digital service and we also started taking a flexible approach to policy looking at what we were learning about what was working in delivery what wasn't and making changes in the policies to fix those issues and then seeing how it worked and making more changes it didn't work before people this line is like the last day to turn in an application for affordable housing lines across around the block each developer and each development had a different application a different process for accepting applications and and passing out applications and required a boatload of documents upfront before a lottery so you're applying with 4,000 other people but you might not even get called but still you have to submit all of your bank statements and pay stubs and all of the information that proves that you qualify before the lottery even happens and then the lottery itself this is no joke it was Circus tickets where you know keep this this part for yourself and we keep that part what happened was people it was chaotic you can imagine having that little being desperate for affordable housing and having to collect these little things and figure out where your ticket which development that you applied for and and losing them people lost their lottery tickets all the time then you don't even know what your status is not only did the applicants lose the ticket but what about the developers that were supposed to be collecting them were they keeping good track of all those lottery tickets so we made it a lot better this is one screenshot of the product we built all the listings are in one place you can see what you can apply for there's one common standardized shorter application and you get your lottery number instantly as soon as you submit it and via email and then we do an instant electronic lottery so no more like pulling tickets out of a mesh cage on a stage and we're getting really good feedback this is two quotes from actual housing applicants talking about how it's really like little things are the big things like not having a printer not having to buy envelopes or buy stamps the numbers really reflect this we've had over 106,000 applications submitted online this is a Tuesday so it's probably hundred and seven now 87% digital take up that means 87% of people choose the digital option and I appreciate the applause but actually that was pretty easy the very first pilot was 86% so like the hunger for this was so big that we didn't even really have to push people to digital and then the last one it just shows overall demand and traffic 1.5 million sessions on our site since we went live in February of 2016 and I want to give a shout out to some people who made this possible berry rotor who's in the audience today a critical member of our team if we could have three people up here he'd be here Michael Solomon who was not able to be here and then xyg our design and development partner with whom we could not have done this it took more than this is we love the system don't get me wrong it's the best system in the world but what I'm most proud about is the way that we took the system and used it as a catalyst for changing some of the policies and procedures that had been in place for a long time we we used it to look back on what we were doing and to evaluate it and do constant evaluation of all of the policies and procedures in place so the whole portable housing program is governed by this PDF called the program policies and procedures manual and it's a dense PDF which we edited a lot and we changed the processes that govern Lisa application review the lottery we made that standardized shorter application and we changed a lot of the public labels and titles that we use to describe things we don't try to tell you all of them so we're gonna discuss two of those changes today documentation that's the first thing we changed less documentation people don't need to submit all of those bank statements but to get into a lottery so we were able to reduce that and that also not only reduced the workload for the applicants but also the developers that are collecting all that paper and not to mention staff city staff government staff who had to process all of that paper needlessly so before we made these changes people had to self determine if they were eligible for a particular building or apartment based on their income and household size and then also if they could get those special priority benefits we described for people who live or work in San Francisco or who live in certain neighborhoods and it just wasn't working we learned in our user interviews that leasing agents or property managers would sometimes have to reviewed up to ten or more applications to find someone who fit and could actually take the unit and if you think about those other nine families like they put in all this time and effort they got their hopes up they maybe sat on the wait list patiently for months or longer and then at the very last step they're told that this isn't a fit when they could have been spending their energy applying to other things and the priority programs were even worse like we have one program that quite tries to fight displacement by and gentrification by giving priority to people who live in the neighborhood where the housing has is being built and only 36 percent of people were claiming that benefit that the law intended that for them to have so now we screen it for them and we we can do that the technology makes them possible and we can decide if there we can tell them if they're eligible or for the benefit or the house we had to get buy-in of course to make all these changes buy-in from the lawyers that's the biggest hurdle one of them littles to make sure we're not breaking any laws our commissions and of course our other funding partners that provide the affordable housing in the city oh boy culture change this probably was the biggest hurdle government policies and procedures government staff we created an entire culture change we were able to shift the idea that we were trying to make things easier for ourselves in government it's easier for us to ask for all this documentation up front and shift the culture to making it easier for the people we're trying to serve isn't that what we're supposed to be doing yeah and then there's this idea that people can't tell the difference between policy and law not people but city staff sometimes don't know the difference yes and over time you have all of these policies that are put on top of the laws and you can't tell over over the years which ones are we can change and which ones we can't change so we have to peel back and figure out which our laws and which ones our policies and procedures one of the things I love that Maria says is that it actually increases the integrity of the program if you peel back those layers and look at the original intent of the law so this culture changed kind of snowballed as people started realizing that their fears were unfounded that people weren't gonna complain about the changes they're gonna be really tolerant of the messiness of new stuff and that you could actually trust that most people are trying to follow the rules the best they can and then the final feedback loop that we're working on now is using all this data that we're collecting from delivery about income family size seen whether people whether people are seniors or have children and using that to actually decide what housing we build where we build it who we price it for what unit sizes so this is the really big thing I the one last takeaway from for us for me for me as a city government manager is that I didn't know agile development I don't you know I'm not coming from the world but I'm now I understand it completely and what we're able to do in San Francisco is take that agile development and not just use it for web-based products but use it for our own policies and procedures and look back every time we make a rule or a policy or procedure look back and see is this working for the people is this really what we need to move more people into affordable housing and I can't leave without saying that we're hiring so if this is appealing to you and you want to come work on projects like this this is how we're working with all the departments we partner with the city so check out our jobs thank you [Applause]