In her beautifully written review of Stephanie Land's new book Maid: Hard Work, Low Pay and a Mother's Will to Survive, Emily Cook notes in the NYT that:
For a while, as Land recounts in "Maid," her memoir of her time as a cleaner, she was on seven kinds of government assistance, and still hardly surviving. The paperwork she was forced to complete in order to qualify for help was interminable: applications with questions about her plans for the years to come, detailed proof of income that included documentation of her schedule and letters from clients verifying that she did indeed work for them, and continual updates to account for any change in status.
Yes, we have always been determined to make the poor prove their worthiness, at least in part by demonstrating the perseverance to obtain any help at all. It was the ACA, by promoting simplification of Medicaid application and maintenance of Medicaid eligibility status that really shook that up. Or, tried to. The ACA, however, did leave the states to experiment in how best to streamline these processes.
We can learn something about the different directions taken by the various states by considering a late 2018 report from MACPAC, surveying how and how well Medicaid eligibility processing was streamlined in representative states. It makes for some pretty interesting reading.
The big takeaways? Integrated applications are the goal. Medicaid applications sometimes do not mesh well or at all, however, with applicants for other forms of benefits. And so the gains were significant, but only incremental. The biggest problem? Completely different standards of eligibility between and among the programs.