Personalized for People

The current system is paternalistic toward beneficiaries. Many on the left view the safety net through a lens of protecting the vulnerable from an oppressive economic system. Many on the right take the opposite outlook, focusing on individuals gaming the system: “welfare queens.”¹Max Gulker, “The U.S. Welfare System’s Paternalistic History,” American Institute for Economic Research, June 3, 2019, https://www.aier.org/article/the-u-s-welfare-systems-paternalistic-history/.

Both are incorrect approaches. Instead of attempting to handle the situation from the perspective of a parent believing they know better, expectations need to shift toward recognizing that safety-net recipients can achieve self-sufficiency.

Rather than assuming that those on safety-net programs need “policing,” we should expect that they are capable of making rational decisions and achieving independence. A reformed approach should emphasize a working relationship similar to that of a financial advisor and a high-net-worth client, or that of a doctor-patient in direct primary care. In each example, the relationship focuses more on extending advice and guidance to the recipient rather than micromanaging their portfolio or health.

Inherent to this shift is an expectation of responsible behavior on the part of recipients and a corresponding system of accountability. The client-centric approach provides the beneficiary with more freedom, autonomy, and trust, which requires that they, in turn, be good stewards of these resources. Such an accountability system is akin to a physician calling to check in on a patient following a procedure or a financial advisor scheduling regular portfolio reviews with their client. Both the patient and client are free to disregard the advice of the physician or financial advisor, but in doing so risk bearing the negative consequences of their choice. This analogy is not perfect, given that recipients are benefitting from social safety net programs funded by taxpayer dollars as opposed to their own resources. Accordingly, there should be strong negative consequences associated with failure to meet expectations and wasting limited resources.

These perspective changes take into account how clients have unique and substantial obstacles to employment, including disabilities, health problems, addiction, behavioral problems, and criminal records (which can prevent employment). We know that programs that are more tailored—emphasizing employment or human capital development depending on the individual—tend to lead to higher gains.²Dan Bloom and Charles Michalopoulos, How Welfare and Work Policies Affect Employment and Income: A Synthesis of Research (Manpower Demonstration Research Corporation, 2001), 15, https://www.mdrc.org/sites/default/files/full_393.pdf.

These obstacles all require the client to participate in their unique path to independence. Assistance requires accountability, but the expectations discussed above should provide the beneficiary with more freedom, autonomy, and trust, which requires the beneficiary to be a good steward of these resources.

Addressing an individual’s needs also requires community-based caseworkers who partner with recipients. Caseworkers’ expertise, dedication, and compassion are essential to help individuals negotiate the welfare system. They are also invaluable in encouraging positive behaviors, putting recipients on a path toward self-sufficiency, and enforcing program integrity to ensure benefits go to the neediest in society.

Decentralizing the safety-net system requires transferring responsibility for delivering services to recipients from government agencies to local mediating structures like charities and other nonprofits. This is not to be understood as creating a new class of government-funded charitable organizations, but rather transferring services like job training and coaching as well as accountability functions from a cold, impersonal bureaucracy to the local community level. By applying the concept of subsidiarity—that essential social functions are most effective when performed at the lowest level possible—to the social safety net, we can increase its effectiveness at promoting self-sufficiency while cutting down on opportunities for waste, fraud, and abuse.   

Under this structure, community-based charitable organizations would be responsible for delivering services to recipients, leaving the government to merely control the distribution of funds and provide contract oversight of providers. In transferring these responsibilities, the local nonprofits administering programs would be held to stringent outcome-based accountability standards that prevent waste and ensure optimal outcomes for recipients. These metrics must require nonprofits to demonstrate success at moving recipients off the program and into sustainable self-sufficiency as quickly as possible.

Examples

Advance Memphis – Memphis, Tennessee.

Advance Memphis works alongside vulnerable adults to break cycles of poverty through knowledge, resources, and skills.³“Misson and Vision,” Advance Memphis, accessed December 5, 2021, https://www.advancememphis.org/mission-vision. The Work Life program partners unemployed clients with volunteer mentors to identify barriers to employment and set professional and educational goals. The program provides job readiness basics such as integrity in the workplace, effective communication, resume building, and interview skills.⁴“Work Readiness,” Advance Memphis, accessed December 5, 2021, https://www.advancememphis.org/work-readiness.

Padua – Fort Worth, Texas.

In 2015, Catholic Charities of Fort Worth, Texas, launched an innovative pilot program called Padua. Born out of frustration with ineffective government anti-poverty programs that trap families in cycles of poverty and waste taxpayer dollars, Padua is designed to be relationship-based and client-led.⁵“Padua,” Research and Evaluation, Catholic Charities Fort Worth, accessed December 5, 2021, https://catholiccharitiesfortworth.org/who-we-are/what-we-do/research-and-evaluation/padua/. At its core is a holistic system that matches case managers with a small group of beneficiaries. Each beneficiary works with their case manager to design a unique, actionable service plan centered on their individual goals and strengths and coordinated with other community service providers. The Padua model focuses on addressing the root causes of poverty and empowering clients to be the agents of their own success.

Between February 2015 and October 2016, the Wilson Sheehan Lab for Economic Opportunities at the University of Notre Dame (LEO) followed a cohort of Padua clients as they worked through the program.⁶“New Research on Why Padua Works,” Catholic Charities Fort Worth, October 19, 2020, https://catholiccharitiesfortworth.org/new-research-on-why-padua-works/. LEO’s randomized control study revealed that clients served by Padua experienced substantially better outcomes compared with a control group that did not participate in the program. The study found that Padua program participants were 25% more likely to secure full-time employment and had earnings that were 18% higher after two years than those in the control group. Those who entered the program without any type of employment were 67% more likely to secure either full-time or part-time employment than individuals in the control group. As a result, Padua participants were less likely to depend on the government safety net following completion of the program.

LEO is continuing its study of Padua to evaluate how different types of strategies help improve workforce and self-sufficiency outcomes. This next iteration of the study is scheduled to be published in 2022. However, initial findings present strong evidence that community-driven case management is vastly superior to government welfare at reducing poverty, promoting sustainable employment, and increasing self-sufficiency.

CareSource Life Services Initiative – Georgia and Ohio.

CareSource is a Case Management Organization (CMO) based in Dayton, Ohio, that contracts with the states of Ohio and Georgia to operate their Medicaid managed care plans.⁷“About Us,” CareSource, accessed December 5, 2021, https://www.caresource.com/about-us/. In 2015, CareSource created its Life Services program to help the low-income clients it serves to achieve economic and social stability.⁸Hearings on House Bill 166 Before the Finance Subcommittee on Health and Medicaid, 134th General Assembly, Ohio Legislature (May 14, 2019) (testimony of Karin VanZant, Vice President, Integrated Community Partnerships at CareSource), https://www.legislature.ohio.gov/legislation/legislation-committee-documents?id=GA133-HB-166. Participants who opt into Life Services can access the JobConnect program, which matches them with a Life Coach who helps the client develop a plan for achieving self-sufficiency based on their unique strengths and needs. Life Coaches serve as a support system, assist clients with employment and financial planning, and connect them with other community services. Even after clients have obtained employment, Life Coaches continue to work with them for up to 24 months to ensure that they are able to sustain success and, critically, navigate the welfare cliff so that they do not fall back into old patterns of dependency.

Among a group of 2,323 CareSource clients in Ohio who opted into the program and worked with a Life Coach, 1,014 obtained employment. Of these, 83% of those who were employed while working with JobConnect retained that employment at 90 days in the program. While more research will need to be done into the long-term success of CareSource’s Life Services program, the model is an example of a way to effectively marry community-based case management with government safety-net programs. As an employment resource for individuals on Medicaid, CareSource also illustrates that case management services need not be directly related to the type of benefit the client is receiving.