Michigan tames a 18,409-word testament to bureaucracy run amok

Federal and state regulations about Medicaid and other assistance programs tally some 1,700 pages. Each regulation had to be met to rework Michigan’s assistance application. (Bridge photo by Joel Kurth)

Menica Harper needed help. What she got was a bureaucracy that seemed designed to prevent her from getting any.

The Detroit home health care aide had already endured a lifetime of woe –  sexual assault, mental health issues and chronic neck injuries –  when her home burned in 2016. After moving around for a year, Harper became homeless last fall and applied to the state for emergency aid.

First step: Filling out the longest public assistance application in the nation. Known as Form 1171 of the Michigan Department of Health and Human Services, it was a doozy: 42 pages, 18,409 words, and 1,204 questions.

“It was hell,” said Harper, 48. “It took me more than two hours to fill out, and I still got it wrong and left stuff out. The whole system is messed up.”

Menica Harper says she needed more than two hours last year to complete a Michigan Department of Health and Human Services form for public assistance. It still was incomplete, she said. (Bridge photo by Joel Kurth)

State officials don’t disagree. The form is required for services from Medicaid and food aid to childcare and emergency cash that are used by more than 2 million Michigan residents. Over the years, the application has gained notoriety as a testament to bureaucracy run amok, so overwhelming that it frustrated both case workers and recipients.

So officials did something not always associated with government: They went to work to make things better.

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The state partnered with a Detroit design firm, Civilla, to rework the form and test it in a few state offices. The process took more than two years and culminated last week with the debut of a user-friendly, 18-page application at MDHHS offices statewide.

Yes, it is just a form. But to hear participants of its redesign tell it, it’s about much more. They say changing the form will increase efficiency and free the state’s 4,000 MDHHS case workers from hours of tracking down information on incomplete forms so they can focus on helping residents escape poverty.

Everyone knew Form 1171 was too long. But it grew every time the state or federal government passed a new regulation about public assistance programs. Until it was redesigned, it was 42 pages. (Bridge photo by Joel Kurth)

“Nobody wakes up in the morning and decides they want to make life harder for people who need help,” said Michael Brennan, CEO of Civilla.

“They’re managing a high-risk population with a lot of needs and circumstances, and they are (doing so) with a system that didn’t work for anyone.”

Brennan estimates one-third of the state’s residents will fill out the form at some point in their lives. Some 1.8 million residents are on Medicaid, while 1.3 million million receive food assistance known as the Supplemental Nutrition Assistance Program or SNAP. (Many receive multiple benefits.)

“Over time, as legislation and federal regulations changed, the form just grew and grew,” said Terry Beurer, deputy director for field operations administration for the MDHHS.

“Things kept getting added, but nothing was removed. Over the years, we tried to downsize it, but there were always other priorities or limited resources.”

But taming bureaucracy, to no one’s surprise, was no simple task.

Long form, ‘dehumanizing system’

Nearly $1 billion in federal money allotted for assistance programs are unspent in Michigan. Brennan suspects the form was a reason way.

The former CEO of the United Way of Southeastern Michigan, Brennan said he’s has spent his career trying to untangle systems that complicate poverty. He introduced the nonprofit’s 211 hotline in Metro Detroit, for instance, that helps some 400,000 callers per year navigate social services that help those who are hungry, homeless or jobless.

At a glance

Here’s a look at how many people receive help from five public assistance programs administered by the Michigan Department of Health and Human Services.

  • Food assistance (SNAP): 1,321,240
  • Cash assistance (Family Independence Program): 45,052
  • Child care (Child Development and Care): 67,549
  • Medicaid: 1,803,344
  • State Emergency Relief: 6,751

Source: Michigan Department of Health and Human Services

MORE COVERAGE: Demand for Michigan workers is very high, but many have given up looking

Brennan became convinced that Form 1171 was emblematic of everything wrong with the safety net. A few years ago, he taped the pages of the form together, rolled it into a nearly 40-foot-long scroll and used it as a prop for speeches.

When he stepped down from United Way in 2015, he decided to do something about it. His solution: Something called “human-centered design,” which focuses on the needs of users rather than the bureaucracies.

“This system was dehumanizing. It was less of a help system than a fraud prevention effort, and it created an us-versus-them mentality,” Brennan said, adding that public assistance bureaucracy “creates pain for residents and front-line workers alike.”

Brennan talks like that.

He and the six-member, mostly Millennial, team at Civilla don’t hide their earnestness. They start and end their days in what they call a “Dream Cocoon,” a giant wooden canopy in their Midtown Detroit studio where they read affirmations and share stories.

A display about the project – dubbed “Re:Form” – consists of a maze that is decorated with 800 strands of yarn hanging from the ceiling. Each symbolizes a client for each state MDHHS worker, whose average caseload has increased from 300 in 1999 to 750 in 2015.

But Brennan also has powerful connections. In late 2015, he persuaded MDHHS Director Nick Lyon and Rich Baird, then a top aide to Gov. Rick Snyder, to drive to Detroit for a demonstration on the form. Each tried to fill it out in 45 minutes. They failed.

Michael Brennan, CEO of Civilla, and Lena Selzer, the firm’s design director, prepare to unfurl Form 1171. (Bridge photo by Joel Kurth)

The meeting forged a bond between Brennan and Beurer, the MDHHS administrator. When he started working for the state as a caseworker 35 years ago, Beurer immediately knew the form was a problem.

“Everyone back then had trouble filling it out, and it was clear this was something we needed to fix,” he said. “Since then, it’s only grown.”

‘Do the right thing’

Reworking the form began with interviews with case workers and clients, and “inch-by-inch” scrutiny of redundancies, Beurer said. Most difficult: Ensuring the  dramatically reduced form still complies with 1,700 pages of state and federal regulations.

Everything from the form’s font –  Helvetica to Akkurat –  was reimagined, Brennan said, and tested during a pilot program for a few months last year in field offices in Eaton County and Hamtramck, the immigrant enclave of Detroit. Bridge Magazine highlighted the project in an article about  the “plain English” movement in government.

The result of the new form: Some 86 percent of users are able to complete the form in less than 20 minutes; and applications are turned in at a 94 percent completion rate, up from 72 percent.

Before and after: The new form to access Michigan assistance programs is 18 pages, down from 42. (Photo courtesy of Civilla/Marisol Dorantes)

“It has allowed our staff to actually work with the individual to remove any other barriers that may exist and assist that client in the path to self-sufficiency,” Beurer said. “It’s a really exciting time.”

Both he and Brennan say it’s among the most significant work of their careers. The state ended up paying Civilla $830,000 for the project. MDHHS spokesman Bob Wheaton said the firm’s work will improve staff efficiency to better help clients.

Civilla also trained MDHHS case workers, and many of the lessons from the project are being applied to a revamp planned in the spring of MIBridges, the website that allows public assistance recipients to apply and check cases online, Wheaton said.

The cost savings are an added benefit, said Geralyn Lasher, director of communications for the MDHHS.

“This is about coming together as a department to do the right thing in how we serve people,” she said.

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Comments

Carrie Rheingans
Thu, 02/01/2018 - 8:51am

What seems to be missing from this story is HOW these forms got so complicated - you mentioned the 1,700 pages of regulations, but WHY were there so many? Well, it's because we (taxpayers, elected officials, Americans in general) don't want anyone to abuse the system and really PROVE that they're in need... we think, "If they REALLY need help, they'll do whatever it takes to fill out that application". It's easy for us to think that of these mysterious "others", but one day it could be us, too. Some see government as an ineffective bureaucracy, but it's only because we, the taxpayers, force it to be so by demanding that we know what's done with every single cent.

Rich
Thu, 02/01/2018 - 11:14am

And why shouldn’t we demand to know what is done with OUR money. There are so many needs or demands and so little money, unless you would rather the governments take more of OUR money, and yes, that was plural governments at local, state, and federal levels.

John Saari
Thu, 02/01/2018 - 10:23am

Including healthcare, housing and education, we must find a way to pay for it.

Kevin Grand
Thu, 02/01/2018 - 2:29pm

"Menica Harper needed help. What she got was a bureaucracy that seemed designed to prevent her from getting any."

And now for the elephant in the room.

Where does the government derive the authority to forcible take from one segment of the population and give to another?

It really makes no difference if the other happens to have a name that ends in Illitch or Gilbert or anyone else cited in the article above.

Not only is coercive charity is an oxymoron, but people have lost sight of the fact (or just have not learned) that this is not, nor ever has been, a function of government.

Lynnette Rhodes
Thu, 02/08/2018 - 9:18am

Funny, I was taught that the function of government was to provide for the general welfare of the population. I also learned that it was a Christian value to feed the hungry. An internet search will give you 25 quotes from the Bible to back that up. Are we a Christian nation or do we just give it lip service? I am becoming fearful of knowing the answer Jesus would provide, if asked.

Lynnette Rhodes
Thu, 02/08/2018 - 9:09am

Simplification of the application has been needed for decades. Thank you! Next project should be to revise the Request for Verifications form. Applicants do not realize that they can be denied if the requested verifications are not on the workers desk within 10 days or how to request an extension if, for instance their physician is too busy to complete a form within a few days time. I once saw this form presented to a judge, inquiring when verifications were due, and even he, with a law degree, could not find it! Would an applicant with 6th grade reading skills, not knowing that there is a deadline, see it ...or be able to find it even if they knew there was a deadline?