FOR IMMEDIATE RELEASE

Wednesday, August 12, 2026

Contact:
Jillian McKoy, jpmckoy@bu.edu 

Michael Saunders, msaunder@bu.edu

##

Each year, millions of Americans spend a significant amount of time applying to Medicaid, Supplemental Nutrition Assistance Program (SNAP), and other public assistance programs to meet their basic food and healthcare needs. The arduous process of completing forms, interviews, verifications, and potential appeals—which often must be repeated for each program a person applies to—places a substantial administrative burden on applicants and their families, as well as the state government agencies tasked with processing these applications. 

This burden could be alleviated by developing a streamlined application process that considers the real experiences and barriers that public assistance applicants frequently encounter, according to a new commentary by researchers at Boston University School of Public Health (BUSPH) and Children’s HealthWatch.

Published in a special issue of the American Journal of Public Health that focuses on government efficiency, the commentary argues that the current application process for public assistance programs creates “a lose-lose scenario,” as eligible applicants often abandon the time-consuming applications out of frustration and miss out on opportunities to improve their health, which defeats the purpose of these services. 

Designing a user-friendly multibenefit application that enables people to submit just one application to multiple public assistance programs would conserve valuable time and resources—and represent true government efficiency, write Dr. Cristina Gago, assistant professor of community health sciences at BUSPH; Mr. Richard Sheward, director of system implementation strategies at Children’s HealthWatch; and Dr. Stephanie Ettinger de Cuba, research associate professor of health law, policy & management at BUSPH. 

The authors argue that it is critical to reassess what government efficiency truly entails, and how the US can achieve it across public assistance programs—especially as these programs undergo major funding cuts and implement stricter eligibility standards and work reporting requirements mandated by the One Big Beautiful Bill Act (OBBBA).

“Discussions about streamlining systems with the goal of government efficiency should not be about cutting support,” the authors write. “Rather, they should focus on removing barriers that prevent programs from reaching their full potential, which may ultimately require greater investment in a human-centered development process.”

Research has shown that reducing burdensome requirements for public assistance programs—such as through multi-program-enrollment applications—can improve participation, but only a few states offer this option. In the commentary, the authors share four recommendations from policy experts, state employees, and public assistance applicants on how to improve the design of multibenefit applications to promote equitable access to these services, improve health, and achieve true government efficiency. The recommendations were part of data collected in a related study by the authors on administrative burden and enrollment gaps in safety-net programs, published ahead of print in the Journal of Health Politics, Policy & Law.

To simplify public assistance applications and ensure applicants understand eligibility criteria, the authors write that states can shorten these applications, incorporate autopopulated responses from previous applications, update their systems so that employees can identify complex cases, and enable the systems to screen applicants for eligibility before they begin the full application process. “Multibenefit applications should serve as a ‘one-stop shop’ that provides one entrance and no wrong door to multiple benefits,” they write.

As most applications are online, the authors also identify the need for technological improvements to the application process, such as mobile-friendly applications with clear visuals, and the ability for applicants to save their information in the system. Applications must be intentionally designed with diverse populations in mind—particularly those who have historically faced the greatest barriers to access (i.e., people with disabilities, people whose first language is not English, and immigrants). States can make their applications more accessible with design adjustments such as high-quality translations, simplified instructions across all languages, and removing the requirement for open-text responses.

Lastly, these changes to states’ applications should undergo comprehensive user testing to ensure that the updates succeed in simplifying the application process and create a more manageable experience for the intended audiences.

“Too often, lack of accessible, clear instructions results in unintentional misreporting and benefit denial, followed by multiple rounds of corrective resubmission—wasting everyone’s limited resources,” the authors write. These errors now have significant financial consequences for states and applicants, as under the OBBBA, states must share the cost of SNAP benefits (which was previously 100-percent funded by the federal government), with the amount rising if the error rate (including both under and overpayments) rises above a certain threshold.

Importantly, the authors note that implementing these design changes requires substantial time for research and development, as well as robust funding for staffing, training, infrastructure design, participant engagement, and more. Under the OBBBA, they write, states had a mere four months to implement such changes that restricted SNAP eligibility from previously eligible refugees and those seeking or granted asylum, and incorporated new reporting processes for work activities, which are also now required for many more households. Since this bill passed in July 2025, more than four million Americans have lost their SNAP benefits, and millions more stand to lose Medicaid by 2034.

“Too often, states are asked to make large systems changes quickly and with minimal resources, which results in outside vendors being hired to meet deadlines. However, metrics of vendors’ success rarely account sufficiently for the importance of a human-centered process versus just reaching the finish line,” the authors write. Therefore, they conclude, “rethinking efficiency in a human-centered fashion as we have described is all the more important. Efforts to educate decision-makers about the costs—human and financial—of ignoring these principles is vital.”

** 

About Boston University School of Public Health 

Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master’s- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.

Journal

American Journal of Public Health

DOI

10.2105/AJPH.2026.308619