Making Written Notices Understandable: a Collaborative Approach
By Adinah Robertson, Coordinator of Community Education, Legal Aid Society of Middle Tennessee and Russ Overby, Tennessee Justice Center
From the April 1999 issue of Welfare News
We cannot give you the Families First check you applied for on: 11/10/97. These are the problems or reasons: Reason: FAILED TO MEET ALL ELIGIBLITY REQUIREMENTS We are going by State Rule # 1240- SR1- 14-.06
What is written just above is the complete explanation provided by the Tennessee Department of Human Services to an applicant for TANF (called Families First in Tennessee) benefits in November of 1997. If this notice looks disturbingly familiar, your state, like Tennessee, is not effectively communicating with people seeking TANF, Food Stamp, or Medicaid benefits. Such states may be subject to litigation claiming that they are failing to provide adequate notice as required by due process. Litigation challenging inadequate notices is currently pending in Colorado. For information on the Colorado case, Weston v. Hammons, and other cases raising notice issues see the Welfare Law Center's website - www.welfarelaw. org.
The Tennessee Justice Center, a not-for-profit law firm which represents low income persons with respect to issues involving access to health care and public benefits, has negotiated a procedure with the Tennessee Department of Human Services to improve the written notices sent to TANF, Food Stamp, and Medicaid applicants and recipients. As part of this agreement, the Tennessee Department of Human Services has contracted with the Legal Aid Society of Middle Tennessee to obtain the advice and assistance of their Coordinator of Community Education in revising more than one hundred different notices.
While the final content of the written notices in Tennessee is still the subject of negotiation, we hope that the issues that have been identified in this process, the potential solutions, and the collaborative partnership model may be helpful to advocates and human service agencies in other states.
What is the Problem?
Tennessee uses a computer system similar to that utilized by several other states to determine eligibility for TANF, Food Stamp, and Medicaid benefits. All written TANF, Food Stamp, and Medicaid notices are generated by the computer system. Because the system does not allow for the insertion of individualized text by human service workers, explanations as to a denial, termination or reduction of benefits are left to a series of reason codes. Tennessee has several hundred reason codes, including the reason code noted above, which is the functional equivalent of "other." Because the notices have no specific explanation of the facts upon which a determination was made, persons receiving the notices are left to try to figure out why something is happening based on reason codes like the one noted above.
Another problem is that in an effort to conserve space and reduce the number of pages for a particular notice, the text on many of the notices is printed in the equivalent of 8-point type.
If you don't know how small 8-point type is, try reading this.
Because the notices are computer generated, the human services worker who has generated the notice is usually unaware of the content of the actual notice received by the client. Finally, many Tennessee notices require too high a reading level, given the group who will read them.
What is the Solution?
We decided that written notices should focus on answering, in order, three fundamental questions:
What is happening to a person's benefits?
Why is it happening?
What can a person do about it?
To answer the first question, we proposed that the text of the notice begin with a specific heading explaining what program was affected; whether benefits were being denied, terminated, increased or decreased; and when this was going to happen. For example, for a reduction in TANF benefits, the heading would read "Your Families First cash payments will go down as of December 1, 1998."
The second question would be answered in a section titled "This is Why" which would follow immediately below the heading. This section would require the worker to type in the specific factual basis for the action being taken. In response to the third question, we completely rewrote the information with respect to appeal rights and added information advising clients how to attempt to resolve problems with their case workers and of toll-free hot lines available for TANF and Food Stamp recipients who could not reach their workers. Before and after examples of this portion of the notice are shown.
The Department of Human Services agreed to reformulate all of their notices using this proposed format. While this sounds relatively straightforward, we soon discovered that the reality is much more complex. Many notices must provide information about eligibility for all three programs, since a single event could potentially affect TANF, Food Stamp, and Medicaid benefits. Information as to which household members are affected by a particular action had to be included. Information as to household income and resources was included to allow a household to check the accuracy of the assumptions the Department was making in determining eligibility. Other information, such as the obligation to cooperate with child support enforcement, had to be included. Finally, the notices needed to be "smart enough" so that only relevant and needed information was contained on a notice. For example, a notice with respect to Food Stamps benefits only should not contain information about compliance with child support enforcement obligations which do not apply to the Food Stamp program. Thus, in practice, making Tennessee's notices more intelligible meant not only reformatting them but also reviewing all 109 different notices used by the Department, line by line, to ensure that they were clear and factually accurate and did not include superfluous or misleading information. This included writing notices which did not require more than a sixth grade reading level.
Many of the substantive changes recommended are still in negotiation. With the exception of TANF termination notices, which were redesigned in 1998, the Department continues to use its old notices in the interim.
Tennessee's willingness to partner with advocates and community education experts in order to improve its notices may serve as a helpful model for other states.
Tips for improving the readability of notices
- Put the most important information in the heading and the first paragraph. It is never safe to assume that someone will read all the way to the end. It is wise to put the critical pieces of information first. Also, "hooking" the reader initially with information affecting his or her self-interest increases the likelihood that the reader will continue reading. An example of this is the notice to people who meet all the Medicaid requirements except that they do not have enough medical bills to meet the Medically Needy Spend Down requirement. The notice waits until the last sentence of the third paragraph to tell the reader how many medical bills he or she needs to meet the requirement and get Medicaid. This is a key piece of information that alerts the reader when to submit more bills or apply again. It should appear in the first paragraph.
- Take the client's perspective to help you identify the most important information in a notice. Think about how the information will affect the reader.
- Replace bureaucratic jargon with words the clients use. For example, we replaced "benefits" with "cash payments," "Food Stamps," or "the help you get from us." "Proof" replaced "verification." "Families First plan" or "work plan" replaced "Personal Responsibility plan."
- Use "you" and "we" to personalize the communication.
- Avoid the use of passive voice. It sounds unnecessarily formal. For example, "We will send you a letter," sounds less intimidating than "You will be notified in writing."
- Break up sentences that are longer than 15 words. Avoid using a multi-syllabic word, such as "terminate," when a shorter word, such as "stop" will do. These two steps can quickly reduce the reading skill required.
- Break up the text with subheads, bullets, graphics and white space.
- Use type that is large enough for easy reading. Low-income readers frequently have uncorrected vision problems because they cannot afford eyeglasses.
- AVOID THE USE OF ALL CAPS FOR MORE THAN ONE OR TWO WORDS IN A ROW. Writers use all caps to capture the reader's attention; readers tend to avoid reading material in all caps.
As Tennessee's notices are revised, the Welfare Law Center will work with Tennessee Justice Center to develop a packet of notices and will post them on the Welfare Law Center's website. For more information on the Tennessee Justice Center/Legal Aid Society of Middle Tennessee collaboration with the state agency, contact Russ Overby at Tennessee Justice Center, 203 Second Ave., North, Nashville, TN 37201, tel. 615 255-0331; fax: 615 248-3230; email: tjustice@usit.net.
