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1991.09.25 :  Single Application Form

Contact:  Charlotte Mehuron (301) 443-3376
September 25, 1991

       HHS Secretary Louis W. Sullivan, M.D., and Secretary of
Agriculture Edward R. Madigan today announced a new multi-purpose
application form that will make it easier for mothers and
children to receive the help they need from a variety of programs
and will reduce paperwork for health providers.
       The form, which is optional, will be used to apply to a
number of U.S. Department of Health and Human Services' programs
for mothers and children and the U.S. Department of Agriculture's
Special Supplemental Food Program for Women, Infants and Children
(WIC).
       "By using this single application form, a mother can
enroll herself and her children in up to seven federal programs
and in any other programs the states wish to include," Dr.
Sullivan said.  "Approximately 16 million women and 10.5 million
children can benefit if states choose to adopt either all or part
of this application."
       Madigan said, "Eight states--Georgia, Kentucky, Texas,
Vermont, Virginia, Ohio, Indiana and Washington--are already
using a joint application similar to this form.  Eight other
states are working to develop one, and they should take a look at
our model."  The eight states are Alabama, Colorado, Iowa,
Michigan, Minnesota, South Dakota, Wyoming and West Virginia.
       Over five million women are current Medicaid recipients
and over 14 million children are entitled to Medicaid benefits. 
About 2.5 million women and children now use either the community
health, migrant health or homeless health centers.  In addition,
over one million women and nearly four million children now
receive benefits from the WIC program.  An applicant may qualify
for two or more programs and in many states must now apply on
several different forms.
       "There is no reason people applying for federal benefits
should have to provide the same information over and over to
participate in different programs," Madigan said.  "This will
make it easier for the clients and reduce duplication of effort
among federal and state workers who operate the programs."

       With the new four-page application form, information--such
as address, names, ages, family size and income--can be forwarded
to several programs to determine basic eligibility for the many
health care, food, nutrition and social services that mothers and
children may need.

       "Easy access is the key to reaching those who need health
care and related services the most," Sullivan said.  "By
combining program paperwork, mothers and children will be more
likely to receive essential services.   

       A Health Resources and  Services Administration-led
interagency work group, with representatives from the seven
programs in the two departments, developed the model application
form.  The programs are Maternal and Child Health; Medicaid;
Migrant Health Centers; Community Health Centers; Health Care for
the Homeless; Head Start; and Special Supplemental Food for
Women, Infants, and Children (WIC).  HRSA a is part of the Public
Health Services within the Department of Health and Human
Services.

       The new application form will be sent in about 30 days to
state agencies responsible for state and federal programs for
mothers and children.


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