DCHS Insights CX Human-Centered Design @ DCHS PROTOTYPE no real data

Use needs screening to protect stability after benefit loss

Planning question: Which needs should DCHS ask about first when a client expects to lose SNAP or Medicaid—or has already lost it? The CMS AHC-HRSN tool offers tested questions about food, housing, utilities, transportation, safety, and other everyday needs. During an HR1-related benefit transition, those questions can reveal harm that an eligibility record alone cannot show and point toward another source of practical help.

How needs screening can support an HR1 response

A benefit decision establishes whether SNAP or Medicaid continues. A needs screen shows what the change is doing in a client's life and where another response may be useful.

Screening can identify when food is running short, treatment or medication is becoming harder to maintain, transportation is blocking follow-through, or another basic need has become urgent. It can also surface interest in employment, training, child care, or treatment when those pathways fit the client's goals and an appropriate service is available.

The most useful questions are the ones paired with a credible response. Their order will depend on local service capacity, client experience, privacy and safety protocols, and any requirements for administering the standardized instrument. The sequence below is therefore a first prototype to refine, not a prescribed final order.

Prioritize questions by the help they can open

This starting sequence puts the most time-sensitive consequences first and then broadens as DCHS has reliable ways to respond.

Immediate food, safety, and housing risks come first. The next group helps protect continuity of care and day-to-day stability. A third group can open employment, training, child-care, or treatment pathways when the client wants that help. Broader health context follows once the more direct responses are working reliably. This order reflects how quickly an answer can lead to useful action, not the relative importance of one need over another; urgent concerns still follow established safety and clinical protocols.

Interpreting an answer also requires a small amount of context: which benefit is changing, when the change takes effect, what help the client wants, and what language or access support is needed. Existing notices and case records should supply that context whenever possible. An offered resource should remain distinct from successful contact and help actually received, so a promising referral is not mistaken for a completed response.

Draft starting group Question group Why it may help after benefit loss
1 · Immediate needs Food insecurity AHC-03 · AHC-04 These are the most direct signals that a SNAP reduction or loss is already changing what the household can eat or afford.
1 · Immediate needs Housing stability and quality AHC-01 · AHC-02 Lost food or medical support can force tradeoffs with rent, utilities, and safe shelter. Unstable housing also makes notices and proof harder to receive and retain.
1 · Immediate needs Transportation AHC-05 Transportation can determine whether a client reaches a renewal appointment, provider, workforce activity, food source, or referred service.
1 · Immediate needs Utilities AHC-06 A benefit loss can shift scarce income toward food or health costs and expose an existing shutoff risk.
1 · Immediate needs Interpersonal safety AHC-07 · AHC-08 · AHC-09 · AHC-10 The complete CMS core includes these questions, and financial or housing disruption can increase danger or constrain a person's options.
1 · Immediate needs Request for help LOCAL-03 A positive needs screen does not mean the person wants DCHS to act. This proposed local item separates identified need from requested assistance.
2 · Continuity Financial strain AHC-11 This question can reveal the broader tradeoffs created or intensified by lost food or health coverage, including rent, care, heating, and other basics.
2 · Continuity Mental health and stress AHC-23a · AHC-23b · AHC-24 Coverage uncertainty, interrupted treatment, food insecurity, and administrative burden can worsen distress. These questions help identify continuity and clinical follow-up needs.
2 · Continuity Disability and navigation support AHC-25 · AHC-26 Difficulty concentrating, remembering, deciding, or completing errands can make notices, portals, proof gathering, and appointments harder to manage.
2 · Continuity Family and community support AHC-13 · AHC-14 A person managing a renewal or service transition alone may need practical help with meals, shopping, finances, communications, or follow-through.
2 · Continuity Language access AHC-15 A notice, proof request, or referral that cannot be understood is unlikely to produce a timely response.
3 · Other pathways Employment AHC-12 For clients who want it, employment help may support income stability or connect them with an approved activity pathway.
3 · Other pathways Education and training AHC-16 Training or education may be a client-chosen route toward employment, income, or an approved activity, depending on current program rules.
3 · Other pathways Child care LOCAL-01 · LOCAL-02 Child care can determine whether a parent can work, train, attend appointments, or complete a benefits process.
3 · Other pathways Substance use AHC-19 · AHC-20 · AHC-21 · AHC-22 Loss of health coverage can interrupt treatment or increase the urgency of connecting someone to care.
4 · Broader health Physical activity AHC-17 · AHC-18 These questions add useful health context but are less directly connected to stabilizing a SNAP or Medicaid transition than the earlier groups.

Review the question-by-question prototype → Compare with the full instrument →

Questions that should shape a local sequence

A useful sequence balances urgency, available responses, the integrity of the screening tool, and what clients and frontline staff learn through use.

Sources and implementation context

Policy context checked September 3, 2026. Recheck current state and federal guidance before fielding the workflow.

CMS AHC-HRSN Screening Tool ↗

Exact questions, response options, scoring guidance, and source attributions.

Virginia Medicaid federal work requirements ↗

Affected population, January 2027 start, activity and income routes, exemptions, and notice guidance.

Virginia SNAP policy and procedures ↗

Current SNAP work-requirement changes, notices, and exemptions.

Alexandria DCHS benefits and assistance ↗

Local entry points for benefits, food, health care, utilities, and financial assistance.

DCHS Insights CX

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