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Wednesday, February 25, 2015

From Shopping Malls to Ski Slopes: Enrollment Assisters and Innovation

Cathy Kaufmann

Enrollment Program Director

The second open enrollment period just ended—and it was a tremendous success. The fact that enrollment systems functioned much better this time around certainly made it easier for people to enroll. But there’s no doubt that the commitment and creativity of 23,000 certified application counselors, navigators, and in-person assisters across the country have made big contributions to enrollment gains. In this enrollment period, we saw navigators and assisters reach new heights of creativity as they strove to find consumers and help them sign up for health insurance. 

Enrollment success due in large part to enrollment assisters 

So far, the Department of Health and Human Services (HHS) reports that 11.4 million consumers selected or were auto-enrolled in a plan through healthcare.gov or through their state-based marketplace. (Applications are still being completed for those who applied—or who ran into technical difficulties while trying to apply—in the final days.) In addition, 10.8 million consumers have enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) since the start of the first open enrollment period. 

President Obama agrees that assisters deserve a lot of the credit. In a video posted on Facebook, he said, “None of this would have happened if it hadn’t been for just incredible work done by navigators, volunteers, and assisters at the local level.” During the second open enrollment period, assisters held more than 5,000 outreach events in federally facilitated marketplace (FFM) states alone.

Innovative assister outreach campaigns in California, Florida, New York, and Oregon

Because assisters are on the ground and know their communities, they frequently come up with new ways to successfully reach out to and enroll consumers. Below, we’ve highlighted innovative campaigns by assisters in California, Florida, New York, and Oregon.

Assisters in Ventura County, California used a mobile enrollment unit. They identified areas where consumers were frequently missing appointments with assisters and sent the mobile unit to those communities. The mobile unit had everything assisters needed to enroll consumers, including computer stations with scanning and printing capacity and Internet access. Outside the mobile unit, assisters set up tables with educational materials, welcomed consumers, and encouraged them to apply. 


Assisters outside the mobile enrollment unit in Ventura County, CA

Rita Duarte-Weaver, a Community Services Coordinator with Ventura County Public Health, reported, “Families were able to get in-person application assistance in a familiar environment that was close to home.”

Florida assisters have deservedly won praise for leading the way in reaching out to and enrolling consumers. Florida uses an approach that is often used in public health: putting application data into a “heat map.” Heat maps show where there are gaps in application assistance, which has been particularly helpful in identifying areas of the state where consumers need more help in languages other than English, often Spanish or Creole. 

In a January teleconference hosted by Families USA, Jodi Ray, the Project Director for Florida Covering Kids & Families, said that the heat map allows them to “see where applications are being done, where outreach is being done, and make sure we’re not leaving holes anywhere. We can view this data by region. It’s been a big help to see what we’re doing and how.”

In New York, assisters conducted a statewide shopping mall tour, called “Sign up, New York,” where they encouraged consumers to enroll. Assisters set up booths in malls across the state to provide information and in-person help. What made this outreach event even better is that the tour included guest appearances by Marvel superhero Captain America, who also helped answer questions. 

Oregon assisters hit the slopes in their efforts to find uninsured young adults. According to Rachel Oh, Community Affairs Manager with Cover Oregon, assisters spent the day at a ski resort on Mt. Hood, encouraging seasonal employees to enroll in coverage. They also hung out at the bar at night, laptops open and ready to help. 

Funding for assisters must be preserved—and improved

In-person enrollment assistance isn’t just needed when a new health coverage program begins—it is needed year-round. States and the federal government should support an ongoing, professional workforce of experienced, well-trained enrollment assisters. In order to do that, marketplaces will need:

  • Sufficient funding to support an in-person assistance network
  • Consistent funding that allows programs to plan ahead and to invest in staff and retain qualified, experienced assisters from year to year
  • Strong coordination across the different types of assisters in the state, as well as with the federally facilitated or state-based marketplace and the Medicaid agency
  • Training and evaluation measures that take into account the amount of work assisters do to find the uninsured in their communities, to educate consumers about how insurance works and how to use their insurance, and to help consumers with issues they encounter after they are enrolled (in addition to assistance with applications and renewals)

Moreover, the current funding system does not take into account the reality that application assistance needs to be available throughout the year, not just during open enrollment periods. That’s because assisters must help people enroll not only in marketplace coverage, but also in Medicaid and CHIP, where enrollment is open throughout the year. In addition, funding and training for assisters should be better integrated to ensure that they have the tools, information, and support they need to help consumers who may transition between programs during the year or who have family members who qualify for different programs. 

Preserving and strengthening in-person assistance will ensure that the phenomenal gains we have made in coverage will be maintained and that even more consumers will get the health coverage they need. 

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