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Thursday, April 16, 2015

Improving ACA Enrollment of Communities of Color

Cathy Kaufmann

Enrollment Program Director

In the second open enrollment period that just ended, one million more people of color signed up for marketplace coverage under the Affordable Care Act than enrolled during the first year. This achievement is thanks in large part to the more than 20,000 thousand navigators and assisters around the country who offered in-person assistance in communities of color. But we’re far from achieving equity when it comes to health coverage. Here we share recommendations to improve enrollment efforts in communities of color.

Reducing health disparities by increasing enrollment in the marketplace 

Discrepancies in access to health coverage have long contributed to health disparities for communities of color, causing devastating impacts on people and communities.

Fortunately, the ACA is contributing to reductions in the disparities in health insurance coverage by enabling more people to get affordable and high-quality insurance. Last week, we wrote about the number of people of color enrolled in the marketplace and the huge decline in the rates of uninsurance for Latinos and African Americans since the ACA took effect. 

We can—and must—do better. The improvements in coverage for communities of color show that enrollment efforts tailored to consumers of diverse racial and ethnic backgrounds do pay off. But we can’t afford to rest on our laurels. Fortunately, there are clear steps we can take to continue to build on this progress in the next open enrollment period and beyond. 

1. Increase the number of assisters in communities of color
It is imperative that the next wave of navigator grants as well as state-based assistance programs direct funding to help communities of color in the next open enrollment period. Increasing the number of assisters that focus on communities of color is necessary to ensure that consumers get the help they need to enroll in the right health plan and stay covered. 

The availability of assisters varies widely from state to state and from community to community, as does their ability to provide language-accessible and culturally competent help.

“Some consumers, particularly in hard-to-reach communities with language or other barriers, may not have had access to the information they needed to understand their choices and enroll in a plan that met their needs,” said Cindy Zeldin of Georgians for a Healthy Future in a news article last year, explaining that areas without assisters available tended to have lower enrollment numbers. 

All consumers benefit from having access to in-person assistance, and assisters are especially critical to reducing disparities that communities of color face (particularly African Americans and Latinos). An Enroll America survey found that African Americans and Latinos were 43 percent more likely to seek in-person enrollment assistance than white consumers. 

2. Produce culturally relevant materials in multiple languages. 
In addition to increasing the availability of targeted in-person assistance, more consumers need to know that help is available. Marketplaces and assisters must continue to develop and distribute culturally and linguistically relevant outreach and marketing materials. 

3. Ensure that help from assisters is available year-round
Assistance should be provided year round, not just during open enrollment periods. Enroll America’s recap on lessons learned from the first two open enrollment periods cites two reasons that year round assistance and outreach is crucial:

  • Assisters help identify people who are eligible for coverage year-round. Enrollment for Medicaid and CHIP takes place throughout the year. Year-round assistance will be particularly beneficial for communities of color, as people of color are disproportionately more likely to be enrolled in or eligible for Medicaid, especially in the 29 states that have expanded their programs. And some people will be eligible for marketplace coverage through a Special Enrollment Period (SEP), for example because of the birth of a child or because of a move from one state to another. 
  • Assisters can make sure consumers are ready for the next open enrollment period. Year-round assistance also means assisters can identify consumers who will be eligible during the open enrollment period before it starts, which allows time for the necessary follow-up and support.

4. Integrate training for assisters
Training for assisters should be better integrated—reflecting both marketplace and Medicaid/CHIP requirements—to ensure that they have the tools, information, and support that they need to guide consumers. For consumers who transition between coverage programs during the year, or who have family members who qualify for different programs, in-person assistance is crucial. In addition, to help better track progress and target funding, assister training should underscore the importance of documenting their clients’ race and ethnicity.

5. Improve processes for verifying identity and immigration status
Immigrant communities face additional challenges when it comes to enrolling in marketplace health coverage. The Georgetown Center for Children and Families reports that: 

“People in immigrant families continued to face significant barriers to enrollment during OE2, despite the fact that these barriers were well documented following the initial open enrollment period.”

Immigrants are required to use a complex, longer application form and go through a cumbersome, error-prone process to prove their identity and immigration status. First, marketplaces usually use a consumer’s credit history to verify his or her identity, but immigrant families, families with very low incomes, as well as young adults are less likely to have a bank account or a credit history. In these cases, proving identity requires additional layers of time-consuming bureaucracy, which can extend the application for weeks or even months.  

On top of that, the system for verifying immigration status often fails to accurately verify people’s status, which also adds extra steps for these consumers and results in protracted delays. Systems must be improved to reduce the bureaucratic barriers immigrant and very-low income families face.

Improving health insurance coverage rates for communities of color is key to fully implementing the Affordable Care Act

With tens of millions more people enrolled in affordable, quality health coverage, and significant gains made in rates of coverage for communities of color, we have much to be celebrate after the second open enrollment period. 

The ACA holds so much promise to improve both the health and financial stability of consumers across the country, particularly for those communities that have faced historical disparities in health. While we should tout the law’s achievements and recognize the efforts of the over tens of thousands of assisters who made it happen, we must continue to improve its implementation so that promise is fully realized.