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Wednesday, April 20, 2016

Improving Marketplace Enrollment: Reflections from Assisters

Heather Bates

Director of Community Engagement

After the close of each open enrollment session, enrollment assisters often debrief with each other to discuss what worked and what lessons they learned about successful enrollment. In several debrief meetings we joined recently around the country, discussion frequently touched on the increasing complexity of consumers’ needs and assisters’ growing interest in professional development. 

Debrief meetings can be a powerful mechanism for program growth and celebrating achievements 

As members of the enrollment team at Families USA, we were invited to help plan and facilitate some of these debrief meetings. Reflections about lessons learned from the last open enrollment were a crucial component of those meetings, but many also used this time to look ahead and plan for next year.

Here are just a few key highlights from those debrief sessions that will inform future enrollment work. 

Suggestions for streamlining the marketplace enrollment process 

The debrief meetings offered assisters the opportunity to share their ideas for improving the consumer experience when enrolling in coverage. In the meetings we joined, assisters suggested solutions for common problems ranging from tax-related issues to frustrations with the marketplace call center. 

Improve the marketplace call center: Assisters offered suggestions that the Centers for Medicare and Medicaid Services (CMS) could make to reduce some of the challenges associated with the call center: 

  • Provide assisters with some level of back-end access to the marketplace website to allow them to assist their consumers without having to rely on the call center.
  • Create different “tiers” of call center representatives at the federally facilitated marketplace call center. Some representatives could be designated to help with basic issues related to account access, while others could assist consumers with more advanced issues, such as helping an applicant apply for coverage through a special enrollment period (SEP). 

Tampa Health Center CAC and Primary Care Association staff

Data-matching issues: Assisters have had difficulty with the process for resolving “data-matching issues.” Data-matching issues occur when an applicant has to provide additional information about their citizenship or immigration status. Assisters have continually found that the process is not transparent enough, making it difficult to navigate. Assisters are concerned about similar difficulties with the new processes that will require applicants to provide documentation to enroll through SEPs. They want to ensure the new processes are straightforward and flexible so consumers can successfully enroll when eligible. 

Consumer notices: Deciphering consumer notices to help consumers take necessary action is a big part of the assister’s role. Many report that consumers who come to them for in-person assistance find notices from plans and the marketplace to be too long with confusing jargon. Consumers with limited English proficiency have even more difficulty understanding notices and they often turn to assisters as the first place to go with questions. When consumers don’t understand notices, there can be far-reaching consequences, such as the termination of coverage when someone does not provide needed documentation.

Professional skills necessary for complex consumer needs and year-round work

It is clear from the debrief meetings from around the country that enrollment assisters are entering a new phase of professional growth. There’s a burgeoning interest in training opportunities as enrollment assisters strive to handle consumers’ complex needs.

Seeking training and partnerships: Enrollment assisters have sought additional training and resources to further enhance their programs. There’s a hunger to find new ways to meet the evolving needs of consumers in their communities. To that end, assisters have diversified their training portfolio to include support for: 

  • year-round outreach
  • program development
  • partnerships with organizations within their communities
  • advancing staff’s overall understanding of consumer protections
  • continuously improving the consumer assistance staff provide 

Sarasota CHW/CAC staff from the health center

Programs are showing creativity about how they develop their staff—from developing mentorship programs to allowing new assisters to shadow veteran assisters when they’re first starting out. 

Seeking certification to become community health workers, tax preparers, and more: Assisters want career pathways to further develop and apply their skills. In Florida, as in several states, certified application counselors in health centers are moving toward becoming dually-certified as community health workers. Not only does this enhance their ability to serve the community during open enrollment, but it also allows program managers to deploy this highly-skilled staff in a multitude of programs all year long.

Assister programs are also looking at ways to create or expand the roles of senior and junior level assisters in order to promote a visible career path. In many of our visits, we were encouraged to see that many assisters have been serving in their roles since the first open enrollment period, having institutional knowledge that they’re imparting on newer assisters joining their ranks. Many of these more senior assisters have taken on more formal responsibility since the first open enrollment period, now overseeing aspects of their organization’s program. Other locations are expanding assisters’ responsibilities by having them become volunteer tax preparers to be able to better assist consumers with complex needs.

There’s no off-season to outreach and enrollment work

Assisters also talked a lot about how there is no “off-season” to outreach and enrollment work. Strong programs are busy year-round helping consumers engage in a “culture of coverage.” Keeping assisters occupied is ongoing enrollment in Medicaid, the Children’s Health Insurance Program, and enrollment through special enrollment periods (SEPs). 

Assisters also help consumers navigate their health insurance plans once enrolled. This includes follow-up about what services and care is covered, education about reenrollment and renewals, help with marketplace eligibility and coverage appeals, and help with tax-related issues.

The help assisters provide is still much-needed and the out-of-the-box solutions they offer can empower consumers to get the most out of their coverage.