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Health insurance enrollment outreach & support

Health Factors: Access to Care
Decision Makers: Educators Healthcare Professionals & Advocates Nonprofit Leaders Public Health Professionals & Advocates
Evidence Rating: Some Evidence
Population Reach: 50-99% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Health insurance enrollment outreach and support programs assist individuals whose employers do not offer affordable coverage, who are self-employed, or unemployed with health insurance needs. Such programs can be offered by a variety of organizations, including government agencies, schools, community-based or non-profit organizations, health care organizations, and religious congregations. Outreach activities vary greatly, and can include community health worker (CHW) efforts, other person-to-person outreach, mass media and social media campaigns, school-based efforts, case management, or efforts in health care settings. Outreach can occur at local events, via hotlines, or at fixed locations (e.g., community centers, non-profit offices, etc.) and are often supported through grants from federal agencies or private foundations.

Expected Beneficial Outcomes

Increased health insurance coverage
Increased awareness of health insurance availability

Evidence of Effectiveness

There is some evidence enrollment outreach and support activities increase enrollment in health insurance programs (Mathematica-Hoag 2014), especially among children (Cochrane-Jia 2014, Cousineau 2011). However, additional evidence is needed to confirm effects.

Health insurance application support and information by community-based case managers may increase enrollment of uninsured children and reduce the time it takes for them to be enrolled (Cochrane-Jia 2014). Providing insurance applications to families seeking care in emergency departments may also increase child enrollment (Cochrane-Jia 2014). Multi-component approaches may also increase new enrollments of children (Cousineau 2011).

Based on the experience of programs working to enroll children in public insurance programs, school-based programs and campaigns appear to be successful strategies to reach those who are uninsured (Urban-Courtot 2009, Mathematica-Irvin 2006). An evaluation of Covering Kids and Families, a broad effort to reach uninsured children and their families, indicates that the program increases awareness of the availability of public health insurance programs for low and moderate income families, and may increase enrollment (Urban-Courtot 2009).

Partnering with other organizations (Urban/SHADAC-Courtot 2012, Urban-Courtot 2009) and using a mix of targeted messages and approaches is often recommended for successful outreach and enrollment activities (Urban/SHADAC-Courtot 2012). Including technology-based systems (e.g., online benefit applications) in enrollment efforts may maximize enrollment overall, while more traditional methods (e.g., community health worker outreach) may increase enrollment among harder to reach populations (Cousineau 2011). Outreach efforts that consider cultural and linguistic norms appear to increase insurance enrollment among Hispanic populations (AHRQ HCIE-Capitman, AHRQ HCIE-Chaves-Gnecco).

Early studies suggest that outreach programs such as Enroll America appear to increase ACA enrollment (Mathematica-Hoag 2014).

Implementation

United States

Insurance outreach and support efforts played a large role in the 1997 launch and subsequent expansion of the State Children’s Health Insurance Program (SCHIP). States’ outreach efforts evolved as their programs matured; general outreach and awareness strategies such as mass media campaigns were often replaced with targeted outreach via community organizations for hard to reach populations (Mathematica-Rosenbach 2007).

Outreach and enrollment programs have also accompanied the launch of the Affordable Care Act (ACA). An estimated 10.6 million individuals were supported by a mixture of 28,000 paid and volunteer workers from 4,400 programs in navigating the ACA health exchanges in their first year (KFF-Pollitz 2014), and organizations such as Enroll America provided outreach and education to maximize coverage uptake (Mathematica-Hoag 2014).

Wisconsin

Covering Kids and Families Wisconsin is a statewide coalition that works to maximize participation in health insurance coverage and other services that promote the health and well-being of children and families (CKFWI). Wisconsin’s ACCESS portal allows Wisconsinites to determine eligibility and apply for public health insurance such as Medicaid and BadgerCare Plus online (WI-ACCESS). 

Implementation Resources

CMS InsureKidsNow-Connecting Kids to Coverage - Centers for Medicare & Medicaid Services (CMS). InsureKidsNow: Connecting kids to coverage national campaign. Accessed on February 2, 2016
Kreuter 2014* - Kreuter MW, McBride TD, Caburnay CA, et al. What can health communication science offer for ACA implementation: Five evidence-informed strategies for expanding Medicaid enrollment. Milbank Quarterly. 2014;92(1):40-62. Accessed on February 2, 2016
Urban-Monitoring and tracking state ACA implementation - Urban Institute. Monitoring and tracking implementation efforts of states and the Affordable Care Act. Accessed on February 10, 2016

Citations - Evidence

AHRQ HCIE-Capitman - Capitman JA, Gonzalez A. Bilingual, culturally competent community health workers increase insurance enrollment, access to care, and self-efficacy among low-income Latinos. Rockville: AHRQ Health Care Innovations Exchange. Accessed on February 2, 2016
AHRQ HCIE-Chaves-Gnecco - Chaves-Gnecco D. Culturally competent outreach, services, and education improve access to insurance, primary care, and immunizations for Hispanic and Portuguese children. Rockville: AHRQ Health Care Innovations Exchange. Accessed on February 2, 2016
Cochrane-Jia 2014* - Jia LY, Yuan BB, Paul G. Strategies for expanding health insurance coverage in vulnerable populations. Cochrane Database of Systematic Reviews. 2014;(11):CD008194. Accessed on February 2, 2016
Cousineau 2011 - Cousineau MR, Stevens GD, Farias A. Measuring the impact of outreach and enrollment strategies for public health insurance in California. Health Services Research. 2011;46(1):319-335. Accessed on February 2, 2016
Mathematica-Hoag 2014 - Hoag S, Orzol S, Orfield C. Evaluation of enroll America: An implementation assessment and recommendations for future outreach efforts. Princeton: Mathematica Policy Research; 2014. Accessed on February 2, 2016
Mathematica-Irvin 2006 - Irvin C, Trenholm C, Rosenbach M. Detecting enrollment outbreaks in three states: The link between program enrollment and outreach. Princeton: Mathematica Policy Research; 2006. Accessed on February 2, 2016
Urban-Courtot 2009 - Courtot B, Klein A, Howell E,  Benatar S. Covering kids & families evaluation. Performing outreach with limited resources: CKF grantees' successes and challenges over three years. Washington, DC: Urban Institute; 2009. Accessed on February 2, 2016
Urban/SHADAC-Courtot 2012 - Courtot B, Coughlin TA. Best practices in SHAP outreach, eligibility, and enrollment activities. Issue Brief #30. Minneapolis, MN: University of Minnesota State Health Access Data Assistance Center (SHADAC), Washington, DC: Urban Institute; 2012. Accessed on February 2, 2016

Citations - Implementation

CKFWI - Covering Kids & Families (CKF) Wisconsin. Accessed on February 2, 2016
KFF-Pollitz 2014 - Pollitz K, Tolbert J, Ma R. Survey of health insurance marketplace assister programs. Menlo Park: Henry J. Kaiser Family Foundation (KFF); 2014. Accessed on February 2, 2016
Mathematica-Hoag 2014 - Hoag S, Orzol S, Orfield C. Evaluation of enroll America: An implementation assessment and recommendations for future outreach efforts. Princeton: Mathematica Policy Research; 2014. Accessed on February 2, 2016
Mathematica-Rosenbach 2007 - Rosenbach M, Irvin C, Merrill A, et al. National evaluation of the state children's health insurance program: A decade of expanding coverage and improving access. Princeton: Mathematica Policy Research; 2007. Accessed on February 2, 2016
WI-ACCESS - State of Wisconsin (WI). ACCESS: Your connection to programs for health, nutrition, and child care. Accessed on February 2, 2016

Page Last Updated

January 23, 2015

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