Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage: A Case Study on Eagle, Garfield, and Pitkin Counties, Colorado

Abstract

The Patient Protection and Affordable Care Act (ACA) 1 laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. 2 During the first openenrollment season, states used a variety of strategies to reach out to and enroll newly eligible people. Typically, federal and state funding was used to develop navigator programs in each state. The design of these programs differed by location, 3 and, although many stakeholders were involved in these efforts, state and local health departments (LHDs) were, and remain, a relatively untapped resource.4 This is somewhat surprising, given that LHDs serve as trusted entities in communities, can reach the most-vulnerable populations, and have access to data and resources that might facilitate ACA outreach and enrollment. This is one in a series of reports designed to highlight innovative models and best practices that leverage LHD involvement in ACA outreach and enrollment and to facilitate knowledge transfer to other geographic regions looking to leverage the full range of roles for LHDs in ACA outreach and enrollment. Potential roles include serving as a coordinator for community activities, being a trusted source of health care information for consumers, and leveraging community partners to increase capacity for outreach and enrollment. These reports identify compelling models for how LHDs can implement similar activities in their own communities. Further, they provide guidance and insight into the role LHDs can play now, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage. Each case study • Outreach and enrollment efforts face challenges, such as inconsistencies between national and state enrollment processes, the fact that a major grant was not actually awarded until just before open enrollment began, underestimations of the time required to complete enrollments, and high insurance costs.• Some factors-such as a long history of partnership, trust, and strong communication; complementary, not competing, interests; strong community presence; the ability to influence policy; and shared decisionmaking across the alliance-help local health departments' efforts.