Maintaining public health insurance benefits: How primary care clinics help keep low-income patients insured

Abstract

Low-income families struggle to obtain and maintain public health insurance. We identified strategies used by Community Health Centers (CHCs) to assist patients with insurance applications, and assessed patients' receptivity to these efforts. Observational cross-case comparative study with four CHCs in Oregon. We observed insurance assistance processes, and interviewed 26 clinic staff and 18 patients/family members. Qualitative data were analyzed using a grounded theory approach. Patients' understanding of eligibility status, reapplication schedules, and how to apply, were major barriers to insurance enrollment. Clinic staff addressed these barriers by reminding patients when applications were due, assisting with applications as needed, and tracking submitted applications to ensure approval. Families trusted clinic staff with insurance enrollment support, and appreciated it. CHCs are effective at helping patients with public health insurance. Access to insurance expiration data, tools enabling enrollment activities, and compensation are needed to support enrollment services in CHCs.

Medicaid coverage accuracy in electronic health records

“…As over 26 million patients, many of whom belong to vulnerable populations, are seen at CHCs ( National Association of Community Health Centers, 2017 ), the use of EHR data for research may also be an important resource for population health planning and health equity initiatives moving forward. Correct insurance information in CHCs is also important as many CHCs offer insurance enrollment services to help their patients gain or maintain insurance ( https://www.hrsa.gov/about/news/press-releases/2015-11-13-outreach-enrollment.html, 2015 ; Hall et al, 2017 ; DeVoe, 2013 , DeVoe et al, 2014a ; Harding et al, 2017 ). We found that EHR and Medicaid data agreement varied with patient demographics, visit types, and clinic characteristics; agreement also varied by these characteristics depending on the time period.…”

Addressing Gaps in Children's Health Insurance Coverage During the COVID-19 Pandemic

“…9 Meanwhile, at a community-based clinic, barriers to enrollment for lowincome families were successfully addressed by creating reminders for deadlines, offering assistance with paperwork, and tracking submissions until approval. 10 Compounding the existing barriers to insurance coverage, the COVID-19 pandemic has created further constraints on interventions meant to increase public insurance enrollment related to physical distancing guidelines, rapid shifts to telemedicine, and limited resources for sustaining or expanding outreach efforts. To address these timely concerns, several recommendations can be extrapolated from the existing evidence base to mitigate anticipated impacts on the continuity of children's coverage.…”