Health insurance enrollment outreach & support

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 (Rated)

  • Increased health insurance coverage

Other Potential Beneficial Outcomes

  • 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).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

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).

Implementation Resources

CMS InsureKidsNow - Centers for Medicare and Medicaid Services (CMS). InsureKidsNow: Connecting kids to coverage national campaign.

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.

Urban-Monitoring and tracking state ACA implementation - Urban Institute. Monitoring and tracking implementation efforts of states and the Affordable Care Act.

Citations - Evidence

* Journal subscription may be required for access.

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 (MPR); 2014.

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.

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.

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.

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 (MPR); 2006.

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.

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.

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.

Citations - Implementation Examples

* Journal subscription may be required for access.

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 (MPR); 2007.

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.

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 (MPR); 2014.

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