This report from the Pacific Health Consulting Group describes promising practice strategies that community health centers in California can use to enroll their uninsured patients through the health insurance marketplaces being implemented under the Patient Protection and Affordable Care Act (ACA).  The report was funded by the Blue Shield of California Foundation.

The ACA will expand coverage to millions of  Californians: as many as 880,000 Californians will be newly eligible for Medicaid (Medi-­Cal) and 1.6 million will be eligible for subsidies through California’s health insurance marketplace, Covered California.  An additional  880,000 residents are already eligible for Medi-­Cal but not yet enrolled.

Community health  centers have an instrumental role to play in educating their patients about the major changes in health care coverage options, explaining their eligibility requirements, and  assisting with their application, enrollment and health plan choices. Additionally, the ACA transition provides a window of opportunity for health  centers to strengthen their financial viability by significantly increasing the proportion of  their patients with insurance coverage and reinforcing patient loyalty to their health center provider.  Among the practices described are:

  • Engaging and educating the community health center staff in a “culture of coverage”
  • Promoting patient awareness/understanding of new coverage options and health center resources;
  • Targeted in-­reach strategies to those uninsured patients that are most likely to be eligible for Medi-­Cal (high-­yield populations)
  • Understanding how health center policies and practices incentivize or dis-­incentivize patients to apply for coverage
  • Establishing enrollment assistance as a core health center function, and
  • Re-­imagining enrollment assistance in a post-­reform environment.

In California, there will be multiple enrollment pathways available to patients through Covered California:  online, phone-­based, in-­person and mail/paper-­based  enrollment. The report reviews the key features and design of these pathways, and highlights some of the practical challenges and limitations that health centers should be aware of, including:

  • Electronic verification functionality and initial limitations
  • Timing for interfaces between the CalHEERS online portal and county SAWS eligibility  systems
  • Interim enrollment pathways for new versus currently Medi-­‐Cal eligible patients, and
  • Certified Enrollment Entity application requirements, certification process and tools to  support patients.

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