This report from the Texas Health Institute highlights lessons learned in reaching and enrolling diverse racial and ethnic populations in health insurance through the health insurance marketplaces created by the Affordable Care Act (ACA).  As of February 2015, nearly 11.7 million Americans had obtained health insurance through one of the ACA marketplaces.  It is projected that at least 24 million individuals will obtain health insurance through the marketplaces by 2019, of which nearly half will be persons of color, and one in four will speak a language other than English at home.

The report contains updates on marketplace policies and practices in seven previously profiled states (California, Colorado, Connecticut, Maryland, New York, Oregon, and Washington), along with profiles of two states that have partnership marketplaces (Arkansas and Illinois) and two states that use the federally facilitated marketplace (Florida and Texas).

Key informants in the various states were interviewed and identified the following best practices for successfully enrolling diverse populations through the health insurance marketplaces:

  • Work with trusted, culturally and linguistically competent messengers and in- person assisters.
  • Work to advance positive experiences and word-of-mouth as in certain diverse communities this is important for spreading awareness, dispelling myths, and helping overcome fears.
  • Assure in-person assistance is sustained over time, including between open enrollment periods to provide continued education and support.
  • Continue to make an intentional effort to plan for, reach, and assist diverse and vulnerable populations and subpopulations.
  • Utilize and analyze data to identify communities in need, and target interventions by region, population, community, or other factors.
  • Collaborate with community groups, including non-health-based or non-traditional groups, to reach harder-to-reach diverse communities.
  • Work with bilingual assisters as much as possible, as a language line where the interpreter is not present may not offer the level of assistance needed to help an individual enroll and effectuate.
  • Assure ongoing input from diverse community representatives.
  • Understand that the enrollment process— especially when compounded by language, culture, or lack of trust—can take much more time and “multiple touches” than anticipated to help people renew, answer questions on using insurance, interpret notices, and handle other concerns.

The report was funded by the Kaiser Permanente Community Benefit Fund and the W.K. Kellogg Foundation.

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