« November 2014 Issue

Open Enrollment Year Two: Reaching Underserved Communities in Missouri

With the second open enrollment period of the Affordable Care Act (ACA) now underway, the Missouri enrollment community has launched an aggressive outreach campaign to enroll uninsured Missourians, whose number currently stands at 742,000. Though that may seem like a daunting task, the campaign builds on a well-coordinated effort led by the Cover Missouri Coalition, which helped over 150,000 Missourians gain coverage through the federal Marketplace in the first enrollment period, operating under the Missouri Foundation for Health’s Expanding Coverage Initiative.

The Missouri enrollment experience provides a window into the complex and challenging process of helping people sign up for Marketplace coverage, particularly in states that did not create their own state-based Marketplace.

“The first enrollment period was a big step forward,” says Dara Taylor, Expanding Coverage through Consumer Assistance (ECTCA) Project Director at Community Catalyst. “We faced significant barriers in our work to spread awareness about the Marketplace – everything from legislative opposition, to anti-ACA advertisements, to letters given out in clinics that said ‘Do you know you have Obamacare?’ as a way to stigmatize the ACA.”

Missouri has also refused to accept federal funding to cover more of its residents through Medicaid. This leaves 300,000 Missourians who earn too much to qualify for the state’s existing Medicaid program but too little to get a tax credit through the Marketplace, to continue to fall into the coverage gap.

The Expanding Coverage through Consumer Assistance program (ECTCA) is part of the Missouri Foundation for Health’s Expanding Coverage Initiative, which is working to reduce the number of uninsured people in Missouri to less than 5 percent in five years. As a member of the ECTCA team, Community Catalyst’s St. Louis-based staff, Dara Taylor and Carrie Rogers, along with Boston-based policy support from Wells Wilkinson, provide technical assistance to the Cover Missouri Coalition: 17 organizations leading enrollment efforts across the state to reduce the number of uninsured. This initiative is unique among Community Catalyst’s projects because the target audience isn’t advocates, but those working on the ground to enroll people in ACA-based coverage: Certified Application Counselors, In-Person Assisters and Navigators.

During the first year of enrollment, working with the ECTCA staff the Cover Missouri Coalition worked to create awareness, train assisters to facilitate enrollment, and educate consumers about their best options for insurance plans. Working directly with enrollers, the ECTCA staff established a learning community to provide training on strategies for enrollment. This included monthly conference calls, informative updates and resource sharing via emails, one-on-one and small-group phone calls and webinars on topics such as use of social media, mobilizing volunteers and engaging the faith-based and Latino communities. The ECTCA team also created fact sheets and tools to help enrollment organizations understand specific issues such as extended enrollment periods and hardship exemptions for consumers in states that have not closed the coverage gap.

Since Missouri is facing similar enrollment challenges this year, using both tested and brand new strategies will be important “We made a lot of progress, and this year we’re incorporating much of what we learned from last year to develop new strategies,” said Taylor.  “We are working to identify new partners and train new messengers to talk to people about enrollment. Assisters are also doing pre-screenings of consumers with questionnaires to see their eligibility for subsidies prior to enrollment.”

Enrollment remains a challenge this time around. Missouri is a large state with only two major urban areas and many smaller rural communities, making it harder for enrollers to reach out to potential enrollees and educate them about their insurance options.  According to Taylor, lack of awareness about enrollment opportunities and financial assistance, cultural barriers, and mistrust of government are among the numerous challenges assisters face when trying to engage the uninsured. For many lower-income Missourians, other budget priorities, like housing, often take precedence over health insurance. This is why spreading the message that financial help is available to reduce the costs of coverage will be even more important this year.

In this second enrollment period, there will be a focus on hard-to-reach populations, including people living in rural communities, African Americans, Latinos, and members of the LGBT community. Enrollment strategies will also build on what worked the last time. Collaboration with community-based organizations, churches, and partners was a very effective way to provide resources to people in the community on how to sign up for coverage. Another successful approach was coupling enrollment events with other types of community events that address services other than health care.

This year the Missouri enrollment community hopes to capitalize on all these strategies, lessons learned, and improvements to the Marketplace to have an even more successful enrollment period.  There is a great deal of work ahead, but coalition efforts on the ground are stronger than ever and poised to face the challenge.

Jessicah Pierre, Communications Associate

O N   T H E   W I R E

Even in challenging environments, outreach and enrollment under the ACA was hugely successful last year. Community Catalyst’s  new video, Getting to Covered, tells the story of enrollment in three Southern States – Alabama, Florida and North Carolina. Thank you to everyone who worked to make the video a reality and to all the video participants. Special thanks to Jim Carnes with Alabama Arise, Ryan Morris with Florida CHAIN, and Nicole Dozier and Adam Linker with North Carolina Justice Center.

The New England Alliance for Children’s Health (NEACH) convened advocates from all six New England states at the 2014 Children’s Health Care Summit on November 12. NEACH celebrated this year’s Children’s Champion, Sandi Van Scoyoc, for her dedication to the health of children in New Hampshire and the true impact her work as president of the HNH Foundation created for them. Lieutenant Governor Elizabeth Roberts of Rhode Island spoke about her role as a child health advocate and the importance of such advocacy going forward.

More than 70 advocates, geriatrics provider experts, speakers and panelists attended the Voices for Better Health second annual Convening, held October 22 through 24 in Chicago, participating in sessions covering a wide array of topics central to the dual eligible demonstration projects. A highlight was the inspirational keynote address delivered by Marca Bristo, President and CEO of Access Living, Chicago’s center for independent living. Ms. Bristo helped draft and win passage of the ADA and is currently leading a campaign to promote the ratification in the United States of the UN Convention on the Rights of People with Disabilities.

Christine Barber, Senior Policy Analyst, and Eva Marie Stahl, New England Alliance for Children’s Health Director, explain to U.S. News & World Report how coverage options like the Children’s Health Insurance Program help children remain covered.

Dara Taylor, Director of the Expanding Coverage through Consumer Assistance Program in Missouri, explained successful strategies to engage the uninsured to enroll in coverage on KCUR 89.3FM.

Michael Miller, Director of Strategic Policy, discusses in the Washington Post the importance of hospital finance assistance, even as more consumers gain coverage.

Join us in welcoming new staff members: Sherry Dai, Sadie DeCourcy, Amber Ma, Trevon Mayers, Meredith Munn, Puja Patel, Jackie Rivera and Tory Stephens.

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