Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage: A Case Study on Eagle, Garfield, and Pitkin Counties, Colorado
Jul 8, 2016
The Patient Protection and Affordable Care Act (ACA) laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. This report summarizes seven case studies — Eagle, Garfield, and Pitkin counties, Colorado; Tacoma-Pierce County, Washington; New Orleans, Louisiana; Boston, Massachusetts; West Virginia; Houston, Texas; and Illinois — that leverage local health department (LHD) efforts in ACA outreach and enrollment to facilitate knowledge transfer to other geographic regions. Potential LHD roles include serving as a coordinator for community activities, being a trusted source of health care information for consumers, and leveraging relationships with community partners to increase capacity for outreach and enrollment. Also, the case studies provide guidance and insight into the current role of LHDs, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage.
Challenges to outreach and enrollment include inconsistencies between national and state enrollment processes, lack of access to major grant funding, underestimations of the time required to complete enrollments, and high insurance costs.
LHDs can be creative with limited resources and serve as an important liaison between state agencies and community organizations or residents.
Some factors — such as a long history of partnership and strong communication; complementary, not competing, interests; strong community presence; the ability to influence policy; and shared decisionmaking across alliances — help LHDs' efforts.
Trust established between LHDs and residents facilitated LHD communication to harder-to-reach residents facing barriers to enrolling in health insurance and the public about the availability of health services.
LHDs are skilled at contracting with local community-based organizations that have reach into specific communities for outreach and enrollment.
The diverse perspective of LHDs is critical to understanding the ACA, for successful outreach and enrollment efforts, and helping to shape the dialogue around health insurance within the community.
LHDs found creative ways to apply the practice of public health to outreach and enrollment.
Case study discussants identified different ways that national and federal agencies can support LHDs and their partners including:
A Case Study on Eagle, Garfield, and Pitkin Counties, Colorado
A Case Study on Tacoma-Pierce County, Washington
A Case Study on New Orleans, Louisiana
A Case Study on Boston, Massachusetts
A Case Study on West Virginia
A Case Study on Houston, Texas
A Case Study on Illinois