Future of Obamacare enrollment assistance still being determined

Eva Bermudez was one of nearly 300 people tasked with helping the uninsured get covered as Obamacare rolled out last fall.

Her job might have seemed easy compared to those of her counterparts. An organizer with the union CSEA SEIU Local 2001, Bermudez focused her efforts on union members, many of whom had technological experience, Internet access and the ability to sign up for coverage online or by telephone.

Even so, they came to her for help.

“They wanted that hand-to-hand contact,” said Bermudez, who helped close to 1,000 people sign up for private insurance or Medicaid through the state’s health insurance exchange, Access Health CT.

She described her experiences to the exchange’s board Thursday, imploring state officials to make the same type of in-person assistance available this fall, when the next round of open enrollment for health care coverage under Obamacare begins.

The federal funding for the assistance program ran out earlier this year, and there’s no publicly available plan for what will happen during the next enrollment period, which begins Nov. 15.

Others who helped people sign up for coverage last fall and winter made similar appeals. They spoke of helping people who didn’t initially understand the application questions or who had questions about what insurance was. Some said people have returned with questions about how to use their coverage or get care, even though the assistance program is now over.

“Every state is struggling to figure out how to keep it going,” Access Health CEO Kevin Counihan said.

Connecticut will have an in-person assister program in the fall, Counihan said. But he said it might differ from the previous version. And how it will be funded remains unclear.

During the previous open enrollment period, the program ran on close to $2.6 million in federal funds, with additional grants from foundations.

This year, Access Health plans to contribute about $456,000 in funds and supplies, and the state Department of Social Services might come up with some money, too, Counihan said. The exchange is also applying for federal money for the program.

And Counihan said the program could be more targeted. Two-thirds of those who remain uninsured are concentrated in 10 cities. Most are eligible for Medicaid. And there’s data on which assisters were the most effective at helping people sign up.

“Now we can be a lot more focused,” Counihan said.

Fewer uninsured, but harder to reach

Recent research done on behalf of the exchange indicated that more than half of those who signed up for coverage were previously uninsured.

“We have fewer people to go after in terms of the uninsured population,” Jason Madrak, Access Health’s chief marketing officer told board members Thursday. “But finding those people can be quite difficult.”

Even though research suggests that most of the uninsured are concentrated geographically, Madrak noted that people who haven’t signed up for coverage are those who didn’t respond to a major marketing and outreach effort last year, suggesting the need to refine messaging and enrollment assistance.

Benjamin Barnes, the state budget director and an exchange board member, said it would make sense to put more emphasis on “trust-based channels” like in-person assisters to reach people who haven’t responded to mass marketing, who might have other challenges.

“As we shrink down, we’re probably going to need to have more high-touch, high-trust interactions with our customers,” he said.

But the next open enrollment period won’t just be about finding the uninsured; it will also require keeping people covered. Customers who signed up for private insurance last year will have to re-enroll, and there will be many new plan options to choose from.

In addition, more than 50,000 Connecticut residents have individual-market health plans that they won’t be able to keep past this year, meaning many are likely to be searching for new plans.

From enrollment to getting care

During the previous open enrollment period, which ran from Oct. 1 to March 31, 239 people worked as in-person assisters. About a third spoke Spanish. By the end of March, they reported having worked with 289,072 people and signed up more than 19,000 state residents for health care coverage, according to a report on the program presented to the exchange board earlier this year.

Access Health officials say one of their goals for the future is to help people understand how to use their coverage, not just get them signed up.

Two Yale School of Public Health researchers who studied the enrollment experience suggested that could be part of the job of a year-round, in-person assistance program, focused on meeting the needs of underserved communities.

“If Connecticut is to cover as many people as possible under the [Affordable Care Act], this effort must be preserved and improved,” wrote the researchers, Jeannette Ickovics and Alycia Santilli, of Yale’s Community Alliance for Research and Engagement, or CARE.

They surveyed 164 people who received in-person assistance and 121 uninsured state residents. They also held focus groups and focus groups with people involved in the assistance and outreach work.

Santilli said the in-person assisters stood out.

“They provided a critical service for consumers who were having a hard time navigating either the helpline or the website,” she said.

When asked about the ability to get needed information, 94 percent of survey participants who sought in-person assistance said they always got the information they needed, compared with 33 percent of telephone helpline users and 28 percent of website users.

They also found overall high rates of satisfaction with the enrollment process and with Access Health. Latinos, blacks and people with less education reported higher levels of satisfaction, although Santilli said data wasn’t available to explain why.

Michelle Jimenez, an outreach and enrollment specialist at Planned Parenthood of Southern New England, said many people need someone to spend the time to help them through the enrollment process, and said being able to do it in person is key. While helping a 20-year-old woman in Stamford apply for coverage, Jimenez said, she realized the woman didn’t understand the questions she was asking.

“Luckily we were in the same room, so I was able to physically review the paperwork I’d asked her to bring,” she said.

Jimenez said some people have questions about what “household” — a key term in the application — means. Some people have questions about how to proceed if some of their family members are not in the U.S. legally. Others have questions about insurance terms, like “out-of-pocket maximum,” that they need to evaluate which insurance plan to buy, or about the federal tax credits that are available to discount some people’s premiums.

“It’s a lot of education,” she said.