Making the Most of Public Health Insurance Benefits: Getting Eligible Individuals and Families Enrolled and Connecting them to Care

Over the last several years, much media attention has been given to our nation’s health care delivery system and access to health insurance. According to Kaiser Health News, the number of uninsured people in the United States rose to an all time high of over 50 million people during 2010.^[i] In an attempt to address this growing concern, the federal government passed the Affordable Care Act (ACA) to create health insurance exchanges and extend Medicaid coverage to all children and adults that fall below 133% of the federal poverty level over the next several years. The increase of health insurance program access will undoubtedly have an impact on the number of insured patients that community health centers serve.

However, increasing the number of people eligible to receive public health insurance coverage is just one piece of the puzzle.  Just because someone becomes eligible does not mean that he or she will sign-up for public health insurance or utilize health care services. Outreach staff is well-positioned to help ensure newly eligible individuals understand new requirements for public health insurance, help with enrollment to health insurance programs, and increase the likelihood that these individuals and families fully use the available health services. Specifically, outreach staff can work with newly enrolled individuals and families to overcome the common barriers of accessing health care such as transportation and language needs.

For outreach workers to effectively ensure that enrollment and utilization of public health insurance benefits occurs for hard-to-reach populations, they must increase their own knowledge of public health insurance benefits programs. In particular, outreach workers should remember that the health delivery system and enrollment process for health insurance can sometimes be overwhelming and confusing, especially for individuals and families that migrate for work. Many public health insurance programs, while governed by broad federal guidelines, are implemented differently from state to state. Navigating the different ways in which states implement similar programs can be frustrating. It is imperative that outreach workers actively seek accurate information and stay informed to help individuals and families navigate this complex system.

Public health insurance outreach should strive to increase eligible individuals’ and families’ access to these programs by informing their communities about the various benefits for which they may qualify. Understanding the application processes, the eligibility requirements, and the documentation required to successfully apply will also help demystify the process and increase comfort levels. In addition to explaining the application process, helping to complete applications can be a tremendous help to individuals and families with limited literacy or familiarity with seeking any type of public assistance. Finally, building in steps for following-up will ensure that eligible families continue to maintain their health benefits. For example, consider phone calls, visits, or welcome packets to help guide individuals and families regarding next steps once insurance coverage is obtained. Consider including specific action steps they can take in making appointments and receiving preventative care, what to expect out of the health care delivery system in the case of acute illness, and how to maintain insurance coverage including documentation they will need to keep track of over the next months or year to come. Helping those enrolled follow renewal and re-enrollment procedures will help keep more people connected and engaged in their health care.

Making increased enrollment a priority will not only help the communities you serve, but it will help your community health center meet the organization’s financial goals by having more patients covered by insurance. For more specific information on how to make sure your outreach program is prepared to increase enrollment in public health insurance benefits programs, contact Health Outreach Partners. We can assist you in identifying concrete ways to connect with your populations, increase your knowledge about public health insurance programs, and plan for the upcoming changes to their eligibility requirements.

Additional Resources:

To learn more about Medicaid and CHIP programs in each state or to access links to administering agency websites, please visit: http://insurekidsnow.gov/state/index.html

Following is a link to a public benefits eligibility tool, which connects you to government benefits and assistance programs and offers guidance on application processes: http://www.benefits.gov/