Geiger Gibson / RCHN Community Health Foundation Research Collaborative, issuing body.
Geiger Gibson Program in Community Health Policy, issuing body.
George Washington University. School of Public Health and Health Services, issuing body.
[Washington, D.C.] : George Washington University, School of Public Health and Health Services, January 14, 2014
This nationwide analysis of community health centers' early outreach and enrollment experiences under the Affordable Care Act (ACA) finds that all health centers are engaged in a significant and sustained effort to identify and assist eligible patients and community residents in obtaining health insurance coverage. Virtually all health centers have received expanded outreach and enrollment grants; in this survey, conducted on the eve of open enrollment, nearly three-quarters reported offering a range of outreach and enrollment assistance, such as locating eligible patients and community residents, assisting with both online and paper applications, and making the application process accessible to a multi-cultural, multi-language population. But in states with restrictive policies toward ACA implementation (defined as both opting out of the Medicaid adult expansion and adopting Navigator laws), health centers are confronting significantly greater outreach and enrollment challenges compared to health centers in states that have fully implemented the law through Medicaid expansion and without outreach and enrollment restrictions. Health centers located in restrictive states are significantly more likely to report constrained outreach and enrollment activities. Health centers in restrictive states were significantly less likely to: receive financial support for outreach; notify patients of potential eligibility; complete paper applications; and monitor the status of applications. In restrictive states, health centers were significantly more dependent on the federal government and their own primary care associations for information about the ACA. Health centers in restrictive states were also significantly less likely to have access to information from state officials, including information about Medicaid, which even in restrictive states is controlled by the state. Health centers in restrictive states were also less likely to provide access to legal services in the event of application denials. Of particular significance in measuring the impact of Navigator restrictions is the fact that health centers in restrictive states were significantly less likely to assist with plan enrollment. Many health center patients can be expected to have limited familiarity with health insurance and will need extensive help not only to obtain subsidies but also to enroll in health plans. Even though only slightly more than 2% of health centers receive Navigator grants, the significantly lower rate of plan enrollment assistance suggests that the regulatory burdens created by Navigator laws are affecting not only the work of certified Navigators but community outreach and enrollment efforts more generally. The greater outreach and enrollment challenges faced by health centers in restrictive states were mirrored in health center leaders' views regarding the ACA's ultimate impact on their patients. Among respondents in full implementation states, over one-third (37.5%) believed that the ACA would reduce their uninsured proportion to less than 10% of all patients. By contrast, only 11.3% of health center leaders in restrictive states believed that the ACA would have such a beneficial impact. In restrictive states, more than 10% of health center leaders believed that 75% or more of their patients would remain uninsured. These findings suggest that the policy and political environment in which community-based outreach activities are undertaken has a significant impact on the scope of outreach efforts as well as on perceptions regarding the ACA's ultimate impact on medically underserved communities. These findings also underscore the critically important role played by national organizations, state primary care associations, and the federal government in assisting community outreach efforts through information, technical assistance, and resources.
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