Organizing Stakeholders for Health Coverage Outreach and Enrollment: A Call to Action
September 23, 2026 | By Heather Bates, MSW, ACC, and Ani Fête Crews
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We are facing substantial health coverage disenrollment as the impacts of H.R. 1 take effect. During this upcoming open enrollment period, multiple policy changes and market factors including cost, complexity, and eligibility changes will force some individuals and families to make hard choices about their coverage. Reduced and insufficient coverage will further health disparities, worsen population health, and increase medical debt for consumers.
Now is a critical moment for organized, well-resourced outreach and enrollment efforts to ensure individuals and families can make the most informed choices and access the care available to them in their communities.
The need for outreach and enrollment support is not new. Plan options, networks, formularies, premiums, and out-of-pocket costs change from year-to-year.
People seeking access to affordable health care — through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or the Health Insurance Marketplaces established by the Affordable Care Act (ACA) — have always needed to understand when and how to enroll in, retain, and use coverage that meets their needs and budgets.
Today’s consumer needs this assistance, too, as they navigate significant change and misinformation in an already complex environment.
We know what works to build and sustain outreach and enrollment efforts.
Successful outreach and enrollment programs over the last few decades were funded across private, public, and philanthropic channels.
These efforts require coordination across multiple sectors and stakeholders who play important roles in the health coverage system with resources, capacity, power, and networks to help minimize coverage loss and optimize coordination.
Stakeholders include government, health care, insurance, pharmaceuticals, employers, researchers, consumer advocates, trusted community messengers, and more.
Medicare is an example of the sustained efforts needed to support these programs. We are still debating solvency issues and Medicare has been a successful and popular program that generations have relied on for over 60 years. We have used and funded these same strategies for Medicare outreach and enrollment because they work.
The stakes are high for the health of our communities.
Millions of Americans will lose coverage across Medicaid, Medicare, and private coverage through health insurance marketplaces over the next several years due to changes in eligibility and administrative error, through no fault of their own.
Consumers are already navigating changes like mandatory Medicaid work requirements in Medicaid expansion states, new six-month determination cycles for Medicaid in every state, upcoming mandatory pre-enrollment verification for all qualified health plans offered through HealthCare.gov, eligibility changes, premium increases, cost sharing and network changes, drug formulary adjustments, and more.
The Building Blocks for Year-Round Outreach and Enrollment
Philanthropy and others can fund an outreach and enrollment strategy that we know works, as demonstrated by previous efforts, to educate the public through trusted messengers about critical timing for enrolling in and retaining coverage.
The seven fundamental building blocks that we know work to make that possible include:
Story Banks
Create vetted stories of consumers impacted by coverage gains and losses to provide policy makers with timely and relevant data for ongoing implementation decisions. Access to quality, affordable health coverage will need to remain constant in policy conversations if we want to keep populations from losing coverage due to H.R. 1., and these stories will be especially helpful as state budget deliberations begin again in 2027 in many parts of the country.
Focus Groups
Test what messages work with consumers and document what does not make sense or prohibits enrollment.
Marketing Campaigns
Use the tested messages to inform enrollment campaigns that help people know when, where, and what to do each year. Earned media remains a powerful tool to reach people locally.
Public-Private Partnerships for Workforce
Match funding for enrollment assisters to expand their reach in the community and serve in the trusted messenger role.
Education Materials for Referral Partners
Create referral partner materials to direct consumers to the right trusted messengers for enrollment services (e.g., hospitals, community clinics, pharmacies, libraries, schools, colleges).
Collaborations
Convene partners to share educational needs and learnings, messages for consumers to take action, and opportunities to engage in outreach and enrollment.
Data Tracking
Monitor coverage loss and enrollment outcomes to elevate impact. The census data released this month provides a starting point for keeping track of coverage losses going forward.
Answer the Call
Start organizing stakeholders to minimize coverage loss and ensure consumers have the information they need to make the most informed choices in this environment.
We know what works, but it will take funding, planning, and coordination to execute effectively and quickly and document impacts and outcomes that can inform further policy deliberations in the future.
Book a discovery call with Transform Health to explore options and what this means for you.
Transform Health is an Inc. 5000-ranked national private health care consulting firm with a mission to drive systems change to build healthy communities.