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The Top 6 Resources Every Assister Needs for Open Enrollment

October 3, 2024 |  By Jodi Ray, MA

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The 12th Open Enrollment Period (OEP) is almost upon us. Whether you are a seasoned assister (i.e., Navigator or Certified Application Counselor) or you’re new to outreach and enrollment through HealthCare.gov in the Federally-Facilitated Marketplace states, we have learned from past experiences that preparation is key to success.

Over the previous 11 OEPs, statistics have shown that enrollment in health coverage through the Marketplaces as well as Medicaid and CHIP is crucial to many individuals and their families. Since the first OEP in 2013, assisters helped over 45 million people enroll in ACA coverage through State-Based and Federally-Facilitated Marketplaces, Medicaid or CHIP, and Basic Health Programs, yet a significant number remain uninsured. KFF found that over 20% of consumers lack the confidence to apply on their own or have a limited understanding of Affordable Care Act (ACA) requirements and benefits.

At Transform Health, we believe outreach and enrollment work is mission critical to health systems change, and we want to support assisters in making the most out of Open Enrollment to increase access to affordable, quality health care.

Check out these essential resources for assisters this fall:

1) Registration for Technical Assistance Portal (REGTAP)

The Biden Administration expanded the toolkit for assisters and enrollment teams with REGTAP, from the Centers for Medicare and Medicaid Services (CMS). Log in today to find materials including:

  • 30/60/90-Day Checklist for Navigator Awardees, outlining a series of steps that will help you build a successful program over the first three months.
  • Webinars on Reducing Racial Disparities in Health Outcomes and Promoting Equity, How to Resolve Income Data Matching Inconsistencies (DMIs), and Health Plan Coverage Effectuation: Payment, Grace Periods, and Terminations.
  • Job Aids such as Understanding the Summary of Benefits and Coverage and Serving Individuals with Disabilities.

2) Creating Outreach and Education Events

Learn how to research outreach and education opportunities and plan outreach events with this CMS job aid. Tips include how to conduct effective outreach and how to engage vulnerable communities. It also includes ideas on how to track, monitor, and evaluate your efforts, which is especially helpful to demonstrate the value of outreach to organizational leadership and funders.

Find more educational and promotional resources from CMS.

3) Health Equity Technical Assistance

The CMS Office of Minority Health offers health equity technical assistance resources to help health care organizations address health disparities, including:

  • Personalized coaching and resources to help you embed health equity into your service delivery model.
  • Assistance developing a language access plan and ensuring effective communication with the diverse populations you serve.

4) Coverage to Care (C2C) Presentation

Strengthen your consumer support and enrollment activities by providing information to help consumers understand and navigate the health care system. These webinar slides cover key C2C tools that will support your assister team’s consumer education efforts, including:

  • 5 Ways to Make the Most of Your Health Coverage
  • Prevention Resources
  • Roadmap to Better Care
  • Roadmap to Behavioral Health
  • Manage Your Health Care Costs
  • Enrollment Toolkit
  • Partner Toolkit and Community Presentation

5) The Assister’s Roadmap to Resources

This toolkit is your quick guide to CMS resources that can help you navigate the Marketplace. Topics include:

  • How to get the latest information on Marketplace policies and operations from CMS.
  • What coverage options are available to consumers.
  • What you need to know about the Marketplace eligibility and enrollment process to help consumers get covered.
  • How to access Marketplace information and resources in other languages.

This resource also explains how to make sure you and your assister staff can stay up to date on any program and policy changes.

6) Working with Outside Organizations Job Aid

Assisters may be required under CMS regulations to provide certain kinds of referrals, or you may find it helpful to collaborate or partner with outside organizations as part of your outreach and enrollment assistance efforts. This CMS fact sheet provides information and guidance on making those referrals and engaging other outside organizations. Some common reasons to make referrals are:

  • Consumer grievances, complaints, and questions about health coverage.
  • Consumer questions about certain tax topics.
  • Consumers’ legal questions related to Marketplace eligibility appeals.
  • Referrals to other Assisters, the Marketplace call center, and how to refer to brokers/agents if requested by a consumer.

Additionally, you get tips for working with outside organizations and best practices for what is allowed and what is prohibited to maximize your partnerships.

Additional Resources

Other reliable, tested resources supporting the Federally-Facilitated Marketplace states include the Center on Health Insurance Reforms from Georgetown University and Beyond the Basics resources from the Center on Budget and Policy Priorities.

And not to be overlooked, HealthCare.gov’s glossary of health care terms can help move conversations forward.

Bookmarking some of these resources to support your targeted outreach and enrollment efforts may help increase your outreach activities into new areas.

Transform Health is a nationally certified women and minority led health care consulting firm. Reach out to us today if you would like to work together. Contact Heather Bates, COO, and VP of Stakeholder Engagement at heather@transformhc.com. We would love to hear from you!