With Open Enrollment Eight (OE8) coming up during COVID-19, outreach and enrollment is still critical and most of it is going to be done remotely or virtually with some level of social distancing efforts where space permits. Enrollment Assisters, Certified Application Counselors (CACs) and Navigators—be it state or federally funded, are redesigning their workflows to focus primarily on providing virtual consumer assistance. This means that internet, technology, translation, and telephonic tools all need to be ramped up as well as capacity-building in anticipation for handling this increased volume needs to happen now. Consumers are used to handing over stacks of papers or showing health insurance cards and generally do not speak insurance jargon– so those used to in-person help enrolling need to plan ahead now to meet the needs of consumers remotely.
Virtual outreach can be done in a variety of ways to engage consumers, just effectively as in-person outreach. For example, Facebook Live, elected official town halls, text messages, online church groups and school groups, and also in-person food delivery by including promotional stickers with a phone number or website on food packaging delivery items, etc. Over the course of the last six months, the world has had to reimagine and reconfigure almost every system and process to fit into a virtual setting, enrollment assistance being no exception. Transform Health, in partnership with the National Association of Community Health Centers (NACHC) conducted key informant interviews with assisters around the country and we developed a virtual outreach and enrollment workflow training tool to help assisters of all types engage in in this work virtually. This tool was created to serve as a guide for enrollment assisters and is a “living” document that can be amended based on individual program needs.
Please see NACHC’s resources for the Virtual Outreach and Enrollment Workflow.
Challenges in Fulfilling the Unmet Need
We know that outreach and enrollment assistance remains essential—even more so given the cuts to Navigator programs and outreach at the federal level, as a recent Kaiser Family Foundation survey found that about one in five consumers (18%) who looked for coverage or actively renewed their coverage received consumer assistance in the past year.[1] The decision to cross the threshold once all of the insurance options are reviewed and considered often requires the encouragement by an assister in order for the consumer to take action. With the uncertainty of COVID-19 and its impacts, our conversations with partners uncovered that while there are some shared challenges, unique issues and even solutions to outreach and enrollment during this time vary greatly each of those challenges, provides an opportunity to reimagine specific promising practices, efficiencies, strategies and lessons learned.
For example, Shelli Quenga, Director of Programs at Palmetto Project noted that, “[there is a] whole new crop of people who had employer coverage and never had to decide these things before.”[2] Indicating a trend found among many assisters that as the pandemic has caused a huge cohort of people whether transitioning off of employer-sponsored coverage the gig economy workers who have never sought insurance before, or simply those who are entering the insurance market for the first time, need help deciding coverage beyond the employer making those decisions for them.
Medicaid enrollments have also been on the rise, yet many states are struggling to keep up, as backlogs of applications, lag on processing times, and the issues borne out of the quick transition to remote work have shown a Medicaid flat line in most areas even as applications increase. To that end, Jodi Ray, Program Director of Florida Covering Kids & Families—a statewide Navigator program, remarked that in just the first two weeks of the pandemic alone, Florida was “slammed with Medicaid applications”, an experience all too familiar with assisters across the country.[3]
Promising Practices & Lessons Learned from Virtual Outreach and Enrollment So Far
In spite of the myriad of challenges during 2020, many assister organizations, including health centers, have found that previously tested methods can be modified to support our new remote world can continue to contribute to outreach and enrollment workflows. For example, Florida Covering Kids & Families held town halls with elected officials in Florida to get the word out about enrollment assistance, which has worked in the past before the pandemic and in a virtual world is met with increased demand. In Wisconsin, Allison Espeseth, Managing Director of Covering Wisconsin—a Navigator program based out of the University of Wisconsin, noted their increased promotion of the 2-1-1 hotline and use of webinars to jumpstart additional outreach efforts.[4]
The assisters we spoke with also shared caveats to look out for including the imminent rise of Enhanced Direct Enrollment (EDE) by private industry as it relates to efforts to defund the federally facilitated marketplace. Enhanced Direct Enrollment is an enrollment pathway that allows web-brokers to directly enroll consumers in Qualified Health Plans (QHPs) without redirecting consumers to Healthcare.gov. While EDE is a legitimate pathway to enroll in health insurance, it raises serious concerns about the implications of steering consumers away from the regulated healthcare.gov website. In addition to these concerns, web-brokers, unlike CACs and Navigators, earn commissions on enrollments and are not legally required to provide impartial information to the consumer as Navigators are obligated.[5]
Tia Whitaker, Statewide Director of Outreach and Enrollment, of the Pennsylvania Association of Community Health Centers (PACHC)—prior to 2020 served as the sole statewide Navigator organization, now in partnership with Cognosante as a subcontractor, helped delineate caveats for enrollment appointments in the virtual setting and how to set yourself up for success when enrolling someone virtually.[6] Tips such as signing on to your appointment a few minutes early or do a pre-call before the appointment to make sure that your equipment is functioning properly, your internet connection is working, and both parties can hear each other if visible connectivity gets cut off. Also, instituting a pre-screening workflow to triage what the consumer needs are and developing some preliminary pathways to sketch out what the appointment might look like can help to triage and prepare scheduling, especially when there is high-demand.
Additional Resources & What’s on the Horizon for Outreach and Enrollment Assistance
Additional resources such as the Special Enrollment Period (SEP) reference charts created by the Center on Budget and Policy Priorities (CBPP) are useful tools to share critical information such as the new “FEMA SEP” which allows consumers who lost qualifying coverage, but missed their 60-day SEP window, to enroll in Marketplace coverage until. This SEP lasts 60 days after the end of the disaster declaration.
In late August, CMS announced $10 million to be distributed in Navigator grants in the 28 states that use the Federally Facilitated Marketplace (FFM). A recent Health Affairs blog, “ACA Round-Up: Navigator Grantees, EHB Changes, And More” breaks down the updates to this new round of funding as well as the impact of states’ changes to Essential Health Benefits (EHB) benchmarks.[7]
Virtual Outreach and Enrollment is Year-Round
Outreach and enrollment still needs to occur year-round as we have seen with the over 30 million unemployed across the country and their changes in life circumstances under COVID-19. While Open Enrollment occurs from November 1st to December 15th in the FFM, and these dates can vary widely in state-based marketplaces, there are also options under Special Enrollment Periods (SEPs).
We would like to acknowledge the work of the several assisters who, through interviews and conversations, helped us develop this workflow and learn more about how they are doing this essential work during COVID-19.
And to the National Association of Community Health Centers for their partnership in developing and presenting this workflow.
To work with us or learn more about Transform Health please contact Heather Bates at heather@transformhc.com
[1] Pollitz et al. “Consumer Assistance in Health Insurance: Evidence of Impact and Unmet Need” Kaiser Family Foundation, (August 2020).
[2] Shelli Quenga, Interviewed by Heather Bates & Sara Gleysteen (June 2020)
[3] Jodi Ray, Interviewed by Heather Bates & Sara Gleysteen (June 2020)
[4] Allison Espeseth, Interviewed by Heather Bates & Sara Gleysteen (June 2020)
[5] Center for Consumer Information and Insurance Oversight, Navigators and Other Marketplace Assistance Programs, 2013
[6] Tia Whitaker, Interviewed by Heather Bates & Sara Gleysteen (June 2020)
[7] Centers for Medicare and Medicaid Services, “CMS Issues 2020 Federally-Facilitated Exchange Navigator Awards” (August 2020)