Key Implementation Issues: Outreach and Consumer Assistance

The ACA has the potential to result in millions of individu¬als obtaining health care coverage—reducing the number of uninsured children by 3.2 million or 40 percent after 2014.1 To realize this potential it will be important for states to continue to develop and execute outreach strategies that target families with children. States must also grapple with a new vision for consumer assistance, one that employs technology to provide a seamless and high-quality customer experience. Along with providing new tools for web-based consumer assistance, such as online accounts and e-communications, the ACA introduces certified application counselors, in-person assistors, and navigators, to help educate and provide enrollment assistance to individuals and families about their coverage options.

For ACA expansions and innovations to successfully increase coverage for children and their families, states could consider leveraging the lessons learned from CHIP outreach and consumer assistance efforts. Some of the lessons learned and resources related to those lessons are provided in the bullets below:

In addition, the ACA presents multiple opportunities for Medicaid, CHIP, and marketplace programs to coordinate and improve the consumer experience. Some challenges and considerations include:

  • Coordinating outreach and consumer assistance across insurance affordability programs: This will be particularly important for families in complex coverage scenarios, such as when a child is CHIP or Medicaid-eligible and his or her parents are eligible for coverage in the marketplace.
    • Marketplaces have the option to target whole families by creating navigator programs that also assist with CHIP and Medicaid administrative functions. Federal CHIP and Medicaid funds are available to states that take this option. The final rule (Federal Register Vol. 77 No. 59) from the Department of Health and Human Services outlines requirements and options related to the navigator program.
    • Navigators and In-Person Assistors: State Policy and Program Design Considerations: This State Health Reform Assistance Network issue brief outlines state options in designing new consumer assistance entities and shares examples from states that are working towards a highly coordinated consumer assistance program.
  • Coordinating with community-based organizations and schools:These organizations have existing relationships with families and often offer application assistance. They can continue being an important tool for reaching eligible families, particularly in hard-to-reach populations, if existing efforts are coordinated with the ACA’s new consumer assistance requirements.
  • Coordinating call centers to assist consumers applying for Medicaid, CHIP, and marketplace coverage: The ACA requires call centers available to assist consumers whether they are applying for coverage through Medicaid, CHIP, or the marketplace.
    • States may want to consider consolidating call centers under one entity, with one phone number and built in referral structures, in order provide consumer-friendly assistance.
    • This presentation by Wakely Consulting Group provides a detailed assessment of Vermont’s existing call center operations and provides recommendation for meeting ACA requirements and industry best practices.

Additional State Resources

New: CoveredU:, funded by the Colorado Consumer Health Initiative (CCHI), is an interactive educational website for consumers to better understand what health insurance is and how to use it. The website is both an outreach tool that explains the value of health insurance through exploring different hypothetical scenarios that may cause individuals to seek care, and offers questions about health and emergency department utilization to help assess the best kind of health plan for the consumer. The site also links consumers to the Colorado state-based marketplace or to to enroll in coverage, and provides a checklist of the information consumers will need to navigate those marketplaces.

Massachusetts: The Blue Cross Blue Shield of Massachusetts Foundation, the Robert Wood Johnson Foundation, and the Commonwealth Health Insurance Connector Authority, developed a toolkit to share key outreach lessons learned by state leaders in Massachusetts.

Oregon: As of August 2012, Oregon had reached and enrolled an additional 114,000 children, representing a 42 percent increase in caseload. This presentation from the Oregon Health Authority shares lessons learned from these efforts, including the importance of message testing, culturally aware marketing, and dedicated outreach staff.

Other Resources

Consumer Assistance Small Group Convening: The State Coverage Initiatives brought together experts and state officials to discuss issues related to consumer assistance. Presentation slides are available here.

Designing Consumer Assistance Programs: Resources from the Field: This State Health Reform Assistance Network issue brief outlines major state decisions regarding consumer assistance strategies. This federal government website provides access to materials developed for the Connecting Kids to Coverage National Campaign.

Key Issues to Consider for Outreach and Enrollment Efforts Under Health Reform: This Kaiser Family Foundation brief highlights key issues for states to consider.

Medicaid: Messages, Messengers, and Mediums: This presentation by DC communications firm, GMMB, shares expert insight into Medicaid messaging and marketing.

Genevieve M. Kenney, et al., Improving Coverage For Children Under Health Reform Will Require Maintaining Current Eligibility Standards for Medicaid and CHIP. (Washington, DC: The Urban, December 2011).