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Ensuring that Eligibility Equals Enrollment

May 7, 2013

By Phillip Chung, The Colorado Trust

The Colorado Health Institute recently released a report stating that there are nearly 90,000 uninsured children in Colorado who are eligible for but not enrolled (EBNE) in a public health insurance program, such as Medicaid or Child Health Plan Plus. We know all-to-well the grim reality and repercussions of a lack of health insurance; studies show that compared to insured children, uninsured children are:

Five-times more likely to have an unmet need for medical care
Three-times more likely to not get a needed prescription drug and
Less likely to receive preventive services such as immunizations, dental and vision care.*

But let’s take it a step further and put those 90,000 EBNE children into context. Imagine if the entire population of Longmont (86,270) or the combined populations of Durango (16,887), Steamboat Springs (12,088), Alamosa (8,780), Louisville (18,376) and Wheat Ridge (30,166) didn’t have health insurance even though they were eligible for it?** That’s our reality in Colorado today.

As dizzying as those realities are, we know that advocates, policymakers, community partners and families are working tirelessly to make sure this unacceptable and unnecessary situation becomes a thing of the past. To help achieve the goal of all children covered, The Colorado Trust launched a three-year, $3.3 million strategy in 2009 called Expanding Outreach Enrollment for Children and Youth. The purpose of this effort was to create new outreach and application assistance programs within community-based organizations (CBOs), most of which had never provided public health insurance assistance. What was important is that these CBOs had well-established access to, regular contact with and trusted relationships with EBNE children and their families.

Through this effort, The Trust funded 19 CBOs across the state that operated in a variety of different settings, including homeless and housing organizations, youth development agencies and community health clinics. The Trust also partnered with The University of Colorado Denver to conduct an evaluation of 12 of the 19 participating organizations. The evaluation focused on three primary questions:

Reach: Which populations do CBOs reach and not reach?
Implementation: What outreach and application assistance strategies are CBOs using?
Effectiveness: What is the impact of these CBO models and strategies on enrollment, renewal of enrollment and use of benefits?

Key findings include:

The 12 CBOs assisted a total of 6,242 clients with public health insurance outreach and enrollment-related efforts. (Across all 19 Trust-funded grantees, application assistance was provided to over 30,000 clients.)
The majority of clients assisted were Hispanic (63 percent) and approximately half identified Spanish as their primary language.
93 percent of clients served by the 12 CBOs were successfully enrolled in Medicaid or Child Health Plan Plus and almost 90 percent used their health insurance benefits at least once.

The evaluation also identified the organizational characteristics important to implementing and sustaining an effective outreach and application assistance program for CBOs:

Ensure appropriate planning and start-up time. CBOs new to providing application assistance services need time to hire and train outreach workers, plan the new services and identify relevant community partners.
Organizational fit is key to enrollment success. CBOs that were the most successful in enrolling children had strong alignment between their outreach and application assistance services and the organization’s overall mission.
Emphasize in-reach rather than outreach strategies. The majority of CBOs in the evaluation used strategies within their organizations to identify and enroll EBNE children (i.e., in-reach) rather than outside of their organizations.

The evaluation findings speak to the important role that CBOs can play in assisting EBNE children and youth in Colorado. We hope you find the reports helpful to your work, share them with others and use them to foster conversation and action. We also encourage you to contact us if you have any ideas, questions or comments.

* http://www.insurekidsnow.gov/qa/index.html#Health_Insurance_Important
**2010 United States Census Bureau