I was pleased to see a report released this week by the Henry J. Kaiser Family Foundation examining the role of Assister Programs in helping people enroll and remain enrolled in health coverage under the Affordable Care Act (“ACA”). The report, “Survey of Health Insurance Marketplace Assister Programs: A First Look at Consumer Assistance under the Affordable Care Act,” found that Federally Qualified Health Centers (FQHCs) played a large part in the more than 4,400 Assister Programs which helped an estimated 10.6 million people during the first open enrollment period for the Marketplaces.

The term “Assister Programs” as used in the Kaiser report refers to Navigator, In Person Assister, and Certified Application Counselor programs under the ACA whose purpose is to help consumers understand their coverage options, apply for assistance, and enroll in health care coverage.  Assister Programs established in the first year authorized under the law (2013-2014) were predominantly funded by sources other than the Marketplaces.  Although the ACA requires all Marketplaces to establish and pay for Navigator Programs out of Marketplace operating revenues, Marketplaces didn’t have operating revenues in time for open enrollment. In fact, more than 70% of Assister Programs were supported by a federal safety net clinic program or privately, with $208 million in first year financing coming from HRSA grants to FQHCs.  HRSA also awarded $6.4 million in grants to state and regional Primary Care Associations to provide technical assistance and support to FQHC Assister Programs.

The report makes clear the important role specifically played by FQHCs – programs sponsored by FQHCs accounted for over a quarter of total Assister Programs and operated in every Marketplace. Additionally, 67% of Assister Programs run by FQHCs reported helping more than 1,000 people during the open enrollment period.

The report makes clear that the support of Assister Programs was integral during open enrollment, as most individuals who sought help were uninsured, and many also had limited health insurance literacy – such as struggling to understand even basic health insurance terms such as “deductible” and “network service.” Assister Programs reported that most or nearly all consumers they dealt with didn’t understand the ACA or the coverage options available to them, or lacked the confidence to apply on their own.

Read the full report here.
A second report from the Henry J. Kaiser Family Foundation also showed the importance of federally-qualified health centers to the efforts by Assister Programs to enroll eligible individuals into health coverage under the ACA. The brief, “What Worked and What’s Next? Strategies in Four States Leading ACA Enrollment Efforts,” explored the successful efforts of four states that each established a state Marketplace and implemented the ACA’s Medicaid expansion – Colorado, Connecticut, Kentucky, and Washington – in enrolling eligible individuals.

The brief outlines how FQHCs and other safety net providers “were key partners in outreach and enrollment efforts” for a number of reasons, notably because of these organizations’ existing relationships providing care in the community as well as consumer trust. The report cites specific examples of the work of FQHCs, such as a Kentucky FQHC that conducted “in-reach” to existing uninsured patients to help them enroll in coverage, and a Washington FQHC that used phone and email contact to encourage uninsured patients in its service area to visit the center for enrollment assistance.

Some FQHCs were also found to be taking steps past enrollment, such as an FQHC in Washington that established a tracking system to connect newly enrolled individuals  to primary care services through proactive appointment scheduling and follow-up about missed appointments to help address barriers to preventive care. Read the full issue brief here.