Stakeholders Aim To Boost Rural Enrollment in ACA Coverage
Many of the millions of U.S. residents who remain uninsured even after the Affordable Care Act's initial open enrollment period are in rural areas, and such residents will be a key target as states and advocacy organizations develop strategies to enroll more people during the ACA's second enrollment period, Kaiser Health News reports.
HHS allocated $2.5 million towards enrollment outreach to rural areas during the ACA's initial enrollment period. Another $60 million is allocated to assist navigators with enrollment in states that are using the federal insurance exchange, although it is unclear how much of that funding will be used to bolster rural enrollment efforts, according to KHN.
Rural Residents Face Challenges Obtaining Coverage
According to KHN, residents of rural areas face several challenges to obtaining coverage, including needing to travel long distances to receive face-to-face help from navigators and having Internet connectivity problems, which have been accentuated by some state and federal exchange website glitches.
In addition, states and advocacy organizations have had more difficulty assisting residents of rural areas with obtaining coverage in states that have not expanded Medicaid or do not operate their own state-based exchanges. Challenges have included:
- States that have both declined to operate their own exchanges and expand Medicaid have had less federal funds and revenue generated from their exchanges to conduct outreach efforts, including to rural areas;
- Non-expansion states have had had fewer coverage options for rural residents, with many such residents falling into the "coverage gap" of residents with incomes too high to qualify for standard Medicaid coverage but too low to qualify for federal subsidies to help them purchase exchange coverage; and
- CMS has not yet released enrollment data by county for states that are using the federal exchange, making it more difficult for stakeholders to carry out targeted outreach efforts.
Strategies for Upcoming Open Enrollment Period
Stakeholders are developing strategies to enroll more rural residents in the upcoming open enrollment period, KHN reports. For example:
- Enrollment navigators in Virginia are using anecdotal evidence to target enrollment in the absence of federal enrollment data by county;
- A private consortium, backed by Blue Cross and Blue Shield of Minnesota Foundation, is gathering data on where outreach efforts worked for the past open enrollment period to refine plans for the upcoming open enrollment period; and
- Minnesota's state exchange, MNsure, plans to bolster its enrollment of rural farmers and miners by advertising on specific radio stations and sending state exchange representatives to various events, such as farmers' markets and county fairs (Luthra, Kaiser Health News, 9/8).