San Diego Navigators Target Hard-To-Reach Groups for Exchange

SAN DIEGO — Twelve California agencies have been awarded navigator grants to boost health insurance enrollment in the San Diego area. The third open enrollment period under the Affordable Care Act starts Nov. 1 and runs through Jan. 31, 2016.

The twelve agencies will receive a combined $1.7 million, distributed in grants ranging from $50,000 to $500,000. In total, Covered California has issued more than $10 million in grants to 68 navigator organizations throughout California.

As of March 2015, more than 1.3 million Californians have signed up for insurance through the exchange; 168,000 of them were from San Diego County. Prior to the law taking full effect in 2014, San Diego County had just shy of 400,000 uninsured people.

Efforts for the third open enrollment period are focused on bringing harder-to-reach groups into the exchange. Nationwide, 18 million people who are eligible to buy insurance under the ACA haven’t signed up yet. Latinos and young adults have historically had the highest uninsured rates and remain the focus of outreach efforts. These groups also experienced the largest drop in their uninsured rates since the law took effect.

According to a recent report by the Commonwealth Fund, young adults ages 19 to 34 saw their uninsured rate fall from 28% to 18% since September 2013. The rate among Latinos declined from 36% to 23%, and the rate among low-income adults dropped from 35% to 24%.

In its second open enrollment period, Covered California participants became more diverse and younger across the state, said James Scullary, spokesperson for Covered California.

“During our first open enrollment period, 31% of subsidy-eligible consumers statewide self-identified themselves as Latino. That figure jumped to 37% during our most recent open enrollment,” he said.

The exchange’s population of blacks eligible for a subsidy increased from 3% to 4%, and the number of millennials — people between ages 18 and 34 — increased from 29% to 34% between the first and second years of open enrollment.

“These groups remain extremely important to what we’re doing, and we know we have more work to do,” Scullary said.

Community Focus Needed To Increase Enrollment

Navigator grants are awarded to community-based organizations that help consumers with in-person enrollment and renewal, as well as provide ongoing support and education on how to get the best value from their health plan, according to Covered California officials.

Having a “store front” presence in the community is critical to reach those who remain uninsured, said Gary Rotto, director of health policy and strategic communications for Council of Community Clinics, an organization providing support services to community health centers in San Diego, Riverside and Imperial counties. Council of Community Clinics is receiving a $500,000 navigator grant for the upcoming open enrollment period.

People, he said, want a trusted name and location, and a place in their community they can come to for help.

Those who still lack coverage “will be arguably the most difficult to reach and those that need the most education in what health coverage is, how to get access and how to get covered,” Rotto said.

Many are likely to come from a range of ethnicities, including Hispanic, Middle Eastern and Southeast Asian, and are low income. Often language and other barriers call for in-person assistance with navigators who can speak their language and understand their culture.

Learning From Past Enrollment Periods

Many of the community organizations working as navigators in San Diego are adjusting their strategies based on past years’ experience.

Access California Services, which is receiving a first-time, $50,000 navigator grant, focuses on providing social and economic resources to local Arab- and Muslim-Americans, refugees and immigrants throughout Southern California.

This year, the agency will focus its attention most heavily on lower-income members of the Arab and Muslim community with annual earnings between 138% and 250% of poverty, said Nalha Kayali, founder and executive director of Access California Services. Work within the community in the past several years has demonstrated that this is the population with which the organization can have the biggest impact, Kayali said.

“They work and make money but it’s very hard for them to navigate the system,” Kayali said.

To reach those who remain uninsured, Access California Services will employ a number of strategies.

“We go where people work, shop and play and congregate,” Kayali said.

The organization will conduct outreach and provide educational sessions at churches and special community events.

A successful campaign used last year to get the word out — advertisements in ethnic newspapers — will be repeated. Many in the Arab and Muslim community, particularly people with lower incomes, rely on newspapers as a primary source of information, Kayali said.

“Those people still like to be connected with their culture and still read a lot of ethnic newspapers, so this is another great tool to bring them in,” Kayali said.

211 Infoline of San Diego County is scheduled to receive a navigator grant of $250,000. This is the organization’s second award.

According to Camey Christenson, director of partnership and development for 211, a study conducted by her organization after the first open enrollment to determine what kept people who remained uninsured out of the market identified cost and the documentation required to sign up for coverage as major barriers.

“That informed us as far as messaging and helped us in talking to callers about the average cost of not having health insurance. And in terms of documentation, making sure that we were experts in the nuances of what folks are eligible for and breaking through those barriers,” Christenson said.

The organization will make other adjustments to its outreach approach this year. “We originally began providing outreach in the community at several different existing events like farmers markets, and we found that rather than having one booth among many it was more meaningful to have many personalized relationships,” she said.  

Focusing on schools and businesses in specific industries with high rates of uninsured workers — such as tourism and restaurants — will be one way the organization targets groups still in need of coverage, Christenson said.

Christenson and Rotto said there’s also an opportunity to sign up many people their organizations are already working with.

211 Infoline of San Diego operates a call center that runs 24 hours a day, seven days a week in more than 200 languages. Those already calling in will be encouraged to sign up. 

Rotto said people using services offered by the Council of Community Clinics may have family members who can help in the organization’s outreach efforts and that workers will have those conversations with the clients they serve.

Whatever the approach, all agree that the third open enrollment period under the ACA must be more targeted than before.

“The folks that were already at the starting line and eager and ready already signed up,” Christenson said. “Now it’s really getting to the folks who may not be within a system of care now and may not be thinking they need insurance or understand the marketplace.”

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