Wednesday, June 23, 2021

Obamacare enrollment at vaccination sites Part II: Navigators on their own, mostly

Subscribe to xpostfactoid

A month ago, I posited that the impressive drive to vaccinate all U.S. adults is also a golden opportunity to insure the uninsured. 

Vaccinations are free to all, but in the vaccination process the uninsured must identify themselves as such. An estimated 11 million uninsured are eligible for marketplace subsidies (now often zeroing out premiums entirely), and another 7 million for Medicaid. The emergency Special Enrollment Period launched by the Biden administration on February 15, running through August 15, opens the enrollment door to anyone who's uninsured and lacks access to other coverage -- and coincides with the vaccination drive. 

As noted in the prior post, while some assister groups have done outreach at vaccination sites, and at least a couple of states have supported such efforts to some degree, the initiative has come mainly from the assisters themselves (generally operating on a shoestring through the lean Trump years), not government agencies, and efforts have been scattered.  

That is accurate. CMS confirmed to me that while the agency gives assister groups vaccine information to disseminate, "CMS...has not promoted or organized any official Marketplace outreach or enrollment events in conjunction with any COVID-19 vaccination site or event."

Subscribe to xpostfactoid

That's a shame. Logistics and communications maestros on the Biden administration's vaccine task force, including Jeff Zients and Andy Slavitt, were previously steeped in the ACA enrollment process. The vaccine drive is of course incredibly high-stakes and highly complex: not wanting any distractions is understandable. Still, perhaps CMS* could manage a literature drop? Or a line item in the instructions to providers seeking vaccine reimbursement?  

Nope.  So what about initiatives from enrollment assisters?

Enrollment action on the vaccination grounds

There have been some. Mina Schultz at Young Invincibles heads up the National Get Covered Coalition,  comprising over 500 enrollment assister groups (it's the successor to EnrollAmerica, the primary private sector ACA enrollment initiative launched in 2013).  Schultz says that coalition members were discussing outreach at vaccination sites back in January. When the Biden administration announced the emergency Special Enrollment Period commencing February 15, however -- essentially a second Open Enrollment Period -- most groups were preoccupied with meeting demand, with resources severely limited by massive Trump administration budget cuts to the federally funded navigator program (from $63 million in 2016 to $10 million in 2018 and years following**). 

"Every program says funding cuts affected their ability to staff," Schultz says. "Outreach was always the part that got cut." Still, "a lot of groups are doing [outreach at vaccination sites] to varying degrees."

Jeremy Smith, Outreach Coordinator at First Choice Services in Charleston, West Virginia, has been an ACA navigator since the marketplace launched in fall 2013 -- weathering the Trump budget cuts that forced First Choice to provide enrollment assistance mainly by phone as opposed to in person, even before the pandemic struck. 

First Choice reached out to county vaccination sites about enrollment assistance. "We were able to get into one small county’s vaccination clinic for a few weeks," Smith told me.  "We set up an information booth and were able to hand out information to everyone coming in. It has since stopped because they have transitioned away from doing the large events." 

That county was exceptional, Smith said. "We asked a lot of counties and were told no, or they never called back.  They thought it was too dangerous to have additional people at the events." 

In Wisconsin, a little help from the Department of Health Services

Courtney Harris is the outreach and partnership development manager at Covering Wisconsin, the state's sole current grantee in the "navigator" enrollment assistance program funded by CMS (and mostly defunded by the Trump administration).  Doing outreach at vaccination sites "seems obvious to us" to, Harris says, "especially now, when vaccination is one of the few in-person event opportunities we have to be out in the community."

As elsewhere, though, "most assister groups these days are low-staffed, and we ourselves are just getting into a place of everybody being vaccinated and comfortable going back to in-person work." (The Biden administration did allocate a quick $2.5 million to navigator groups for the emergency SEP, and Covering Wisconsin received about $50,000.)

Vaccination sites have been available to assisters, Harris says, because the state health department is receptive to their efforts. But state officials have helped mainly by helping the assisters connect with local groups.  "They're also strapped for resources and focused on vaccine messaging. They're supportive, but we haven't gotten them to say 'this is what we're going to do -- we as an agency will start co-messaging.'"

The state health department "has helped us connect with local public health departments, and we've had some success there," Harris says. 

Based as it is at the University of Wisconsin, Covering Wisconsin has been active Dane County, which is transitioning away from mass vaccination sites, focusing on small brick-and-mortar sites and mobile sites. That shift is helpful for enrollment outreach.

"That's where we're going now," says Harris. "Not flagging people down at a mass site, but working in a smaller space, run by groups more trusted locally." Those spaces have included a pop-up vaccination site at a barber shop (a venue that's been getting some attention nationally). Covering Wisconsin and partners did previously set up booths at FEMA mass vaccination sites in Milwaukee, "but that was rare."

While public health officials are sympathetic, Harris says, "They're focused on the vaccine -- that's their priority. Because there's challenges just in messaging the vaccine, they're hesitant to confuse that message at all." Even for trained health insurance enrollment assisters, "we've had to talk people through how to distinguish: 'you don't need to be insured to get the vaccine, but if you're uninsured there's a new opportunity.'"

In fairness to federal as well as state healthcare and public health officials, those challenges should be acknowledged. In Wisconsin, says Harris, "The people running the Department of Health Services are ACA champions." But the lack of state initiative to integrate enrollment outreach with vaccination is "testament to how difficult it is when you're in serious COVID mode. Even for people who have the ACA in their heart, it's still a challenge to split your focus."

One thing vaccination and health insurance enrollment drives have in common is the sustained challenge of reaching vulnerable and hesitant populations. In those ongoing efforts, Harris sees opportunity. "The good thing about all this is that local public health departments are a natural partner for health insurance outreach. We need to build these relationships and leverage them." 

* Within CMS, the Center for Consumer Information and Insurance Oversight (CCIIO) oversees the Health Insurance Marketplace Navigator and Certified Application Counselors (CAC) programs,

** The Biden administration has allocated $80 million for navigator grants for the 2022 Open Enrollment season.

Corrections, 6/29/21: 1) Madison is in Dane County, not "Madison County" as originally written; and Covering Wisconsin did not, as originally reported, do an event at a library.

N.B. For a dive into the history and current state of ACA enrollment assistance, see this recent report from the Young Invincibles.

Obamacare enrollment at vaccination sites, Part I
HHS devotes $4.8 billion to COVID-test the uninsured. How about insuring them?
The ACA marketplace in Year 7: The navigators' view

Photo by Lagos Techie on Unsplash

Subscribe to xpostfactoid

No comments:

Post a Comment