Promising practices and lessons for reaching and enrolling racially and ethnically diverse communities in health insurance marketplaces

The Affordable Care Act (ACA) requires that each state’s navigator program for its health insurance marketplace consider culture and language in outreach and enrollment. Despite this intent, data suggest that a majority of eligible non-white and limited English proficient individuals are not enrolling for reasons including lack of awareness, lack of trust, and limited health insurance literacy. Recognizing the need for more tailored, effective outreach, The San Francisco Foundation is providing support to document models and strategies emerging across the country for effectively educating and enrolling diverse communities in the marketplace. Our study applies a multi-pronged approach including: a review and synthesis of research on outreach and enrollment in diverse communities, ACA-related federal guidelines for navigators and assisters, and emerging state/local initiatives, along with semi-structured interviews with leading states. To ground theory in practice, we also convened a co-educational forum in the San Francisco Bay Area, engaging key navigator and assister stakeholders to reach consensus on implications and practical application of study findings for local outreach and enrollment efforts. Our session will present findings, highlighting effective strategies for addressing equity, diversity, and cultural competency in navigator and assister program structure, staffing and training, communication and marketing, outreach and enrollment, and evaluation. Specific models will be presented from leading states, such as California and Connecticut, along with emerging tools and strategies for meeting federal requirements to assure culturally and linguistically appropriate outreach. Major challenges to advancing equity through navigators and assisters and practical ways to overcome them will also be discussed.