Fulfilling the vision: The role of enrollment workers in promoting health insurance access

Background: Though some immigrants have enrolled in insurance under the ACA, many are eligible for Medicaid but remain unenrolled. This includes those with Deferred Action for Childhood Arrivals (DACA) who are eligible for Medicaid under California state policy.

Methods: This study includes eight focus groups with 7 to 19 certified enrollment counselors (CECs) or government enrollment workers and 8 interviews with site program managers. Topics included successful enrollment practices and enrollment barriers for Latinos, immigrants, and mixed immigration status households.

Results: Participants noted that stigma related to accepting government entitlement programs and the quality of care available through Medicaid leads some clients to refuse coverage. Fears that using Medicaid might have immigration related consequences also limits its uptake.  Delayed communication between policy makers and front-line enrollment workers leads to confusion about how to process Medicaid applications for DACA recipients and mixed immigration status households.  Front-line enrollment workers also expressed frustration about inconsistent application of policies regarding various immigrant groups. They advocated for regular structured communication between government enrollment workers and CECs to improve application processing and increase enrollment. Participants also proposed educating clients about enrollment through community outreach and rebranding Medicaid as “just another plan” on the state exchange to decrease stigma. 

Conclusion: The ACA offers new opportunities to enroll immigrant groups in health insurance.  Consistent application of policies for immigrant groups and increased communication between government Medicaid enrollment workers and CECs can decrease enrollment barriers. Decreasing Medicaid’s stigma through community outreach and education may also increase enrollment.