Research Brief Report Community Health Events for Enrolling Uninsured Into Public Health Insurance Programs: Implications for Health Reform Scott Cheng, MPH; Kai-ya Tsai, MS; Lori M. Nascimento, MPH; Michael R. Cousineau, DrPH rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Objectives: To determine whether enrollment events may serve as a venue to identify eligible individuals, enroll them into health insurance programs, and educate them about the changes the Patient Protection and Affordable Care Act will bring about. Methods: More than 2900 surveys were administered to attendees of 7 public health insurance enrollment events in California. Surveys were used to identify whether participants had any change in understanding of health reform after participating in the event. Results: More than half of attendees at nearly all events had no knowledge about health reform before attending the event. On average, more than 80% of attendees knew more about health reform following the event and more than 80% believed that the law would benefit their families. Conclusions: Enrollment events can serve as an effective method to educate the public on health reform. Further research is recommended to explore in greater detail the impact community enrollment events can have on expanding public understanding of health reform. KEY WORDS: community enrollment event, education, health,
health insurance enrollment, health reform
The Patient Protection and Affordable Care Act (ACA) expands health care coverage for many Americans.1 The Congressional Budget Office projects that 32 million more people may gain coverage under the ACA by 2019.2-5 However, eligibility does not guarantee enrollment; an effective plan to identify and educate potentially eligible individuals and assist them J Public Health Management Practice, 2014, 20(6), 583–586 C 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright
enroll will be important.6 This will be particularly challenging in low-income communities where more than 1 strategy may be required to identify a significantly large number of new enrollees.7,8 New methods of engaging, enrolling, and retaining potentially eligible people will be necessary.9 However, many people still have limited knowledge about the ACA and how they might benefit from the new programs. Many will not know how to enroll, and navigate, and use public programs.10 Effective systems will require simplified enrollment tools and trained navigators and other strategies.11 Community health events offer a common approach for reaching a large number of individuals eligible for public health insurance programs.12 They represent an opportunity to educate the community about the ACA while offering health services and enrollment.13 Such events target many people and therefore may be one of many cost-effective approaches to outreach and enrollment. Still, these events require substantial investment of time and resources in planning and logistics without a guarantee of the number of people attending and eventually enrolling in programs. This brief discusses an evaluation of 7 enrollment events called WE Connect (WCEE) in California. WE Connect is supported and coordinated by The California
Author Affiliations: Department of Family Medicine and Preventive Medicine, Keck School of Medicine of the University of Southern California (USC), Los Angeles (Mr Cheng, Ms Tsai, and Dr Cousineau); The California Endowment, Los Angeles (Ms Nascimento); and USC Sol Price School of Public Policy, Los Angeles (Dr Cousineau). The authors declare no conflicts of interest. Correspondence: Scott Cheng, MPH, Department of Family Medicine, and Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto St, MC 9239, Los Angeles, CA 90089 (scottrocucla@ gmail.com). DOI: 10.1097/PHH.0b013e3182aaa280
583 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
584 ❘ Journal of Public Health Management and Practice Endowment and other funders to provide outreach and education, along with services, through a series of daylong health events in communities throughout the state. They are focused on improving community health and expanding health insurance enrollment. Importantly, events are part of The California Endowment’s comprehensive strategy aimed at increasing awareness about the ACA and facilitate enrollment into new health insurance programs.14 We Connect was organized in various counties throughout California through a collaboration of community organizations, funders, health providers, local governments, and advocates. Not all events of WCEE were selected for the evaluation; 7 events over a 6-month period were chosen for evaluation. Selected events were organized in 7 counties in California and principally involved a collaboration of community organizations, funders, health providers, local governments, and advocates. Thousands of people attended; the majority from low-income communities, drawn by available resources, particularly the promise of assistance in obtaining health insurance. Enrollment events are daylong efforts that are similar to popular health fairs that mobilize human services resources targeted to low-income communities. Events provided education about current and future enrollment options as well as important resources such as free groceries, health and dental screenings, and other types of human services. Health reform education was conducted through booths at the event or during one-on-one consultations, where individuals would learn about the anticipated changes to their health coverage. The approach to education was not uniform across the participants, as it was up to the individual to decide on stopping at the booths and/or one-on-one enrollment consultation. Free produce was provided at the exit of each event. This is also where the voluntary exit survey was conducted. To qualify for the produce, individuals had to visit a minimum number of booths within the fair. This was determined through stamps provided by vendors on a sheet provided to individuals at the beginning of the event.
● Evaluation To document and learn about the effectiveness of WCEE, the USC Center for Community Health Studies conducted an exit survey with participants and worked with Clear Thinking Communications, a public communications firm, to develop learning briefs that reflected on each event. The briefs combined survey results and interviews to provide a summary of key points at each event. The evaluation was designed to assess the effectiveness of community enrollment events as a strategy for enrolling people into public programs
and determine whether the events were a successful strategy to educate the public about the ACA. The exit surveys had 14 questions and measured participants’ knowledge about the ACA and their experiences at the event, including how they learned about the event. It was translated into multiple languages. The survey questions were developed by the WCEE staff prior to the first event. Some augmentation to the questionnaire was made, but in general, the questionnaires were the same throughout the course of the 7 events. One adult from each family was invited to take the survey. Depending on the participants’ preference, paper or electronic surveys were used. Surveys were uploaded on to the online tool (Qualtrics, Provo, Utah).15 An evaluation team attended each of the enrollment events to monitor and assist with survey completion. Volunteers were trained to assist administering the survey. Surveys were completed at the exit point of the events, and interviewers were placed alongside a free food distribution station. Respondents were given free produce from local grocers after completion of the survey, although survey completion was not required to receive the groceries. Surveys were administered at all 7 sites. In addition to the exit survey, event coordinators shared their opinions on the events’ successes and challenges. Interview questions were developed to understand the coordinators’ perceptions on local partners, event planning, event positives, and areas that could be improved. All data were stored on Qualtrics and were exported into the SAS (Statistical Analysis System) software for analysis.16 Because of the size of the event, the evaluators were unable to systematically survey participants and, instead, sought to interview as many people as possible as they left the event.
● Results More than 25 500 individuals attended the 7 events, based on counts that were taken as persons entered the event. Of these, approximately 2600 completed surveys, with the number of completions ranging from 252 in San Francisco County to a high of 646 in Santa Ana County. There were 2168 persons assisted through oneon-one consultations at all sites combined, and of these, 872 adults submitted an application for either Medi-Cal or another low-income health program (Table).
Knowledge about the ACA In all counties, more than half of participants reported that they were unfamiliar with the ACA prior to the event. Attendees were then asked whether they learned new information about the ACA during the event. At least 70% of participants reported “yes” at all 7 sites.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Community Event Implications Under Health Reform
❘ 585
TABLE ● Summary of Exit Survey Results
qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq County Alameda Fresno Riverside
No. Surveys conducted at each county No. Persons participated One-on-one consultations Adults applied for health care programs Parent applied for child for health care programs Knowledge about the ACA Knew nothing regarding the new health law, before the event Learned more regarding the ACA at the event Thought the new health law would be helpful to their family
San Bernardino
San Diego
San Francisco
Santa Ana
Total
127
233
374
504
461
252
646
2597
194 167 10
138 18 4
375 69 60
410 180 15
450 164 ...
185 142 43
416 132 17
2168 872 149a
45% 88% 91%
50% 84% 90%
55% 77% 84%
52% 91% 96%
45% 74% 80%
50% 91% 94%
56% 78% 87%
Abbreviation: ACA, the Patient Protection Affordable Care Act. a The total number of children’s application does not include numbers from San Diego County because the total number was not recorded at this site.
The highest was in San Bernardino and San Francisco (91%), whereas the lowest was in Riverside, San Diego, and Santa Ana counties (77%, 74%, and 78%, respectively). In all the counties, at least 80% reported that they felt that the ACA would help their family (Table).
● Discussion The study provides evidence that the WCEE is an effective strategy to engage uninsured individuals and families. By coupling health services with enrollment assistance, they were able to identify uninsured residents and link them to publicly supported health insurance programs and begin the enrollment process. The high volume of attendees at WCEE events are in line with previous studies, demonstrating that health fairs and enrollment events are a viable method to reaching large numbers in the community. However, reaching a large audience was only part of the goal of the WCEE. The surveys revealed that more than 2500 individuals initiated the enrollment process for public health insurance, about 10% of all those attending. It is possible that attendees were only interested in the health services provided at the events, or there may just not have been enough time due to long wait times for consultation. Further research into this will be valuable to determine how to maximize enrollment numbers at future events. The results also show that in all counties, there was improvement in how much the surveyed population understood about the health reform. The Kaiser Family Foundation polling reveals that approximately 44% of the population is still unclear as to the content and status of the health law.17 This coincides with the percentage of individuals we find at each event, who report no prior knowledge regarding health reform. Although the changes in percentage were relatively close,
there were still variances across counties. This could have resulted from regional specific factors or variance in design of the enrollment event. Future research is also recommended for this to determine not just what causes the variance in improvement but also how much is actually learned. There are some limitations to this study. Those interviewed were not randomly selected but, instead, all those exiting the event were given the opportunity to complete the survey just before obtaining free groceries. While this did increase the number of completed interviews, those completing the survey were not representative of all those attending. In addition, those who initiated an application for public health care insurance were not followed to determine whether the application was completed, submitted, and whether the individual eventually enrolled. This is a difficult task to complete because of the resources needed to follow-up with individuals and because, often times, families require additional meetings with eligible workers to bring in supporting documents to facilitate a completed application and eventual enrollment.
● Conclusion WE Connect provides a model for how community events can serve as a forum for educating the community about the ACA and enroll people into programs. They show that with the assistance from foundations or state and local governments, community organizations can create an effective large-scale enrollment and education tool. By fully engaging with local agencies in planning, foundations are assisting communities engage their residents in implementing a very large social policy. As more of the ACA is implemented and enrollment opens in many health benefit exchanges,
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
586 ❘ Journal of Public Health Management and Practice WCEE provides a model for informing newly eligible uninsured about how they could benefit from the expansions under the ACA and begin the process of enrollment. Further research is recommended to explore the factors that may influence initiating health care enrollment and what type of information participants retain regarding health reform. This study was submitted and approved by the USC institutional review board for the protection of human subjects. This study was supported with a contract from The California Endowment. REFERENCES 1. The Patient Protection and Affordable Care Act (ACA) Pub L No. 111-148. http://www.gpo.gov/fdsys/pkg/PLAW111publ148/content-detail.html. Accessed June 4, 2013. 2. Elmendorf D. 2010. HR 4872, Reconciliation Act of 2010. Congressional Budget Office and Staff of the Joint Committee on Taxation. http://www.cbo.gov/doc.cfm?index= 11355&zzz=40566. Accessed June 4, 2013. 3. Pourat N, Martinez AE, Kominski GF. Californians newly eligible for Medi-Cal under health care reform. Policy Brief UCLA Cent Health Policy Res. 2011;(PB2011-4):1-7. 4. Long P, Gruber J. Projecting the impact of the Affordable Care Act on California. Health Aff (Millwood). 2011;30(1): 63-70. 5. Jacobs K, Watson G, Kominski GF, et al. Nine Out of Ten NonElderly Californians Will Be Insured When the Affordable Care Act Is Fully Implemented. Berkeley, CA: UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research; 2012. http://laborcenter.berkeley .edu/healthcare/aca_implemented12. Accessed April 2013. 6. Kenney GM, Dubay L, Zuckerman S, Huntress M. Opting Out of the Medicaid Expansion Under the ACA: How Many Uninsured Adults Would Not Be Eligible for Medicaid? Washington, DC: Urban Institute Health Policy Center; 2012. http://www .urbaninstitute.org/UploadedPDF/412607-Opting-Out-ofthe-Medicaid-Expansion-Under-the-ACA. Accessed June 4, 2013.
7. Cousineau MR, Stevens GD, Farias A. Measuring the impact of outreach and enrollment strategies for public health insurance in California. Health Serv Res. 2011;46(1, pt 2):319-335. 8. Kempe A, Renfrew BL, Barrow J, Cherry D, Jones JS, Steiner JF. Barriers to enrollment in a state child health insurance program. Ambul Pediatr. 2001;1(3):169-177. ˜ 9. Castaneda X, Clayson ZC, Rundall T, Dong L, Sercaz M. Promising outreach practices: enrolling low-income children in health insurance programs in California. Health Promot Pract. 2003;4(4):430-438. 10. Wallace LS, Devoe JE, Hansen JS. Assessment of Children’s Public Health Insurance Program enrollment applications: a health literacy perspective. J Pediatr Health Care. 2011;25(2):133-137. 11. Fuld J, Farag M, Weinstein J, Gale LB. Enrolling and retaining uninsured and underinsured populations in public health insurance through a service integration model in New York City. Am J Public Health. 2013;103(2):202-205. 12. University of Southern California Division of Community Health. Reaching Out and Reaching In: Understanding Efforts to Identify and Enroll Uninsured Children into Health Insurance Programs. Los Angeles, CA: The California Endowment. http://communityhealth.usc.edu/Materials/ pdfs/(Jan 2006) Reaching Out and Reaching In.pdf. Published January 2006. Accessed September 12, 2013. 13. Main DS, Velonis AJ. The effectiveness of boosting public health insurance enrollment through community events. http://www.coloradotrust.org/attachments/0001/3768/ Published OutreachEnrollment CommunityEvents2010. 2010. Accessed June 4, 2013. 14. The California Endowment. Overview. http://www .calendow.org/about/overview.aspx. Accessed September 12, 2013. 15. Qualtrics [computer software]. Version 37,892 of the Qualtrics Research Suite. Provo, UT: Qualtrics. http://www.qualtrics .com. Accessed June 1, 2013. 16. SAS [computer software]. Version 8 of the SAS System for [Unix]. Cary, NC: SAS Institute Inc. 17. Kaiser Health Tracking Poll: August 2013. http://kff.org/ health-reform/poll-finding/kaiser-health-tracking-pollaugust-2013. Accessed September 4, 2013.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Objectives: To determine whether enrollment events may serve as a venue to identify eligible individuals, enroll them into health insurance programs, and educate them about the changes the Patient Protection and Affordable Care Act will bring about. Methods: More than 2900 surveys were administered to attendees of 7 public health insurance enrollment events in California. Surveys were used to identify whether participants had any change in understanding of health reform after participating in the event. Results: More than half of attendees at nearly all events had no knowledge about health reform before attending the event. On average, more than 80% of attendees knew more about health reform following the event and more than 80% believed that the law would benefit their families. Conclusions: Enrollment events can serve as an effective method to educate the public on health reform. Further research is recommended to explore in greater detail the impact community enrollment events can have on expanding public understanding of health reform. KEY WORDS: community enrollment event, education, health,
health insurance enrollment, health reform
The Patient Protection and Affordable Care Act (ACA) expands health care coverage for many Americans.1 The Congressional Budget Office projects that 32 million more people may gain coverage under the ACA by 2019.2-5 However, eligibility does not guarantee enrollment; an effective plan to identify and educate potentially eligible individuals and assist them J Public Health Management Practice, 2014, 20(6), 583–586 C 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright
enroll will be important.6 This will be particularly challenging in low-income communities where more than 1 strategy may be required to identify a significantly large number of new enrollees.7,8 New methods of engaging, enrolling, and retaining potentially eligible people will be necessary.9 However, many people still have limited knowledge about the ACA and how they might benefit from the new programs. Many will not know how to enroll, and navigate, and use public programs.10 Effective systems will require simplified enrollment tools and trained navigators and other strategies.11 Community health events offer a common approach for reaching a large number of individuals eligible for public health insurance programs.12 They represent an opportunity to educate the community about the ACA while offering health services and enrollment.13 Such events target many people and therefore may be one of many cost-effective approaches to outreach and enrollment. Still, these events require substantial investment of time and resources in planning and logistics without a guarantee of the number of people attending and eventually enrolling in programs. This brief discusses an evaluation of 7 enrollment events called WE Connect (WCEE) in California. WE Connect is supported and coordinated by The California
Author Affiliations: Department of Family Medicine and Preventive Medicine, Keck School of Medicine of the University of Southern California (USC), Los Angeles (Mr Cheng, Ms Tsai, and Dr Cousineau); The California Endowment, Los Angeles (Ms Nascimento); and USC Sol Price School of Public Policy, Los Angeles (Dr Cousineau). The authors declare no conflicts of interest. Correspondence: Scott Cheng, MPH, Department of Family Medicine, and Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N Soto St, MC 9239, Los Angeles, CA 90089 (scottrocucla@ gmail.com). DOI: 10.1097/PHH.0b013e3182aaa280
583 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
584 ❘ Journal of Public Health Management and Practice Endowment and other funders to provide outreach and education, along with services, through a series of daylong health events in communities throughout the state. They are focused on improving community health and expanding health insurance enrollment. Importantly, events are part of The California Endowment’s comprehensive strategy aimed at increasing awareness about the ACA and facilitate enrollment into new health insurance programs.14 We Connect was organized in various counties throughout California through a collaboration of community organizations, funders, health providers, local governments, and advocates. Not all events of WCEE were selected for the evaluation; 7 events over a 6-month period were chosen for evaluation. Selected events were organized in 7 counties in California and principally involved a collaboration of community organizations, funders, health providers, local governments, and advocates. Thousands of people attended; the majority from low-income communities, drawn by available resources, particularly the promise of assistance in obtaining health insurance. Enrollment events are daylong efforts that are similar to popular health fairs that mobilize human services resources targeted to low-income communities. Events provided education about current and future enrollment options as well as important resources such as free groceries, health and dental screenings, and other types of human services. Health reform education was conducted through booths at the event or during one-on-one consultations, where individuals would learn about the anticipated changes to their health coverage. The approach to education was not uniform across the participants, as it was up to the individual to decide on stopping at the booths and/or one-on-one enrollment consultation. Free produce was provided at the exit of each event. This is also where the voluntary exit survey was conducted. To qualify for the produce, individuals had to visit a minimum number of booths within the fair. This was determined through stamps provided by vendors on a sheet provided to individuals at the beginning of the event.
● Evaluation To document and learn about the effectiveness of WCEE, the USC Center for Community Health Studies conducted an exit survey with participants and worked with Clear Thinking Communications, a public communications firm, to develop learning briefs that reflected on each event. The briefs combined survey results and interviews to provide a summary of key points at each event. The evaluation was designed to assess the effectiveness of community enrollment events as a strategy for enrolling people into public programs
and determine whether the events were a successful strategy to educate the public about the ACA. The exit surveys had 14 questions and measured participants’ knowledge about the ACA and their experiences at the event, including how they learned about the event. It was translated into multiple languages. The survey questions were developed by the WCEE staff prior to the first event. Some augmentation to the questionnaire was made, but in general, the questionnaires were the same throughout the course of the 7 events. One adult from each family was invited to take the survey. Depending on the participants’ preference, paper or electronic surveys were used. Surveys were uploaded on to the online tool (Qualtrics, Provo, Utah).15 An evaluation team attended each of the enrollment events to monitor and assist with survey completion. Volunteers were trained to assist administering the survey. Surveys were completed at the exit point of the events, and interviewers were placed alongside a free food distribution station. Respondents were given free produce from local grocers after completion of the survey, although survey completion was not required to receive the groceries. Surveys were administered at all 7 sites. In addition to the exit survey, event coordinators shared their opinions on the events’ successes and challenges. Interview questions were developed to understand the coordinators’ perceptions on local partners, event planning, event positives, and areas that could be improved. All data were stored on Qualtrics and were exported into the SAS (Statistical Analysis System) software for analysis.16 Because of the size of the event, the evaluators were unable to systematically survey participants and, instead, sought to interview as many people as possible as they left the event.
● Results More than 25 500 individuals attended the 7 events, based on counts that were taken as persons entered the event. Of these, approximately 2600 completed surveys, with the number of completions ranging from 252 in San Francisco County to a high of 646 in Santa Ana County. There were 2168 persons assisted through oneon-one consultations at all sites combined, and of these, 872 adults submitted an application for either Medi-Cal or another low-income health program (Table).
Knowledge about the ACA In all counties, more than half of participants reported that they were unfamiliar with the ACA prior to the event. Attendees were then asked whether they learned new information about the ACA during the event. At least 70% of participants reported “yes” at all 7 sites.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Community Event Implications Under Health Reform
❘ 585
TABLE ● Summary of Exit Survey Results
qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq County Alameda Fresno Riverside
No. Surveys conducted at each county No. Persons participated One-on-one consultations Adults applied for health care programs Parent applied for child for health care programs Knowledge about the ACA Knew nothing regarding the new health law, before the event Learned more regarding the ACA at the event Thought the new health law would be helpful to their family
San Bernardino
San Diego
San Francisco
Santa Ana
Total
127
233
374
504
461
252
646
2597
194 167 10
138 18 4
375 69 60
410 180 15
450 164 ...
185 142 43
416 132 17
2168 872 149a
45% 88% 91%
50% 84% 90%
55% 77% 84%
52% 91% 96%
45% 74% 80%
50% 91% 94%
56% 78% 87%
Abbreviation: ACA, the Patient Protection Affordable Care Act. a The total number of children’s application does not include numbers from San Diego County because the total number was not recorded at this site.
The highest was in San Bernardino and San Francisco (91%), whereas the lowest was in Riverside, San Diego, and Santa Ana counties (77%, 74%, and 78%, respectively). In all the counties, at least 80% reported that they felt that the ACA would help their family (Table).
● Discussion The study provides evidence that the WCEE is an effective strategy to engage uninsured individuals and families. By coupling health services with enrollment assistance, they were able to identify uninsured residents and link them to publicly supported health insurance programs and begin the enrollment process. The high volume of attendees at WCEE events are in line with previous studies, demonstrating that health fairs and enrollment events are a viable method to reaching large numbers in the community. However, reaching a large audience was only part of the goal of the WCEE. The surveys revealed that more than 2500 individuals initiated the enrollment process for public health insurance, about 10% of all those attending. It is possible that attendees were only interested in the health services provided at the events, or there may just not have been enough time due to long wait times for consultation. Further research into this will be valuable to determine how to maximize enrollment numbers at future events. The results also show that in all counties, there was improvement in how much the surveyed population understood about the health reform. The Kaiser Family Foundation polling reveals that approximately 44% of the population is still unclear as to the content and status of the health law.17 This coincides with the percentage of individuals we find at each event, who report no prior knowledge regarding health reform. Although the changes in percentage were relatively close,
there were still variances across counties. This could have resulted from regional specific factors or variance in design of the enrollment event. Future research is also recommended for this to determine not just what causes the variance in improvement but also how much is actually learned. There are some limitations to this study. Those interviewed were not randomly selected but, instead, all those exiting the event were given the opportunity to complete the survey just before obtaining free groceries. While this did increase the number of completed interviews, those completing the survey were not representative of all those attending. In addition, those who initiated an application for public health care insurance were not followed to determine whether the application was completed, submitted, and whether the individual eventually enrolled. This is a difficult task to complete because of the resources needed to follow-up with individuals and because, often times, families require additional meetings with eligible workers to bring in supporting documents to facilitate a completed application and eventual enrollment.
● Conclusion WE Connect provides a model for how community events can serve as a forum for educating the community about the ACA and enroll people into programs. They show that with the assistance from foundations or state and local governments, community organizations can create an effective large-scale enrollment and education tool. By fully engaging with local agencies in planning, foundations are assisting communities engage their residents in implementing a very large social policy. As more of the ACA is implemented and enrollment opens in many health benefit exchanges,
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
586 ❘ Journal of Public Health Management and Practice WCEE provides a model for informing newly eligible uninsured about how they could benefit from the expansions under the ACA and begin the process of enrollment. Further research is recommended to explore the factors that may influence initiating health care enrollment and what type of information participants retain regarding health reform. This study was submitted and approved by the USC institutional review board for the protection of human subjects. This study was supported with a contract from The California Endowment. REFERENCES 1. The Patient Protection and Affordable Care Act (ACA) Pub L No. 111-148. http://www.gpo.gov/fdsys/pkg/PLAW111publ148/content-detail.html. Accessed June 4, 2013. 2. Elmendorf D. 2010. HR 4872, Reconciliation Act of 2010. Congressional Budget Office and Staff of the Joint Committee on Taxation. http://www.cbo.gov/doc.cfm?index= 11355&zzz=40566. Accessed June 4, 2013. 3. Pourat N, Martinez AE, Kominski GF. Californians newly eligible for Medi-Cal under health care reform. Policy Brief UCLA Cent Health Policy Res. 2011;(PB2011-4):1-7. 4. Long P, Gruber J. Projecting the impact of the Affordable Care Act on California. Health Aff (Millwood). 2011;30(1): 63-70. 5. Jacobs K, Watson G, Kominski GF, et al. Nine Out of Ten NonElderly Californians Will Be Insured When the Affordable Care Act Is Fully Implemented. Berkeley, CA: UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research; 2012. http://laborcenter.berkeley .edu/healthcare/aca_implemented12. Accessed April 2013. 6. Kenney GM, Dubay L, Zuckerman S, Huntress M. Opting Out of the Medicaid Expansion Under the ACA: How Many Uninsured Adults Would Not Be Eligible for Medicaid? Washington, DC: Urban Institute Health Policy Center; 2012. http://www .urbaninstitute.org/UploadedPDF/412607-Opting-Out-ofthe-Medicaid-Expansion-Under-the-ACA. Accessed June 4, 2013.
7. Cousineau MR, Stevens GD, Farias A. Measuring the impact of outreach and enrollment strategies for public health insurance in California. Health Serv Res. 2011;46(1, pt 2):319-335. 8. Kempe A, Renfrew BL, Barrow J, Cherry D, Jones JS, Steiner JF. Barriers to enrollment in a state child health insurance program. Ambul Pediatr. 2001;1(3):169-177. ˜ 9. Castaneda X, Clayson ZC, Rundall T, Dong L, Sercaz M. Promising outreach practices: enrolling low-income children in health insurance programs in California. Health Promot Pract. 2003;4(4):430-438. 10. Wallace LS, Devoe JE, Hansen JS. Assessment of Children’s Public Health Insurance Program enrollment applications: a health literacy perspective. J Pediatr Health Care. 2011;25(2):133-137. 11. Fuld J, Farag M, Weinstein J, Gale LB. Enrolling and retaining uninsured and underinsured populations in public health insurance through a service integration model in New York City. Am J Public Health. 2013;103(2):202-205. 12. University of Southern California Division of Community Health. Reaching Out and Reaching In: Understanding Efforts to Identify and Enroll Uninsured Children into Health Insurance Programs. Los Angeles, CA: The California Endowment. http://communityhealth.usc.edu/Materials/ pdfs/(Jan 2006) Reaching Out and Reaching In.pdf. Published January 2006. Accessed September 12, 2013. 13. Main DS, Velonis AJ. The effectiveness of boosting public health insurance enrollment through community events. http://www.coloradotrust.org/attachments/0001/3768/ Published OutreachEnrollment CommunityEvents2010. 2010. Accessed June 4, 2013. 14. The California Endowment. Overview. http://www .calendow.org/about/overview.aspx. Accessed September 12, 2013. 15. Qualtrics [computer software]. Version 37,892 of the Qualtrics Research Suite. Provo, UT: Qualtrics. http://www.qualtrics .com. Accessed June 1, 2013. 16. SAS [computer software]. Version 8 of the SAS System for [Unix]. Cary, NC: SAS Institute Inc. 17. Kaiser Health Tracking Poll: August 2013. http://kff.org/ health-reform/poll-finding/kaiser-health-tracking-pollaugust-2013. Accessed September 4, 2013.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
