Many states are looking toward October 1—their deadline for opening insurance exchanges—with growing anxiety. As described in the Affordable Care Act (ACA), insurance exchanges are to serve as marketplaces where people shopping for health insurance can compare different plans. States had the option of creating their own exchanges, having a state-federal partnership or defaulting to an entirely federally run exchange. Seventeen states and the District of Columbia have chosen to make their own exchanges, seven have decided to form state-federal partnerships, and the rest will give the responsibility to the federal government.
Regardless of the type of exchange a state sets up, one key element for their success will be the assistance provided to the newly eligible Medicaid or uninsured individuals that must now obtain insurance. For all exchanges, there are requirements in place that address this issue of outreach. In addition to having hotlines and websites, exchanges are required to have “navigator programs” to provide in-person assistance for those individuals who may have questions regarding plans, exchanges, and eligibility.
While state-based and state-federal partnership exchanges have received a lot of the federal funding available to create navigator programs, some of the states that defaulted to federally based exchanges have not received as much. For example, Vermont, a state-based exchange, received over $170 million in grants, while Maine, a federally based exchange, only received about $40 million. This large discrepancy in funding forces states to think more creatively about how they will reach underserved neighborhoods.
Luckily, there are other options to complement the outreach work that navigator programs will be doing. One promising option that has been overlooked is for states to use their already existing network of community health workers (CHWs). CHWs, according to a draft report from the New England Comparative Effective Public Advisory Council (CEPAC), already have made strong connections with the communities they serve by helping with education and health system navigation. In addition, studies have shown CHWs to be effective at helping patient manage their chronic diseases. The only problem with using CHWs is that there doesn’t seem to be enough of them. There are only about 38,000 community health workers, a small number when compared to the 48.6 million uninsured in the United States.
In May, the Department of Health and Human Services announced that health centers across the United States would receive $150 million for enrollment assistance. This funding represents an opportunity for them to hire more CHWs to enroll people this coming fall when the exchanges open. By expanding the ranks of community workers now, health center can be better prepared for the chaotic first months after the exchanges open.