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Six years ago, Massachusetts implemented a broad expansion of health coverage to the uninsured population in the state. Understanding that outreach and enrollment assistance would be essential to the success of the expansion, state policymakers provided for public education campaigns, but also for person-to-person, hands-on assistance, especially in communities with large numbers of uninsured people. Community health centers play a central role in this effort. As states and communities gear up to provide outreach and enrollment assistance under the ACA, the experience of the Massachusetts health centers offers lessons that can help inform current efforts to reach and enroll millions of low-income, uninsured Americans in health insurance. Recent interviews conducted with a sample of Massachusetts health centers point to four key findings:

Finding #1: Intensive outreach and enrollment assistance is crucial to connect low-income, uninsured people with coverage.

Finding #2: Assistance is not a one-time matter – it is needed at all stages of the enrollment process and to ensure continued coverage.

Finding #3: Immediate access to enrollment assistance boosts the effectiveness of outreach efforts.

Finding #4: Even when health reform is mature, the need for aggressive outreach and enrollment assistance remains high and the resource demands remain significant.

The Massachusetts health center experience demonstrates that, in addition to broad public education about affordable insurance options and how to enroll, intensive one-on-one assistance is a vital complement to help disadvantaged populations and communities obtain and keep coverage that meets their needs. The intensive support they require, and ongoing rather than occasional needs for assistance, suggest the importance of sustained investment in outreach and enrollment efforts conducted by health centers and other organizations.


Issue brief prepared for the Kaiser Commission on Medicaid and the Uninsured. Reproduced with permission of the Henry J. Kaiser Family Foundation.

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