Georgetown University Health Policy Institute
by Sonya Schwartz

If you’re like me, you’re impatiently awaiting more data so that you can understand how immigrant families—many eligible for subsidies for health insurance for the first time—faired in open enrollment.  A new paper from the Greenlining Institute, identifies major gaps in enrollment for immigrant communities and some ways to close them. In addition to using program data, the authors interviewed and surveyed outreach and education grantee organizations and certified enrollment entities in Los Angeles and Fresno counties.

First, the good news. Enrollment of people of color in Covered California was strong. The 57 percent of individuals of color enrolled for private plans in Covered California mirrors the demographics of the state’s overall population. Totally worth celebrating!

However, the same cannot be said for linguistic diversity among Covered California enrollees.  While 40 percent of those eligible for Covered California were limited English proficient, only 20 percent of those enrolled were LEP.  This is a substantial coverage gap of 20 percentage points that we need to close.

The report identifies cultural and linguistic differences as one of Covered California’s most pressing problems. Some of the reasons provided why the LEP community may have found it more difficult to enroll include:

  • Covered California made information available in 13 most commonly spoken languages, but many organizations ran out of materials faster than Covered California could produce them and there was a slow response time to getting more.
  • Certified enrollment counselors noted that the Spanish used on the website, materials, and paper application was poorly translated, so they would often use the online application in English and translate the questions for the client, which was very time consuming.
  • One group that served as the only enrollment center for Japanese immigrants was inundated with phone calls and requests, they used the website for enrollment, but the line by line translation with elderly Japanese-Americans made the process very tedious.

The report also highlighted the important role that Internet access played in Covered California’s outreach, education and enrollment.  Discrepancies in Internet access made it harder to send information to all consumers, given the racial and socioeconomic disparities in Internet access. Respondent’s whose primary language was English received the majority of their health care information from the Internet, while LEP respondents received majority of information from word of mouth, a significant difference. Enrollment counselors ideally schedule follow up appointments in people’s homes, but lack of internet or slow internet service were barriers to that method, so applicants would have to come to certified enrollment entities instead. Enrollers also did not have access to tablets with mobile internet connectivity, but with more resources those could be available in the next open enrollment.

The Greening Institute provided recommendations for making sure limited English proficient individuals and families get coverage in Covered California. Many of these recommendations are applicable to other states and the federal marketplace as well, and you can read the reportfor more details.

  1. Expand on what worked in the first year.  Provide additional resources to hire and train enrollment counselors.
  2. Improve outreach to diverse communities and hire a director of diversity and cultural competency.
  3. Ensure all outreach, education and enrollment materials are accurately translated in the 13 most commonly spoken languages.
  4. Move demographic data on Covered California application toward the beginning of the application.
  5. Streamline and combine outreach, education and enrollment services.
  6. Shift funding priority from large organizations to organizations that work directly with communities underrepresented in Covered California.

If Covered California makes some of these straightforward changes, there’s hope that we’ll see that LEP individuals enrollment numbers go up next year in California and that the rest of the country follows suit.