Bill Sarno
CTLatinoNews.com
As the second annual open enrollment for health insurance under the Affordable Care Act nears its Feb. 15 deadline, organizations such as the Connecticut Health Foundation, the Hispanic Federation and the Hispanic Health Council are looking beyond the immediate need to sign up as many people as possible.
These organizations are focusing on longer term issues related to health insurance and well-being of a Latino participation which has a higher rate of uninsured and a greater incidence of some ailments, such as diabetes, than the general population.
A major emphasis is on bolstering the dialogue with health-oriented state departments that would accelerate implementation of the federally supported No Wrong Door initiative, increasing the use of community agencies to explain health insurance and to enroll Latinos and other under-served groups in the so-called Obamacare health plans.
For the Hispanic Health Council, one of those community agencies working with AHCT to enroll Latinos and others, the closing weeks of the sign up period have been filled with many people calling up with questions and requests for in-person assistance. “Many people prefer one-on-one service,” Sofia Perez-Sezura, associate unit director.
Perez-Sezura and a 10-hour-a-week assister funded by a grant, have performed enrollment services to 250 people and helped educate 300 others about health insurance.
“We are doing a very good job,” Perez-Sezura said. “We have shown we are able to teach the community.” However, she also said that there is a need to do more, especially for low-income Latinos and for a year-round education program, but it is unfair to ask agencies to do this without adequate funding.
By Jan. 9, nearly 100,000 people have enrolled in the ACA’s private health plans since enrollment began in November, with 400,000 joining Medicare, according to recent figures from Access Health CT, which administers the state’s ACA marketplace. AHCT is hoping to have at least 110,000 people sign up for private health insurance, reducing the estimated uninsured population of 140,000 by 25 percent.
Although Latinos, who represent a disproportionate share of the uninsured, as much as 30 percent, were designated as one of the primary groups for enrollment, a tally of how many have signed up may not be available until this summer.
“Unfortunately, like last year, we do not have any way to know the ethnicity of any applicant,” said Kathleen Tallarita, government and public affairs outreach manager for AHCT. “The question is not mandatory and is optional on the application, so very few people answer it,” she added.
However, Access Health CT plans to conduct an in-depth survey after the close of open enrollment in order to get detailed information on such topics such as ethnicity and how people enrolled as well as other important questions, Tallarita said.
What is known is that AHCT had targeted 10 towns and cities with the highest number of uninsured for increased attention during the current signup period and that generally these also are places with the highest concentration of Latinos. New Haven tops this list with 26,988 uninsured, followed by Hartford with 26,680 and Bridgeport with 17,704.
What needs to be explored at greater depth and effectively addressed, according to organizations such as the Hispanic Federation, is why Latinos who represent about 15 percent of the state’s population comprise an estimated 25-30 percent of the uninsured.
“We need to find out what are the challenges Latinos face when trying to enroll, who among those eligible are uninsured and why,” said Ingrid Alvarez-DiMarzo, Connecticut director of the Hispanic Federation, a multi-state coalition of Latino community organizations.
The Federation is seeking answers to these questions in Bridgeport under a grant from the Connecticut Health Foundation. Bridgeport’s uninsured was 12 percent compared to all of Fairfield County, where the uninsured rate dropped last year from 10 percent to 7 percent, according to Enroll America.
Access Health CT has attempted to address the need for in-person assistance by setting up enrollment centers or using community partners, often at libraries, in the 10 towns with the largest uninsured populations. In addition, Access Health CT allocated $353,000 for this year’s enrollment outreach.
However, for the Hispanic Federation and the Connecticut Health Foundation, there is a need for an even greater investment on the state level in in-person assistance to help minority residents navigate through the process.
This includes quicker implementation of the No Wrong Door initiative, a federally funded program, which as part of the state’s ACA program, would allow people to use existing community agencies as as information centers and access points for enrollment in health insurance.
The launching of NWD combined with state’s ACA marketplace would result in cutting the state’s Latino uninsured rate in half, said Alvarez-DiMarzo.
The hangup to implementing NWD, Alvarez-DiMarzo explained, is that while the state Departments of Social Services and Public Health received federal dollars to upgrade its health insurance eligibility processes through Medicaid and communicate with Access Health CT, they are working with 30-year-old systems.
As to why the involvement of “boots on the grounds” agencies is seen as essential, one major factor is familiarity with the communities where many of the uninsured reside.
“People know and trust our agencies,” said Mary Pat Healy, executive director for the Bridgeport Child Advocacy Coalition. She said her agency has a “very strong focus” on helping Latinos and has two bilingual staffers working to enroll families in Bridgeport, with one also covering Norwalk and Stamford.
While language is an obvious hurdle for many Latinos, one-on-one assistance is also generally important because the application procedure, plan choices and the health provider system can be difficult to understand. “Some people will be receiving health care for the first time,” Healy said.
Moreover, in Connecticut enrollment is heavily tied to technology and the use of the Access Health CT website, which can be problematic for some Latinos, said Alvarez-Dimarzo.
The Hispanic Health Council found that it had to provide guidance beyond how to select a health plan and to enroll. People who applied during the first enrollment were unclear about their re-enrollment status. Those who didn’t were encountering the IRS penalty for being uninsured when they did their federal tax return.
Another key factor in the current enrollment is that the signup period is three months as opposed to six months last year when there navigators and more enrollment assisters throughout the state to help smooth the process.
Last year, the Hispanic Health Council served as a navigator agency for Access Health CT with close to 100 assisters available in the Hartford County area, Perez-Sezura said. As a result, more than 7,000 people gained health insurance in that county, she noted.
The Connecticut Health Foundation raised objections when it found there would be no navigators this year and about the level of assistance, Alvarez-DiMarzo said, and wanted to know where the highest performing assisters were last year.
Consequently, the Foundation came up with a $100,000 that was allocated in October as grants to 18 agencies, including the Hispanic Health Council, for hiring in-person assisters.
Moreover, the Foundation in July had awarded the Hispanic Federation a $50,000 grant and was chosen to build and help sustain the capacity and service infrastructure of Bridgeport-based community based organizations to provide long-term health and other services to residents in order to reduce health disparities within the Bridgeport Latino community.
The Hispanic Federation is working with a coalition of grassroots Latino leaders in Bridgeport represent groups such as Bridgeport Caribe Youth Leaders, Greater Bridgeport Latino Network, Bridgeport Hispanic Chamber of Commerce, Dominican American Association of Connecticut, Latino Advocacy Foundation of Fairfield County and the Puerto Rican Parade of Fairfield County.
Moreover, Alvarez-DiMarzo said, the city Department of Social services, community-based health centers and organizations, senior services and faith-based organizations are not only helping minority residents to enroll and stay enrolled in an affordable insurance plans, but are also educating them on navigating the health care system.
Thus far, the Hispanic Federation has conducted a series of Bridgeport community conversations around “understanding the ACA through the lens of the No Wrong Door policy,”launched a communications campaign primarily on the radio, conducted community leader development forums and is helping plan a Town Hall meeting.