What Worked and What's Next? Strategies in Four States Leading ACA Enrollment Efforts

States have taken different approaches to implementing the Affordable Care Act (ACA) and have had varied enrollment experiences to date. This brief highlights the experiences of four states—Colorado, Connecticut, Kentucky, and Washington—that established a State-based Marketplace (SBM), implemented the ACA’s Medicaid expansion, and achieved success enrolling eligible individuals into coverage. Based on interviews with key stakeholders in each state, it identifies effective strategies that contributed to enrollment and current priorities looking forward. Key themes are summarized below; details on specific strategies and approaches utilized by the states are described in the full report.

Lessons Learned

Marketing and Branding

Broad marketing campaigns by the SBMs in all four states raised public awareness of new coverage options. Stakeholders identified several aspects of the campaigns that contributed to their success, including:

  • Branding the coverage expansions as state initiatives;
  • Conducting statewide marketing across diverse channels; and
  • Providing promotional materials, like reusable shopping bags, to consumers.
Outreach and Enrollment Initiatives

Building on the broad branding and marketing efforts, local level outreach and enrollment efforts played a pivotal role in educating consumers and encouraging them to enroll into coverage. Stakeholders highlighted several successful aspects of the study states’ outreach and enrollment efforts, including:

  • Conducting extensive outreach through numerous local avenues;
  • Reaching large groups of people through events and local media;
  • Going mobile with outreach and establishing walk-in enrollment sites;
  • Utilizing existing data to facilitate enrollment; and
  • Engaging providers in outreach and enrollment efforts.

Given that consumers often require significant time and education to enroll, stakeholders agreed that one of the most important elements of enrolling people into coverage is one-on-one assistance provided through trusted individuals in the community. Lessons learned about consumer assistance efforts included:

  • Recruiting a diverse group of assisters with ties to local communities;
  • Developing strong relationships between assisters and brokers;
  • Coordinating assistance through a regional hub and spoke structure;
  • Providing readily available support to consumer assisters; and
  • Expanding call center capacity and creating tiered assistance levels.
Systems and Operations

The effectiveness of the study states’ enrollment systems and their ability to quickly respond to technological glitches contributed to their enrollment successes. In addition, certain aspects of state policies and operations helped promote coverage efforts. Elements highlighted by stakeholders included:

  • Developing close relationships between staff and contractors and setting realistic expectations for systems;
  • Building effective enrollment systems with consumer-friendly features;
  • Implementing workarounds and incremental fixes to quickly address system problems; and
  • Using data and feedback loops to identify and respond to needs as they were identified.

Current and Future Priorities

The states were looking ahead to make continued improvements and focus on helping newly covered people access care. Stakeholders identified a range of key priorities looking forward including the following:

Enrollment and renewal
  • Educating consumers about continued Medicaid enrollment and Special Enrollment Periods;
  • Reaching remaining eligible but uninsured;
  • Supporting continuity of coverage; and
  • Continuing enrollment system upgrades and enhancements.
Consumer Assistance
  • Enhancing training and support for assisters; and
  • Ensuring adequate networks of consumer assistance are available.
Access and Utilization of Care
  • Increasing health insurance and health care literacy among consumers;
  • Connecting individuals to sources of care; and
  • Maintaining safety-net provider capacity.
Introduction & Background

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