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Survey of Health Insurance Marketplace Assister Programs

The Kaiser Family Foundation (KFF) Survey of Health Insurance Marketplace Assister Programs was designed and analyzed by KFF researchers and administered by Davis Research.The survey was conducted through an online questionnaire from April 24 through May 12, 2014 among Assister Programs nationwide.  State- and federal-Marketplaces were asked to provide contact information for all of their Assister Programs.  All organizations received an initial email inviting the director of the Assister Program to participate and included a link to the survey.  In the event the person receiving the survey was not the appropriate person to complete it, they were asked to provide the contact name and email for someone else with their organization or at an affiliated organization.  The survey included Navigators, Certified Application Counselors (CACs), Federally Qualified Health Centers (FQHCs), In-Person Assisters (IPAs), and Federal Enrollment Assistance Programs (FEAPs). To compile the contact information for these Assister Programs, we asked officials from the Federal Marketplace, each of the State-based Marketplaces, and states with a Consumer Assistance Partnership Marketplace to provide names and email contact information for all of their Assister Programs. In addition, we requested contact information for the FQHCs from the Health Resources and Services Administration (HRSA).Although we attempted to include the universe of Assister Programs in the survey, there were some challenges associated with compiling a comprehensive set of Programs.  Some Program contacts we collected from the FFM did not include email address information, so we were unable to invite these Programs to participate in the study.  As a result, our study may have slightly undercounted the number of Assister Programs in FFM states.  It is also important to note that one-in-five respondents (including 28% of IPAs and 42% of Navigators) reported that they operate as part of a coalition of Assister Programs that subcontract with each other.  Though respondents were invited to answer survey questions on behalf of their entire Program, most of these coalition respondents told us they provided information only about their member Program within the coalition.  As a result, we may have underrepresented IPAs and Navigators for some states in our sample.In analyzing the results, we grouped the Assister Programs by type using the categorization provided to us by the FFM or by the states for Assister Programs in SBMs or FPMs, with the exception of FQHCs. We created a separate category for FQHCs and identified them using the contact list provided by HRSA. All FQHCs, regardless of any other categorization they may have had, were placed in the FQHC category. Because IPAs and Navigators performed similar functions in SBMs and were funded with state resources, we further grouped IPAs and Navigators in these states into a single IPA category. In FPMs, where IPAs were funded with state grants and Navigators funded through federal grants, we kept the Navigator and IPA categories distinct.

A total of 4,445 programs were invited by email to participate in the study, and 843 programs responded and were included (for a response rate of 19%). Some program types were more likely to respond than others, so the data was weighted to reflect the distribution of programs in the initial sample by program type and Marketplace type (SBM, FPM, or FFM). Weighted and unweighted proportions of the final sample by program type are shown in the table below.

  Unweighted % of total Weighted % of total
FFM CAC 22% 33%
FFM FQHC 18% 14%
FFM Navigator/FEAP 6% 3%
FPM CAC 2% 4%
FPM FQHC 2% 2%
FPM Navigator/IPA/FEAP 4% 2%
SBM CAC 8% 8%
SBM FQHC 12% 10%
SBM Navigator/IPA 26% 24%

The number of Assister staff nationwide was estimated by analyzing self-reported figures given by survey respondents.  Survey participants were asked to provide the number of full-time equivalent Assisters in their Program by selecting from a range of staff sizes on the questionnaire. For respondents who selected a range response, the midpoint of the range was used.  When respondents selected the range, “less than five” a response of 1 was estimated.  When respondents selected the range “more than 75” a response of 76 was estimated.  For respondents who did not provide a response, staff size was imputed based on the Assister Program type.

The number of consumers helped nationwide was likewise estimated by analyzing self-reported figures given by survey respondents.  For respondents who provided a numeric value for the number of people their Program helped, either in person or by phone, those responses were used.  For respondents who gave an answer by selecting a range, the midpoint of the range was used.  For respondents who did not provide a response, the number of consumers helped was imputed based on the Assister Program type.

Survey toplines with overall frequencies for all survey questions are available at http://kff.org/health-reform/report/survey-of-health-insurance-marketplace-assister-programs/

All statistical tests of significance account for the effect of weighting. The sample size and margin of sampling error (MOSE) for the total sample and key subgroups are shown in the table below.

Group N (unweighted) MOSE
Total 843 +/-4 percentage points
CAC 274 +/-6 percentage points
FQHC 265 +/-6 percentage points
Navigator, IPA, and FEAP 304 +/-6 percentage points
Implications Appendix Tables

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.