Health Centers’ Role in Affordable Care Act Outreach and Enrollment: Experience from Kentucky and Montana
The Affordable Care Act created new opportunities for health centers and primary care associations (PCA) to play a leading role in supporting outreach and enrollment into new and expanded health coverage programs. Health centers and PCAs received new funding, sometimes from multiple state and federal entities, new training and tools, and a new mandate to find and enroll eligible individuals, both within their patient caseload and in the broader community. In undertaking this charge, many health centers and PCAs found themselves engaging new partners, building stronger relationships with state Medicaid and insurance or exchange agencies, and often playing a central role in coordinating outreach and enrollment activities in their state or community.
To better understand the new roles of these entities and identify promising strategies in their coordination with state Medicaid and insurance/exchange agencies, NASHP undertook a case study review of Kentucky and Montana, two states with strong enrollment performance where the state PCA and health centers played an important role. With support from the Health Resources and Services Administration’s National Organizations of State and Local Officials Cooperative Agreement, NASHP interviewed representatives from the PCA, a health center, and a Medicaid agency in each state about their respective roles in and coordination of outreach and enrollment assistance during the first two years of Affordable Care Act implementation.
Findings from these interviews are summarized here, with case studies highlighting each state’s circumstances and experiences, followed by a discussion of common themes relating to collaboration with state and federal agencies, lessons learned, and future priorities for outreach and enrollment work with states.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
