Rounding the Bend: Enrollment and Outreach Updates from the State-based Marketplaces

B2015 has drawn to a close, and with it deadlines for consumers to have coverage on January 1. The Department of Health and Human Services has recently released an enrollment update, citing that over 11.2 million individuals have enrolled in plans through the marketplace, 2.7 million of which have come through the 13 states operating as State-based Marketplaces (SBMs).
In December, we provided an early account of enrollment across the SBMs. As states head toward the finish line of open enrollment they continue to ramp up their efforts to enroll individuals in coverage, including targeted outreach to the hard-to-reach and a ramp up of community events and in-person support. Below, we provide updates on activities and enrollment across the SBMs.
California
 California chose to extend its enrollment  deadline from December 15 to December  17 after receiving  more than 55,000  applications during the  final 48-hours of  sign-up for January  coverage—an increase  of 23,000  applications from the same two-  day period  in 2014. As of January 2,  Covered California reported more than 238,000 new consumers had signed up for coverage, which puts it ahead of projections. In addition, the most recent HHS data showed Covered California with 1.41 million consumers, including 1.18 million who were set to re-enroll, which is an increase of 210,000 over the previous year.
To target its enrollment efforts, Covered California used new maps that highlight neighborhood “hotspots” with high concentrations of uninsured, subsidy-eligible populations. The maps were developed using U.S. Census data and estimates of eligibility for coverage from a model of California insurance markets developed by the University of California, Los Angeles. Once regions of high uninsurance were identified, Covered California expanded the number of storefronts and community partners available in these neighborhoods and targeted local media in the preferred language of residents.
Covered California also teamed with community partners and insurance companies to open an enrollment center in the Los Angeles area, where consumers can immediately enroll in coverage. This enrollment center is the first of its kind in establishing regular hours, having prominent signage and having health insurance companies on site to provide information about benefits. Other targeted efforts included deployment of outreach teams to businesses frequented by targeted populations and a branded Covered California van (“Van with a Plan”).
In addition, Covered California reached out to new members by using “The Force” on social media prior to the opening of a new movie that seems to be pretty popular with the kids. May the coverage be with you.
Colorado
 Connect for Health Colorado reports an all  time high enrollment with more than 145,000 Coloradans enrolling in coverage  between November 1 and December 15  (including over 116,000 enrolled in QHPs).  On December 22 Connect for Health  Colorado chose to extend its deadline for a second time to December 26. This followed an initial 48-hour deadline extension that generated increased interest and  a snowstorm on December 17, which affected the ability of consumers to enroll. Based on the later deadline, additional enrollments for January 1 will likely be reported in the coming weeks.
Connecticut
 Access Health CT (AHCT) has reported higher  enrollment rates for 2016 over previous open  enrollment periods. As of January 5 there are  104,363 consumers enrolled in a QHP. Of these  customers, 22 percent are new to the marketplace.
AHCT has focused on reaching consumers on  their electronic devices and in their communities. Through  its “Get Covered CT” campaign (also available in Spanish at “Asegurate CT”), individuals can share their coverage status through text messages and opt in to text and/or email messages tailored to the registrant. AHCT has also increased the number of community events, called “Community Chats” which are hosted at places of worship, libraries, and schools in the communities where the uninsured work and live. AHCT reports it has developed 100 new organizational contacts through attendees at these chats.
District of Columbia
 The DC Health Benefit Exchange Authority publicly  releases enrollment information at its monthly Executive  Board meetings. The latest numbers were released  January 13. Since opening for business October 1,  2013 through January 11, 2016, 31,188 people have  enrolled in individual market coverage through DC  Health Link; 25,657 employees have obtained Small Business Health Options Program or SHOP coverage through DC Health Link; and 144,329 people  have received Medicaid eligibility determinations through DC Health Link. DC Health Link also reported that to date 3,831 new customers have enrolled for 2016 coverage; 2,594 renewing customers had changed their health plans for 2016; and that DC Health Link had auto-renewed 14,108 individual market customers for 2016 coverage.
DC Health Link has focused on outreach events that attract the District’s young adult population. DC Health Link had major enrollment efforts tied in with the recent release of the newest Star Wars movie and on December 15 the SBM hosted a coverage “café crawl”, where teams of assisters and navigators with internet-ready laptops were stationed at three of DC’s most popular coffee shops..
Idaho
 On December 18, Your Health Idaho  reported that over 93,000 individuals had  selected a QHP for 2016 through Your  Health Idaho. This is a significant increase  over the approximately 86,000 Idahoans  enrolled in coverage for 2015. Your Health  Idaho continues to strengthen its  partnership with agents and brokers including the statewide enrollment event “Super Sign-Up Saturday” on January 16th.

Kentucky
 Enrollment continues through Kentucky’s marketplace,  kynect, although newly inaugurated Governor Bevin may  propose changes. In a recent report, the United Health  Foundation moved Kentucky up three spots in its annual  ranking of state health – from 47^th to 44^th. A significant  factor in the move was increased access to insurance, over  the past two years the report found a 24 percent decrease in  the uninsured across Kentucky. kynect has been continuing to  use their successful “kynect stores,” which had extended hours over the holiday season.

Maryland
 Similar to its counterpart in DC, the Maryland  Health Connection (MHC) has also decided  to increase its focus on the sometimes hard  to reach “young invincible” population. The state launched the #HealthYeah campaign that stresses free, local, in-person enrollment assistance and financial assistance for most enrollees.
MHC is also trying to reach other more difficult to engage populations. Outreach activities include 16 weekend enrollment fairs, including on December 13 in Baltimore where Meredith Hurston, who blogs on health care resources geared to the African-American community hosted a live Periscope video stream / Q&A for consumers.  Other events include a statewide “Library Enrollment Day” on January 9 where enrollment navigators staffed  public libraries; a Hispanic-oriented enrollment fair on January 13 which included radio station “El Zol,” and “Super Health Sunday” on January 24 where navigators will be on hand to assist with enrollments at several predominantly black churches.
Enrollment numbers demonstrate the success of these efforts. As of December 28, 71,055 Marylanders have enrolled in a new Qualified Health Plan, and an additional 79,238 people have already renewed their plan for 2016.
Massachusetts
 As of January 1, the Massachusetts Health Connector  reported a total enrollment of 189,700 individuals, with  more than 27,600 representing enrollees new to the  marketplace. Reports from the state highlight that the open  enrollment period has been smooth, with low wait times  for its call center (average of 9 seconds) and an increased  availability of in-person assistance.
For this open enrollment period, the Connector focused its outreach and education campaign on 10 priority communities with higher rates of uninsured residents. Messaging was delivered predominantly through spots on Hispanic TV and radio, as well as a significant investment in digital outreach, and was focused on benefits of coverage and the availability of support to both pick the right plan and complete the application.
Minnesota
 Enrollment figures released by MNsure on January 4  showed 67,680 Minnesotans enrolled in a qualified  health plan(QHP) by December 28. Of those QHP enrollees, approximately 40 percent are new to the exchange. This is in comparison to last year, where total QHP enrollment was 60,092 after the end of OE2.
Minnesota’s broker enrollment center initiative also  continues to gain momentum in its second year of operation. To date, the 20 walk-in broker enrollment centers statewide have enrolled more than 3,160 Minnesotans in a QHP. That’s more than twice the number of QHP enrollments by the same group compared to this time last year. MNsure offers matching marketing funds to these brokers to help promote their business across the state, and uses them for earned media opportunities where appropriate.
New Mexico
 beWellnm hit the ground running on November 1  with a robust schedule of events, a new consumer  centric website, and advertising that targeted the  rural and remote communities in the state. The  exchange has hosted more than 249 outreach  activities with 15,671 attendees since the launch of  open enrollment.
Exchange outreach efforts have focused on reaching the Hispanic/Latino, Native American, and urban and rural communities by hosting scheduled events at Hispanic marketplace locations, in outlying rural communities, urban centers and pueblo communities. Additional efforts included bilingual town hall radio calls that feature a local celebrity who is highly regarded by the community, partnering with advocacy groups that work with the hard to reach communities, as well as presentations to civic organizations. beWellnm engaged outreach partners located throughout the state to focus on their communities and identified unique language and messaging to help them understand the benefits of having insurance and moving them to enrollment.
These efforts have led to a 47 percent increase of traffic to the call center from the first week of December to two weeks prior to the December 15 deadline. Additionally, the exchange moved from a referral – only call center to a certified application counselor or CAC certified call center, which may have increased enrollment and provided a better consumer experience. As of December 26, 46,816 individuals are enrolled for 2016 coverage.
New York
 In recent weeks, New York State of Health has  reported significant activity on its website (43 million  page views, 1.8 million individuals using the  anonymous shopping tool) and at its call center  (averaging over 34,000 calls a day leading up to  December 15). Based on this interest, the state  pushed back its deadline for January enrollment  from December 15 to December 19.
New to the market this year is the state’s Basic Health Plan, called the Essential Health Plan, which provides low- to almost no-cost coverage to individuals with incomes between 138% and 200% of the federal poverty level. New York State of Health has developed a marketing campaign promoting the plan, with a digital spokesperson named “Essie”, targeted at young New York residents.
Rhode Island
 On January 6, Health Source RI reported that  34,627 individuals have enrolled in a QHP for  2016. Of these enrollees, 4,462 represent  individuals who are new this year.
Rhode Island extended its January enrollment  deadline to December 29 to accommodate the  surge of calls received by the SBM leading up to  its previous December 23 deadline. To help drive enrollment, HealthSource RI has continued to offer a significant number of in-person assistance events (with over 20 scheduled for OEIII), including an Enrollment Fair with all the participating insurers that took place on December 1.
Vermont
In mid-December, Vermont Health Connect launched a new plan comparison feature on its website that will allow potential enrollees to review costs across different health care plans. The tool allows individuals to compare the costs of major medical procedures, premiums, and out-of-pocket costs in various plans and is designed to give consumers an educated look into their potential health care spending for 2016. Vermont Health Connect is hopeful the tool will help Vermonters make more informed choices when selecting a plan for the upcoming year.
Washington
 As of January 6, the Washington Healthplan Finder  reported that it had 173,947 individuals enrolled in QHP  coverage for January 1. During OE3, Washington  Healthplan Finder has worked on its partnerships with  small local businesses and the broker community through  its events, storefront, and referrals.
The exchange has been particularly successful at reaching  the young, “invisible” population. More the 50,000 residents under the age of 35 signed up for insurance through the exchange in the first weeks of open enrollment, representing a 66 percent  increase in young adult enrollment over last year.
NASHP will continue to update the progress during this open enrollment period as we move towards the January 31 deadline. We encourage you to check back on the blog for the latest.