By Megan Comlossy

In the run-up to the March 31 open enrollment deadline, many states, the federal government, nonprofits, and others were on a mission: educate Americans about new health coverage options and help the eligible sign up for coverage. Although we’re still awaiting final enrollment numbers, it is safe to say that enrollment experiences have varied significantly across states—regardless of who is running the health insurance exchange.

Among the many factors contributing to enrollment in all states were consumer outreach, education, and enrollment assistance.

Some states proactively conducted such activities, as illustrated in NCSL’s recent blog on Connecticut’s multi-faceted approach. Other states—including many using the federally facilitated exchange—largely left this undertaking to the federal government, non-governmental organizations and public-private partnerships. States that established their own exchanges received federal funding to conduct outreach and enrollment activities while those with federally funded exchanges did not..

Early results suggest the “many-hands-on-deck” approach, which emerged in a number of states, worked well.

In North Carolina, for example, private businesses, community organizations, nonprofits, social service agencies, health care providers and community leaders were among the many stakeholders actively involved in outreach and enrollment.

  • BlueCross BlueShield of North Carolina (BCBSNC) traipsed from the mountains of Appalachia to the waters of the Atlantic in its “Mobile Enrollment Center,” meeting potential customers in their communities. As one of only two companies providing health insurance through the exchange, and the only one to provide coverage in all 100 counties, BCBSNC sent representatives to community events, authorized licensed insurance agents across the state, and provided online tools, videos, and fact sheets to raise awareness. The company's kiosks popped up in four malls and seven retail shops (similar to those in Connecticut) were built around the state—offering North Carolinians in-person information and assistance. 

All but one of the state’s community health centers received federal funding to assist with outreach and enrollment efforts for FY 13 and FY 14. A total of about $6 million was distributed to 31 health centers—which work with uninsured and underinsured folks on a daily basis—to hire and train staff and conduct community outreach. Nationwide, the U.S. Department of Health and Human Services awarded nearly $150 million to nearly 1,200 health centers.

Organizations from hospitals to community care networks, nonprofits, and the Alcohol/Drug Council received federal funding for some 600 “navigators” to educate and assist consumers.

The North Carolina Hospital Association offered online information and resources for folks interested in gaining health coverage.

Enroll America, a national nonprofit focused on maximizing the number of Americans with health insurance, used small armies of volunteers to canvass neighborhoods, community centers—even grocery store parking lots—to reach and enroll the uninsured.

And while final enrollment numbers remain to be seen, as of March 1, more than 200,000 North Carolinians, or almost 19 percent of the eligible population, had selected plans through the exchange, placing the Tar Heel State toward the top of the pack.

Looking to the future, as states evaluate their performance during the first period of open enrollment, there are surely lessons to be learned, regardless of who is running the exchange. States may want to consider whether the “many-hands-on-deck” approach used in North Carolina would be a good fit—and whether it’s a sustainable approach moving forward. The next open enrollment period begins in November 2014.  For more information on state’s outreach and enrollment efforts, please see NCSL’s resources.

Megan Comlossy is a policy specialist with NCSL's health program. Email Megan.

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This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.


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