Enrollment efforts target hard-to-reach Hispanics as deadline looms

Hispanics represented nearly a quarter of uninsured, non-elderly North Carolina residents, or roughly 370,000, prior to full implementation of the Affordable Care Act. But while North Carolina had one of the most successful initial open-enrollment periods in the country, only about 7,000 of its enrollees indicated they were Latino, according to HHS, or just 3% of respondents who voluntarily provided ethnicity information.

“Right there you can see there's a real need for more outreach,” said Sorien Schmidt, North Carolina state director for Enroll America. And North Carolina is far from alone in needing more outreach to Hispanics.

“We got the low-hanging fruit,” said Sonya Schwartz, a research fellow at Georgetown University's Center for Children and Families. “There's a long way to go because the disparity was huge.”

A primary emphasis for outreach workers across the country in these closing days of open enrollment is Spanish-speaking households. Language barriers and insurance illiteracy complicate outreach efforts. Families with mixed immigration status, in which some members are eligible for benefits and others are not, further confuses matters. Enrolling through a government-run marketplace can cause trepidation in households where some members might not be in the country legally.

“Nobody wants to be the person who signed up for coverage but then got their grandmother deported,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

Hispanics have long had the highest uninsured rate in the country. It did drop from 36% to 23% after the first open-enrollment period last year, according to a Commonwealth Fund study (PDF).

But in states that didn't expand Medicaid, such as North Carolina, the decrease in uninsured Hispanics was much less pronounced. The uninsured rate fell from 39% to 33% in states that haven't taken advantage of the ACA's Medicaid expansion provision. And uninsured rates for Hispanic adults whose primary language is Spanish also remain disproportionately high, with 30% lacking coverage.

Another potential problem for Hispanic enrollees surfaced Wednesday. HHS plans to void the coverage of 200,000 people who enrolled through HealthCare.gov because they were not able to verify information related to immigration and citizenship, according to Andrew Slavitt, principal deputy administrator at the CMS. This will be on top of the 112,000 individuals who lost their ACA coverage after failing to verify their immigration status by Sept. 30 of last year.

Signs of pent-up demand for coverage among Spanish-speaking households have surfaced. Roughly half of the 500,000 California residents who filled out a coverage application but failed to enroll in a plan are Hispanic, Wright said. “We always knew this would be half as (long) and twice as tough,” Wright said of the second open-enrollment period. “You just don't know what will happen in this last week.”

Elizabeth Colvin, director of Insure Central Texas, whose clientele is mostly Spanish-speaking, said Monday was the busiest day of the open-enrollment period. She expects the numbers to swell throughout the week. The group has added volunteers and expanded hours to manage the surge.

The looming sign-up deadline is driving traffic, Colvin said, but so is tax season. Many low-income households file their taxes as soon as possible because they're typically entitled to significant refunds. “The first two weeks of February are our busiest weeks of the whole tax season,” Colvin said.

During the first open-enrollment period, Insure Central Texas surveyed roughly 9,000 individuals that the Austin-based not-for-profit group helped sign up for coverage. It found that roughly 30% reported hearing about the group's services through Spanish-language television. Less effective were outreach efforts at farmers markets and other outdoor events. That's led the group to increase its advertising on Univision for the second open-enrollment period.

The cost of premiums for 2015 coverage among plans offered on Texas' insurance marketplace has narrowed, Colvin said. That's led more clients to focus on other aspects of coverage, such as provider networks and out-of-pocket costs.

“Last year was very new,” Colvin said. “Everything was just completely foreign to the people we were working with.”

In North Carolina, Enroll America added an outreach worker devoted to Spanish-speaking households in the Raleigh-Durham area midway through the first open-enrollment period. This year it added a person devoted to Latino outreach in the Winston-Salem area. They've worked with Spanish-language churches and partnered with the Mexican consulate.

But so far it's unclear if those efforts have paid off since no demographic data has been released by the federal government.

“I know that we have talked to more Spanish-speaking people,” Schmidt said. “We just keep trying to talk to them and let them know you can get free help all over the state.”

Follow Paul Demko on Twitter: @MHpdemko