Impact of COVID-19 on health center outreach and enrollment functions

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Impact of COVID‐19 on Community Health Center Outreach
and Enrollment Functions
Executive Summary
On March 31, 2020, and April 3, 2020, the National Association of Community Health Centers
(NACHC) hosted two listening sessions to gauge the impact of COVID‐19 on how health centers
provide outreach and enrollment assistance.
Outreach and Enrollment Managers from 19 health centers and 12 Primary Care Associations in
24 states were invited to participate (see appendix 1 for a list of all attendees) and
approximately 25 people attended both sessions. Staff from the Health Resources and Services
Administration (HRSA) and the Assistant Secretary for Planning and Evaluation (ASPA) within
the Department of Health and Human Services were also in attendance in listen only mode.
Participants responded to question prompts and poll questions regarding how enrollment
teams are responding to the challenges and opportunities presented by this national healthcare
crisis.
Below is a summary of responses and perspectives on these issues.
Overall Impact to Enrollment Activities
Although experiences vary by state or region, the responses to the five areas addressed in the
listening session demonstrate the profound impact COVID‐19 is having on frontline enrollment
staff at health centers as well as on patients who need access to care. A general definition of
enrollment involves assistance with sliding scale programs, Medicaid and the state‐based and
federal Insurance Marketplaces.
1. Demand for Services Many health centers have adjusted priorities in patient care such
as reducing preventive care or other routine services to minimize risk of infection to
both staff and patients. Although experiences varied, the following were common
among health center:
 Lower overall patient visits to the health center;
 Reported an increase in demand for enrollment with fewer staff to provide
assistance;
 Demand changed according to the need for other programs such as assistance to
apply for SNAP benefits; and
 A corresponding decrease in demand for enrollment services due to lower patient
visits

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2. Staffing to Capacity Staffing of frontline enrollment workers has been impacted either
due to lower patient visits or risk of infection. Three common issues arose:
 Frontline staff were furloughed
 Staff were sent home to work remotely
 Staff retained at clinic sites at reduced levels to handle demand
3. Workflows and Priorities Many frontline enrollment staff are being sent home to work
remotely or repurposed to meet other demands or priorities. Some common functions
included:
 Assisting in screening patients for symptoms before entering clinics;
 Assisting with receiving, tracking, and disseminating personal protective equipment
(PPE);
 Assisting with SNAP benefits or other non‐enrollment social programs, and/or
 Providing limited eligibility screening over the phone from home
4. Health Insurance Marketplaces Health centers are experiencing numerous challenges
in policies and processes for marketplace enrollment both in State‐based and Federally
Facing Marketplaces including:
 State‐based marketplaces opening up Special Enrollment Periods (SEPs) due to
COVID‐19
 No standardized policies for over‐the‐phone enrollment assistance in most states,
 One state allowing virtual assistance with use of video technology
 Many barriers to obtaining and submitting required documentation for tax credit
eligibility, and
 Confusion among health centers and the general population about cost‐sharing for
COVID‐19 testing and treatment due to a lack of communication from carriers and
marketplace administrations, which was the most notable in states with the
Federally‐facing Marketplace.
5. Other Issues Other issues and concerns experienced by enrollment staff included:
 Need for adequate Personal Protective Equipment (PPE) for all health center staff,
including O&E staff.
 Difficulty reaching and assisting homeless populations challenged with document
handling and submission for Medicaid
 Public charge rule further dampening enrollment in some counties, and
 Concern over an increased demand for Medicaid application assistance when
restrictions are loosened

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Polling Data Three electronic polls were taken to assess health center needs, priorities and
insurance marketplace environment. Data displayed in this report show the top two responses
in each category.
 What is your greatest need in responding to COVID‐19 challenges?
1) Telework issues
2) Coverage options for patients
 What strategic changes to types of duties of enrollment staff?
o Health literacy for patients to navigate health insurance and access to care
o Providing assistance with other social service programs, i.e. SNAP, unemployment
 Is there confusion in your state regarding cost‐sharing for COVID‐19 testing or
treatment? (Other and No Answer also included poll options)
o Yes 67%
o No 33%
Opportunities for Innovation In an effort to respond to enrollment challenges, some health
centers and states agencies are attempting to address barriers to coverage. Some innovations
include:
 Amending their sliding scale procedures to allow for emergency or over‐the‐phone
applications and temporarily suspending the need for verification that is usually
requested;
 Providing locked drop boxes at clinics for documentation and release forms that allow
assistance that is not in‐person
 Allowing the taking pictures of required documentation using cell phones and securely
submitting to clinics
 Allowing patients to take documents to clinic workers to be scanned to teleworkers.
 Advocating for state Medicaid agencies to reactivate recently terminated Medicaid
eligibility
 States allowing Medicaid applications for anyone diagnosed with COVID‐19
 States deferring Medicaid dis‐enrollments for 90 days
 State marketplaces relaxing requirements for face‐to‐face assistance
Remaining Challenges Despite some innovations, barriers to providing assistance remain in
most states. The need for required documentation is difficult if staff are teleworking and
unable to assist face‐to‐face. In addition, there are challenges with technology that could allow
virtual assistance when assisters are working from home.

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Appendix 1: List of Participants (By Session)
Session One
Linda Carmona‐Sanchez Florida Association of Community Health Centers
Jesus Blanco Terry Reilly Health Services‐Idaho
Ashley Shoemaker Family Health Centers Louisville‐Kentucky
Matt Robbins Siouxland Community Health Center‐Iowa
Keshia Bradford Health Care Association of Nebraska
Suzanne Roselle Community Health Center Association of New York
Patricia Gepert Washington Association of Community Health
Carrie Pardee Community Health Center of Central Wyoming
Claudia Vigil New Mexico Primary Care Association
Jenny Walden Indiana Primary Care Association
Maria Morris Community Health Center Association of Mississippi
Session Two
Silvia Santana Mountain Family Health‐Colorado
Kurt Berke Iowa Primary Care Association
Cheryl Wolfram Northwest Michigan Health Services
Iva Eggert‐Shepherd Missouri Primary Care Association
David Briseno La Casa Family Health Center‐New Mexico
Joaquin Vidrio‐Ruiz Community Health of Central Washington
Tamara Jones North Carolina Community Health Center Association
Laura Resti Wayne Memorial Community Health Centers
Carol Jameson Health Works of Northern Virginia
Andy Gamez Nuestra Clinica del Valle‐Texas
Alberta Romero New Mexico Primary Care Association
Allie Budenz California Primary Care Association