Issue 1, Number 3 - Fall/Winter 2011

Patient Enrollment Navigators:
Making the Promise of Health Reform a Reality

By Pedro Toledo, Redwood Community Health Coalition

Christine (not her real name) is among thousands of Sonoma County residents who have been laid off in the past few years. Along with her job, she lost her employer-subsidized health coverage for herself and her two teenagers.

Christine has never before requested public assistance. But with diabetes and with her health coverage ending, she goes to the County Medi-Cal office to sign up for public health insurance. She’s given a nearly 20-page application, some of which contains confusing terminology she doesn’t fully understand. But, since no one is available to help her complete the application, she completes the application on her own and turns it in. She ends up being rejected because she hasn’t filled out the forms properly.

Months later, still uninsured and unable to get the prescription medications she needs, she goes to a community health center for care, where an enrollment worker tells her she may be eligible for public health insurance and food stamps. The worker completes the applications, and a few weeks later, Christine and her kids finally have health insurance coverage and food stamps.

In this case, the community health center enrollment worker has served as a patient navigator: a caseworker of sorts who helps patients navigate through the choppy waters of today’s complex public health care system.

Thanks to Health Care Reform, over 32 million currently uninsured people nationwide will be eligible for subsidized health insurance in 2014, and they will be able to enroll starting in October 2013. More than 60,000 of those people live in Sonoma County and more than two-thirds of them are estimated to be low- to moderate-income individuals. Enrolling such a large number of uninsured people in a relatively short amount of time will be a challenge.

Health advocates are working with local, state, and federal agencies to create a robust enrollment system to handle the huge numbers of newly eligible individuals. While Redwood Community Health Coalition and many other stakeholders are advocating for an enrollment and eligibility process that is as easy as signing up for Netflix, we recognize that even a streamlined system will still require enrollment workers to guide many people through their health insurance options. This assistance will be particularly important for people who are low-income, have low literacy levels, or for whom English is not their primary language.

Federal health reform legislation provides funding for patient navigators to ensure the successful enrollment of all uninsured patients. Patient navigators have already been used to improve care coordination for disadvantaged populations who often face many barriers in accessing care, such as transportation, childcare, and difficulties negotiating relationships with clinicians or healthcare organizations because of language or cultural differences. But while some patient navigators have also helped people enroll in health coverage, this usually is not the focus of their work.

For the big push starting in October 2013, we will need patient navigators who can specialize in enrolling new patients in public health care—in essence, a patient enrollment navigator program. Sonoma County is fortunate because we won’t need to build one from scratch. In 2005, community health centers in Sonoma County, in partnership with local hospitals, community-based organizations, foundations, and government agencies, created Healthy Kids Sonoma County, a model enrollment navigator program for enrolling and re-enrolling tens of thousands of uninsured children and their families into health coverage.

Since the inception of Healthy Kids, navigators at community health centers have helped to nearly double the number of low-income children with subsidized health insurance in our community. Today there are approximately 49,000 Sonoma County children enrolled in public health insurance programs because of Healthy Kids—more than before the economic downturn began.

This program can and must be expanded to enroll the tens of thousands of uninsured individuals who will be eligible for health insurance in 2014. While Healthy Kids’ focus is on children and families, we can easily apply its successes to create the foundation for a seamless process to enroll all eligible individuals into health insurance programs.

There’s another thing we can do to help things go smoothly starting next October: we can help by getting as many people as possible who are already eligible for public health coverage programs enrolled now. Because all low-income kids are eligible for publicly-subsidized health coverage now, we should get as many as possible enrolled now so we can better focus on people who will be newly eligible in 2014. The medical community can help by referring uninsured kids to Healthy Kids Sonoma County now at 800.427.8982.

About the author: Pedro Toledo is the Director of Community and Government Relations for the Redwood Community Health Coalition (RCHC), a network of 16 community health centers and clinics serving as the medical homes for more than 186,000 people in Sonoma, Marin, Napa, and Yolo counties. He oversees Healthy Kids Sonoma County, which works to ensure that every child in the county has affordable health insurance and access to health care.