Social workers discuss enrollment process for health care under ACA

Social work students across the nation work, volunteer as navigators

Katie Merrill with a clientMSW student Katie Merrill, left, is part of the contracted navigator program at the University of Albany School of Social Welfare in New York. Students like Merrill guide people who are enrolling for health care under the ACA. — Photo by Mark Schmidt/University of Albany

Talking to people about their health is all in a day’s work, according to Katie Merrill, an MSW student at the University of Albany School of Social Welfare in New York.

Merrill is one of the student health care navigators for the university’s contracted navigator program, which serves the New York counties of Albany, Rensselaer, Schenectady, Columbia and Greene.

“We would go out into the community, talk to people one on one, and sign them up for health care on the spot, using laptops,” she said.

The 2014 deadline to enroll for health care under the Affordable Care Act was March 31, and the University of Albany’s program is one of many across the U.S. that employed NASW members, social workers, and social work students as health care navigators to help people get enrolled by the deadline.

Katharine Briar-Lawson, dean of the University of Albany School of Social Welfare, said social work skills provide the tenacity for navigators to see the process through. The navigators at the University of Albany stayed with individuals until they were able to fully complete, understand and use a health insurance plan they had just enrolled in, she said.

“The work of a health care navigator is pioneering; they are the first people involved at the ground level,” Briar-Lawson added.

About 1 million people in New York enrolled in health care plans by the 2014 ACA deadline, according to the New York state health department. In the South, Alabama also saw high enrollment, said Daniel Liss, co-founder of Bama Covered, a grassroots student movement that works to educate Alabama families about their health care options.

Liss said several social work students volunteered with Bama Covered to get people signed up. The online process to enroll for health care is fairly straightforward, he said, but it can be complicated for those who are not computer savvy. There are a lot of little steps and lots of questions to figure out whether someone is best suited for Medicaid or a private plan, he said.

“It’s very helpful to have someone sit with you to walk you through it,” Liss said. “As of April 12, over 94,000 in Alabama enrolled. (Health care enrollment) has been incredibly successful here.”

Some people seemed a little wary of the ACA enrollment process in states like West Virginia, said NASW member Karen Glazier, a licensed clinical social worker who is a certified application counselor and health coach with Cabin Creek Health Systems.

She said her state declined federal money for health care enrollment publicity, and a lack of knowledge about it affected enrollment.

“There wasn’t a lot going on in West Virginia in terms of publicity to get the word out about signing up for health care,” Glazier said.

But she said some of those who did know about the enrollment were already opposed to the Affordable Care Act.

“This doesn’t apply to everybody, but a fraction of the people here already had a negative view about the ACA because of the coal culture, and it was important for navigators to try to work around that and highlight the important aspects of health care,” Glazier said.

The coal industry has historically been the primary source of good paying jobs in the state, she said, and anything that seems to threaten the industry can be taken personally because it touches on the livelihood of entire communities.

“Certain leaders in the industry have been successful in portraying the EPA and President Obama as anti-coal, and, therefore, anti-West Virginia,” Glazier said. “Unfortunately, this translates into how people vote and how people relate to the Affordable Care Act.”

The main role of a health care navigator is providing those who are uninsured with an access to services and information that many haven’t had the opportunity to access before, said NASW member David T. Elin, director of Enroll America in Chicago. Because the enrollment process is so new, he said there naturally were challenges — and a major one was the complications with the website in the early months of enrollment.

“There are a lot of challenges when you’re doing something new,” Elin said. “What is amazing about this effort is that there are government agencies, nonprofits, community-based organizations, and social service organizations working together to provide health care access for people. With everybody getting on the same page at the same time, there will be some difficulty.”

Glazier said the first couple of months of enrollment were a little frustrating due to website difficulties, and that many older clients do not have an email address, which is essential. This slowed the process down, as it was necessary to create an email account first for these clients before proceeding.

“It was another technical issue to deal with at times,” she said. “It would help to have it set up where an email address is not necessary in order to enroll online.”

University of Albany’s Merrill said talking to people about their financial status was hard at times, but it was a necessary conversation to have in order to enroll people for the health coverage that best suited their needs.

“People are really uncomfortable talking about money,” she said. “A lot did not want to discuss their finances, but we needed to talk about income and budget, and whether they are Medicaid-eligible or not.”

Despite the challenges, Merrill said the navigator experience left her feeling well-prepared in going forward as a social worker.

“I was really excited to get in on the ground level of the rollout of the ACA,” she said. “I’ve met and worked with people I never would have without this experience, and it’s taught me flexibility, perseverance and how to work with different personalities. Through being a navigator, I feel like I’m a part of history.”

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Special ACA Enrollment Period

Those who did not enroll by March 31 may qualify for a special enrollment period if they have a specific circumstance, such as the death of a family member, divorce, birth, relocation or job loss.

NASW member Kelli Soyer, Outreach Manager for Focus ACA in West Des Moines, Iowa, said social workers can help let people know when special enrollment is available and who qualifies.

“The biggest thing is being sure people are educated about what is available to them,” Soyer said. “This is where social workers can fill up the gaps and clear confusion. Now that 2014 enrollment is complete and we’ve experienced the bumps, we can learn and hopefully have a smoother time for 2015.”

Soyer said people who remain uninsured will have to pay increasing tax penalties, starting at 1 percent of their income or $95, whichever is higher.

The health care enrollment process for 2015 starts Nov. 15.