KATCH-ing the Uninsured: Lessons from Kansas’ Out-stationed Eligibility Workers

To increase their capacity to reach uninsured individuals, many states utilize out-stationed eligibility workers to help enroll individuals into Medicaid. “Out-stationed” at community-based organizations (e.g. health centers, clinics, hospitals, schools, community centers), these workers enable individuals to apply for public assistance benefits at locations other than the typical Medicaid or social services offices; optimally in locations that are more geographically accessible to potential consumers than state or county offices might be.

Through support from the SHAP grant, the Kansas Access to Comprehensive Health Project (KATCH) hired, trained, and placed 12 out-stationed eligibility workers in communities throughout the state (target populations include Hispanics, Native Americans, and pregnant women).  Often tasked with a breadth of responsibilities, workers primarily assist individuals and families determine eligibility and enroll in Medicaid coverage options.  These workers often split their time between 2-3 offices at various community hubs while also spending time throughout their designated community to spread information and awareness at local events, such as health fairs, and to build relationships with key leaders at local elementary and high schools. When necessary, some workers also conduct home visits for hard to reach, often elderly, individuals.

Kansas’ out-stationed eligibility workers have largely been successful in the enrollment of eligible populations, processing approximately 5,000 applications to enroll nearly 7,000 individuals since the program began.  One key success of the program has been the ability of workers to conduct outreach efforts while also establishing connections with community stakeholders. Clinics and health centers have been especially receptive to this program, as workers have served to not only connect patients with coverage, but also to develop relationships, build education, and improve health care access among patients.  For instance, in the case of one tribe served by an eligibility worker, it was discovered that most health care needs of the tribal members were absorbed by the tribal health center, prompting many members to only apply for coverage when they needed specialty care outside of the tribal center. After placement of the eligibility worker in that health center, staff noted the positive impact of having someone available to build trust and share information with tribal members so that, in turn, tribal members would be more likely to apply for available programs before they were in need of specialty services. (Click here,  here, or here for some additional resources detailing enrollment strategies across states.)

Kansas continues to evolve the work of its out-stationed program, leveraging lessons from a recent audience analysis to enhance outreach practices, as well as researching better ways to track enrollment and disenrollment information through the eligibility process. Kansas has also learned many valuable lessons from the project about the unique needs and challenges of various populations in navigating current state eligibility processes. For example, the hiring of bilingual out-stationed workers greatly benefited one region of the state with a large concentration of Mexican-Americans.  For communities with large Native American populations, cultural competency was a huge barrier to enrollment, and workers who had an understanding of the traditions and unique needs of local tribes were most successful. Such lessons will be used to enhance the capacity of the state’s new eligibility enforcement system—which will provide consumers with self-service options to inquire about potential eligibility for social service programs—to work for diverse populations within the state.

Thanks to Jenifer Telshaw and Russell Nittler from the Kansas Department of Health and Environment for their input on this blog. For more information about the work of Kansas or any other SHAP state to increase enrollment, please be sure to check out some of our previous blogs, or you can contact a member of our SHAP team directly.