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What Worked and What's Next? Strategies in Four States Leading ACA Enrollment Efforts

Although all states faced challenges during the first open enrollment for new Marketplace coverage, data show that as of April 2014 over 8 million individuals had enrolled in coverage through the Marketplaces and more than 6 million were added to the Medicaid program from before open-enrollment. While all states took different approaches to implementing the ACA, this report highlighted experiences in four states that achieved significant success in reaching and enrolling individuals into coverage, which provide important lessons learned and guidance for other states.

Each state implemented innovative approaches that contributed to this success; however, it is also clear that there was not one single strategy, but rather a combination of strategies related to marketing and branding, outreach and enrollment, consumer assistance, and systems and operations that supported successful coverage efforts.  Underlying all of these strategies, strong leadership and close collaboration across stakeholders were also hallmarks for success. Finally, the ability to be nimble and make adjustments along the way as issues and problems were identified and recognized was an important lesson learned.  From marketing to staffing call centers to reaching the uninsured to launching new enrollment systems, nearly all states hit some road blocks, but one of the keys to success in these states was the ability to quickly implement adjustments, fixes and workarounds.

Looking ahead, states have a number of consistent priorities for their current work and the next open enrollment period.  Key priorities include a continued focus on enrollment and renewal, particularly related to education about ongoing Medicaid enrollment and special enrollment periods for the Marketplaces, maintaining coverage for those that have successfully enrolled, reaching those who remain uninsured, and maintaining an adequate network of consumer assistance. These states also are planning continued upgrades and enhancements to their enrollment systems and consumer assistance training programs to address outstanding limitations and gaps. However, one of the most significant priorities currently facing states is increasing consumer knowledge and understanding of health insurance and supporting access and utilization of care among the many individuals who have newly gained coverage.

This brief was prepared by Samantha Artiga, Jessica Stephens, and Robin Rudowitz from the Kaiser Family Foundation and Michael Perry from PerryUndem Research and Communication. The authors extend their deep appreciation to the state officials and other stakeholders for sharing their time and experiences to inform this project.

Current and Future Priorities Appendix