The role of medical-legal partnership in open enrollment: Spotlight on North Carolina

Monday, December 11, 2017

Access to health insurance and health care is a critical social determinant of health, and with a shortened open enrollment period this year, communities are engaged in a range of activities to quickly screen and help enroll eligible individuals and families. Medical-legal partnerships across the country are playing a critical role by serving as and expanding the capacity of navigators, and in North Carolina, a Medicaid non-expansion state, the public health, medical, and legal communities are mobilizing together to ensure that North Carolinians can access coverage before the December 15 deadline.

Legal Aid of North Carolina, a medical-legal partnership partner to 12 health care systems, including hospitals and health centers operating in more than 30 different locations statewide, leads the NC Navigator Consortium, a group of 12 health care, social service, and legal aid organizations dedicated to assisting consumers from all 100 North Carolina counties to enroll in affordable health insurance plans through the Affordable Care Act (ACA). Formed in 2013, the Consortium is funded by a $2.44 million grant from the Centers for Medicare & Medicaid Services. Thanks in large part to the Consortium’s efforts, North Carolina has the third-highest number of ACA enrollments out of the nearly 40 states that use the federal Health Insurance Marketplace.

The NC Consortium works to organize, streamline, and expand the outreach and enrollment process statewide. This includes establishing a specialized statewide call-in number and on-line scheduling portal to allow consumers to easily access in-person appointments with certified, impartial navigators. Navigators are trained to help consumers understand the details of plans available in the Health Insurance Marketplace, determine eligibility and apply for financial assistance, complete the enrollment process, and identify consumers who are potentially eligible for Medicaid or CHIP. This system is the anchor for connecting North Carolinians to high quality, affordable health insurance options during the shortened 2018 enrollment period.

Legal Aid of North Carolina’s expanding medical-legal partnership work is directly tied to its role in the NC Navigator Consortium and its commitment to helping healthcare partners find innovative ways to screen and enroll even more people, and to incorporate those enrollment-related services into broader efforts to meet other health-harming legal needs. At hospitals and health centers offering MLP services, waiting areas, clinic/exam rooms, elevators, and providers’ work stations are stocked with posters and other materials about enrollment deadlines, how to enroll, and extra information about the ACA. Many MLP clinics and hospitals offer on-site appointments for patients and family members to meet with Navigators.

The University of North Carolina Children’s Hospital has had a formal partnership with Legal Aid of North Carolina for six years, and is one of the places working with legal aid to meet patients’ need for coverage. “We now know that signing up patients, or in our case it is often the parent of a patient, for health insurance coverage through the ACA can improve the lack of access to care and improve health,” said Michael Steiner, MD, MPH, Chief of the hospital’s Division of General Pediatrics and Adolescent Medicine. “Working with legal aid has dramatically enriched our understanding of health beyond health care and has broadened our health care team, and helped us to serve children and families in new, exciting, and innovative ways.”

Moreover, a growing number of the hospitals and health centers partnering with Legal Aid of North Carolina routinely screen patients and family members regarding health insurance status in order to identify people who, due to a change in circumstances, such as a new family member or a job loss, may be eligible for ACA coverage outside of the ACA’s open enrollment season. This year-round screening amplifies ongoing efforts to improve patients’ access to health coverage, whether by enrolling them through the ACA, appealing Medicaid denials or terminations, or connecting them to other financial assistance.

Funding from the Cone Health Foundation and Kate B Reynolds Charitable Trust has allowed Legal Aid of North Carolina to expand its outreach and enrollment work in the Greensboro and Winston-Salem areas, respectively. These dedicated funds have also helped Legal Aid of North Carolina to focus on Medicaid gap work, helping low-income patients and families who may not qualify for ACA coverage to be screened and assisted with Medicaid applications and appeals. And its outreach and enrollment work has directly led to the development of three new medical-legal partnerships in the state that address a variety of social and legal needs beyond enrollment. These new partners include two community clinics in Greensboro—Family Services of the Piedmont and The Mustard Seed Clinic—and FirstHealth of Carolinas, a major, rural hospital system in the south-central part of the state.

“Our collaboration with Legal Aid of North Carolina was built, initially, on our shared commitment to expanding health insurance coverage to individuals living in the 16 rural counties that are served by our health system,” said Roxanne Elliott, Policy Director Community Health Services for FirstHealth of the Carolinas. “Very quickly, we realized that many of our patients were still suffering from complications of chronic diseases at rates greater than state averages, and the impacts of social determinants of health were evident. Now we are embarked on a deeper collaboration to help address other health and social needs together. The MLP is a win-win for everyone, most importantly the patients.”