Tracking your Efforts to Engage Clients who Experience Barriers to Enrollment

ACE TA Center

There are many reasons that a client may not yet be enrolled in health coverage or have trouble staying covered. There are a number of factors, such as housing instability, as well as mental health and substance use issues, that can make enrollment especially challenging. In addition, some clients have fears or concerns about getting health coverage for the first time. These clients may have had negative experiences with the health care system, or may have questions or concerns that need to be addressed before they are ready to share personal information for enrollment. Further, some clients may be ineligible due to state or federal laws.

This resource includes best practices and resources for engaging and enrolling clients and tracking your efforts, using these four steps:

  1. Determine if your client may be eligible for health coverage.
  2. If they are eligible, engage clients in conversations about coverage. 
  3. Develop policies and procedures to document your efforts to enroll clients in coverage.
  4. Document and monitor your efforts to enroll clients in coverage.

Step 1. Determine if your client may be eligible for health coverage.

Assess your client’s eligibility for health coverage on a routine basis. Explore health coverage options such as Marketplace plans, Medicaid, CHIP, Medicare, employer-sponsored health insurance coverage, or other private health insurance. 

Use the ACE TA Center Eligibility Decision Tree to determine your client’s eligibility. 

  1. If the client is eligible for coverage, proceed to Step 2
  2. If the client is not eligible for coverage, proceed to Step 4

Even if the client is ineligible now (e.g., clients that fall into the Medicaid gap), their eligibility may change in the future. Changes in income, household size, employment, and immigration status may impact a client’s eligibility for coverage. Use these ACE TA Center resources to learn more.


Step 2. If they are eligible, engage clients in conversations about coverage. 

Take the time to talk with your clients about their health coverage options, and explore questions and concerns they may have about enrollment.

Clients may not immediately share their concerns about enrolling in health coverage. Take the time to talk with the client about their health coverage options, and about questions and concerns they may have about enrollment. 

Use these ACE TA Center resources to help you address common questions and concerns that clients may have about enrolling in health coverage.

Some clients may still not be ready to enroll, even after many conversations. See Step 3 below to document all of your efforts, whether they immediately result in enrollment or not. Continue trying to engage these clients, but let them know that the RWHAP is still available to provide HIV-related medical and support services to ensure they stay retained in HIV care. 


Step 3. Develop policies and procedures to document your efforts to enroll clients in coverage.

Talk with your local RWHAP Part A or Part B program to ask if they have established policies and procedures on how to document your enrollment efforts. Then, make sure you develop your own organizational procedures for documentation. 

RWHAP recipients must demonstrate “vigorous pursuit” of enrolling clients in coverage. This documentation process can also be valuable for internal quality improvement. 


Step 4. Document and monitor your efforts to enroll clients in coverage.

Document and monitor the process and outcome measures you identified in Step 3. Check with your agency's benefits/enrollment department and your local or state health department to see if they can help you, your staff, and/or your organization identify which clients are eligible for coverage. Be sure to track all clients who are enrolled, as well as those who are not enrolled, for any reason. Any client who remains uncovered (including those who are ineligible) should complete an attestation form to confirm that they will not be enrolling in health coverage. 

If your organization does not already have an attestation form, consider adapting one of these examples to document that the client will not be applying for health insurance:

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