How to Assess Your Work Flow to Routinely Screen Clients for Eligibility and Plan Renewals

ACE TA Center

Clients are most likely to successfully enroll in new coverage when the transition between engagement activities and enrollment support is seamless. Structure your work flow so that engagement and enrollment activities are closely related. Integrate the following into your workflow.

Engage clients in enrollment and make it easy for clients to get help with enrollment, whether it’s on-site assistance or connecting them to a trusted partner agency.

Connect clients to enrollment assistance when they come in for other appointments, and offer assistance over the phone and on a drop-in basis. Make enrollment assistance available after hours and on weekends. Schedule and publicize “in-person assistance” days. When engaging clients in person or by phone, inform them of new coverage options, be prepared to screen them for eligibility on the spot, and know how to connect them directly with an enrollment specialist, (either your in-house enrollment assister or by referral to a trusted partner agency). Having dedicated staff and a confidential space to conduct the screenings will help increase the number of clients you screen.

Establish a process to verify income, qualifying life events, or other special circumstances that may change clients’ eligibility for health coverage, premium tax credits and cost sharing reductions every six months.

Clients may experience changes in employment, wages, or other life events that may impact their eligibility in Medicaid or Marketplace coverage. Establish a process to verify income, qualifying life events, or other special circumstances that may change clients’ eligibility for health coverage, premium tax credits and cost sharing reductions every six months. This screening process could align with the ADAP recertification required every six months by HRSA.

Qualifying life events include moving to a new state, changes in income, change in family structure such as marriage, divorce, or birth of a child, and change in citizenship status. Such events may change clients’ eligibility for subsidies and specific coverage options, and signal the need for a change of plan. Encourage clients to contact their case manager or other RWHAP staff when they have a qualifying event, who can provide them with immediate assistance or connect them with an enrollment assister for follow-up.

Send clients reminders about upcoming renewal dates using a variety of communication channels, including phone calls, letters, and text messages.

At time of enrollment, explain the need to renew coverage yearly and ask clients how they would like to be contacted for issues of reenrollment or renewal. Consider developing a regular schedule of brief communications to clients about health coverage—this could include health system navigation tips, coverage program updates, and answers to frequently asked questions, as well as reminders to come in for renewal assistance.

We'd like your feedback

Was this page helpful?
I found this page helpful because the content on the page:
Check all that apply
I did not find this page helpful because the content on the page:
Check all that apply
Please include an email address if you would like a response
Please include an email address if you would like a response
Did you use this approach in your work?
Not yet because
If no, why not?