Designing Subsidized Health Coverage Programs to Attract Enrollment: 
A Review of the Literature and a Synthesis of Stakeholder Views

December, 2008

Authored by

L.Quincy, P.Collins, K. Andrews, C.Stone

Mathematica Policy Research, Inc.
600 Maryland Ave., S.W., Suite 550
Washington, DC 20024-251 2
Telephone:  (202) 484-9220
Facsimile: (202) 863-1763
Project Director:
Deborah Chollet

This report is available on the Internet at:
http://aspe.hhs.gov/health/reports/08/subenroll/index.shtml

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Abstract

The focus of this study was on the non-price program features that influence the enrollment of non-elderly adults into voluntary state and local programs that subsidize coverage or care.  The study consisted of two Phases -- Phase 1 was a literature review to assess the current state of knowledge regarding the impact of non-price design features on enrollment. Information gathered from this literature was used to inform Phase 2, which consisted of discussions with 67 program directors and other key informants from 17 subsidized coverage programs across the country.  The key findings of the study are as follows:

• There is inadequate knowledge to guide program designers
• Outreach is critical
• A broad spectrum of partnerships is key for creating awareness that leads to enrollment
• Applicants need a high level of insurance counseling and application assistance
• Program officials need to manage expectations and avoid negative perceptions

Table of Contents

• Acknowledgments
• Contents
• Executive Summary
• There Is Inadequate Knowledge to Guide Program Designers
• Outreach Is Critical
• A Broad Spectrum of Partnerships Is Key for Creating Awareness That Leads to Enrollment
• Applicants Need A High Level of Insurance Counseling and Application Assistance
• Program Officials Need to Manage Expectations and Avoid Negative Perceptions
• Programs That Target Adults Directly Attract Enrollment Much More Easily Than Programs That Involve Employers
• Additional Research Is Needed to Quantify the Role of Nonprice Design Features in Enrollment

Chapter I

• Why This Study Is Needed
• Study Approach
• Programs Included in the Study
• Report Structure and Preview of Findings
• Successful Strategies Common to All Programs
• Findings Specific to the Coverage Approach

Chapter II

• Brokered Access to Subsidized Care
• Program Background and Enrollment Experience to Date
• Key Findings
• Program Awareness
• Program Comprehension
• Program Appeal
• Benefit Design/Provider Network
• Premium Subsidy Structure
• Enrollment Process/Eligibility Criteria
• Stigma
• Program Permanence

Chapter III

• Subsidized Nongroup Coverage for Adults
• Program Background
• Key Findings
• Program Awareness
• Program Comprehension
• Program Appeal
• Benefit Design/Provider Network
• Premium Subsidy Structure
• Enrollment Process/Eligibility Criteria
• Stigma
• Program Permanence

Chapter IV

• Premium Subsidies for Workers
• Background and Enrollment Experience
• Unique Features of Medicaid- and SCHIP-Financed Programs
• Key Findings
• Program Awareness
• Program Comprehension
• Program Appeal
• Benefit Design/Provider Network
• Premium Subsidy Structure
• Enrollment Process/Eligibility Criteria
• Stigma
• Program Permanence
• Premium Assistance for Nongroup vs. Group Coverage

Chapter V

• Premium Subsidies for  Employers and Workers
• Program Background
• Sole Proprietors Are a Special Case
• Key Findings
• Program Awareness
• Program Comprehension
• Program Appeal
• Benefit Design/Provider Network
• Enrollment Process/Eligibility Criteria
• Stigma
• Program Permanence
• How Can Programs Get Brokers on Board?

Chapter VI

• Conclusions
• Successful Strategies Common to All Programs
• Program Awareness
• Program Comprehension
• Program Appeal
• Ease of Application
• Findings Specific to Program Types
• Gaining Small-Firm Participation Requires a Very Appealing Design
• Subsidized Programs That Target Adults Directly Have an Easier Time Attracting Enrollment
• Premium Assistance Programs Face Enrollment Challenges
• Varying Perceptions of Demand Among the Target Population
• More Research Needed to Guide Program Designers
• Recommended Next Steps

References

Appendix A

Appendix B

Appendix C

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Last updated:  04/28/2009