With the deadline for enrollment in the Affordable Care Act’s health insurance marketplaces less than three weeks away, University-affiliated volunteers at the Pacific Free Clinic (PFC)—one of two Stanford-funded, volunteer-based local clinics—have recently focused on ensuring as many uninsured patients as possible have signed up.

Despite increased outreach efforts by state authorities and the PFC over the last year, administrators noted the challenge of even ensuring that all prospective patients are aware of the deadline.

“Getting all eligible patients enrolled in an insurance plan took longer than expected,” said Rhonda McClinton-Brown, executive director of the Office of Community Health, which oversees the Cardinal Free Clinics program.

The PFC serves populations in East San Jose, where 94 percent of patients are uninsured.

“Even though there are billboards and radio ads, people still don’t know what that means for [them],” McClinton-Brown said. “They still don’t realize that there’s something that they could be doing.”

Under the recent expansion of Medi-Cal, the state’s health insurance program that provides insurance to low-income individuals, more PFC patients are now eligible for affordable health care options but are unaware they qualify.

“Many of these patients have gone uninsured for most of their lives, and they have not adjusted to the changes under the ACA,” McClinton-Brown said.

To address that lack of awareness, PFC created an insurance enrollment department last year that focuses its efforts on keeping track of the changes in the mandate in order to accurately inform patients about the different insurance options available. Because the PFC volunteers are not certified enrollment counselors, however, the center relies on partnerships with primary care clinics in the region to help patients enroll in programs for which they qualify.

“As the ACA was rolling out, the community partners underwent major changes in the services they were offering,” said Christine Yeh ’16, co-director of the insurance enrollment department at the PFC. “And because the community partners were making their changes at different times, PFC volunteers were frequently revising and re-packaging the information they were presenting to their patients.”

Yeh recalled how volunteers had to caution patients that the material might be outdated.

“At one point in winter and spring quarters last year, we would sometimes feel really, really behind,” she said. “Because we’re students as well we can’t know what each clinic in the area is doing in terms of the changes of the ACA.”

Even as details of the mandate become more firmly established, volunteers acknowledged that the process of obtaining insurance remains complicated.

“The process by which eligibility is determined is rather cumbersome still and a little bit clunky,” said Baldeep Singh, one of the co-directors of Cardinal Free Clinics.

Singh said that volunteers at the free clinics have become more efficient at referring patients to the proper primary care facilities. Between 10 and 15 percent of patients screened are identified as being eligible for some insurance.

Covered California

Volunteers emphasized the value of Covered California, a new state health insurance exchange that compiles the various insurance options available. Previously, volunteers had to keep a running list of the different programs in the area.

Despite the existence of internet services, many patients still rely on the help of the PFC counselors—many of whom speak Mandarin or Spanish—to navigate the website with them. Thirteen percent of the PFC patients are Chinese and 16 percent are Hispanic.

“The insurance enrollment counselors often work one-on-one with individuals or whole families who visit the clinic to ensure that they receive all of the benefits they may be eligible for,” Yeh said.

Counselors are usually able to match around 15 cases—either individuals or families—with insurance programs.

Back-up

Although insurance programs have been expanded and options centralized for better navigability, many patients “still fall through the cracks,” according to McClinton-Brown. She noted that the clinic sees a large number of undocumented immigrants—who aren’t eligible for the ACA’s expanded coverage—as well as patients who worry that insurance premiums will still be too expensive despite federal and state financial assistance.

“Having health insurance is a great thing but living in [Silicon Valley], having to pay a premium can be overwhelming for that population,” she said.

In response, the PFC, as well as the Arbor Free Clinic, refers patients to other insurance programs that do not fall under the state’s insurance program. For example, one of these other insurance programs—Point Care—does not look at legal status.

Contact Vanessa Ochavillo at vochavillo ‘at’ stanford ‘dot’ edu.