Know Your Audience: Lessons for Online Paths to Coverage

Read the latest Mathematica evaluation of California’s web-based application system.

Gene Lewit, David and Lucile Packard Foundation

Enrolling almost 30 million Americans in health coverage starting January 1, 2014, is the sort of thing that can keep people up at night. It’s a daunting task, which the Affordable Care Act (ACA) sought to make easier by calling on states to provide online enrollment portal systems. These new portals are expected to provide a high-quality customer experience while maximizing online use and self-service for people applying for Medicaid, CHIP or exchange coverage.

Many states were already heading in the direction of online enrollment prior to enactment of the ACA. A recent survey by the Kaiser Family Foundation and Georgetown University’s Center for Children and Families found that 37 states now allow online applications for Medicaid or CHIP. Despite this widespread prevalence, little is known about who is applying for coverage online or what their user experience has been. Findings from an evaluation by Mathematica Policy Research of Health-e-Application Public Access (HeA PA) – a fully automated, web-based application for California’s CHIP program (Healthy Families) and a screener for its Medicaid program (Medi-Cal) – may help fill this void.

Last March, I wrote that the first brief from the evaluation provided encouraging information about the positive impact HeA PA had made on families’ ability to enroll their eligible children in public coverage programs. A second brief released last week delves into the characteristics of HeA PA applicants and their experience with the self-service tool. The findings are based on nearly 15,000 surveys completed by applicants in 2011 after they submitted applications.

Users of HeA PA expressed a strong preference to communicate in English but otherwise were not much different on the characteristics measured from applicants who used paper or assisted online applications. Although both Spanish and English versions of HeA PA are available online, only 4 percent of online applicants preferred to communicate in Spanish while 95 percent preferred to communicate in English. In contrast, about 40 percent of applicants using either assisted online or paper applications preferred to communicate in Spanish.

Not surprisingly, HeA PA users are internet savvy: roughly 90 percent said they use the internet at least three times per week and nearly all have access to a high speed internet connection. Most used a computer at home or at work to complete the application, while only 3 percent used a public computer, such as in a library. Just over half of the online users used a HeA PA help feature, with more using built-in features such as the help pages rather than the toll-free telephone help line.

A limitation of the study is that it does not provide information about the experiences or characteristics of people who began an application online but did not complete it or those who did not even try to use HeA PA. More detailed information about the characteristics of HeA PA applicants and their experiences with the tool are contained in the new brief.

For states that are building or updating their enrollment systems, the California experience suggests that tools like HeA PA are a good option for applicants who are internet savvy, have convenient access to a high-speed internet connection, and do not need extensive in-person help when applying for coverage. Furthermore, though Spanish-speaking households may be less likely to use self-service online applications when systems go live in January, this may change as the broadband gap for these households continues to close, and they gain more familiarity using the internet for a variety of tasks.

As we move into this new era of coverage, the use of tools like HeA PA are likely to grow as both awareness of their availability and high-speed internet access improves among individuals and families seeking coverage. In the meantime, however, it will be necessary to build out the system of Navigators and other in-person supports to enroll the large number of people who prefer paper applications and/or the help of a live person.

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