The Affordable Care Act (ACA) has yielded impressive progress in reducing the ranks of the uninsured, with more than 12 million people covered by the health insurance marketplaces alone. However, meeting the goal of enrolling the remaining seven million people who are eligible for marketplace coverage but are still uninsured— even after the third open enrollment period—will be an even bigger challenge than getting the first 12 million people covered. It will require not only targeted, effective outreach with groups that are eligible but unenrolled, but also improved systems to make the application process work better for individuals and families with more complex situations—like families with immigrants—who remain without coverage.

The recommended action steps to reach immigrant families included in this brief are based on an online survey and listening sessions with navigators and certified application counselors who assist immigrants in applying for coverage— conducted by the Georgetown University Center for Children and Families in the spring of 2015 after the close of the second open enrollment period. Additional input was obtained from key stakeholders and national experts in the summer and fall of 2015 and in the third open enrollment period.

Those steps include:

1. Refining the federally-facilitated health insurance marketplace immigration status and citizenship status verification protocols and processes so that valid document numbers are more likely to be electronically verified and immigrants who are not eligible for Medicaid or CHIP are not routed unnecessarily to the state Medicaid agency;
2. Improving communications and expediting the resolution of inconsistencies;
3. Developing an alternative process to confirm identity;
4. Boosting resources for communication in languages other than English and Spanish; and
5. Improving the customer experience for both assisters and applicants, including refining the process for resolving complex cases.