When we hear words like capacity building and infrastructure building, what do they mean? For UHCAN Ohio, it means supporting organizations in communities with high concentrations of people of color, people in poverty and other at-risk populations, to strengthen their ability to serve their communities. This includes creating or strengthening access to resources that provide the outreach, enrollment, and health literacy/consumer activation services needed in their community.

The Reality of Working in Communities of Color: Often, organizations in communities of color lack the financial and personnel resources to add new services, particularly in urban cities where there are higher numbers of people living below the poverty line. Yet often these organizations are the best way to reach those living in communities of color to spread the word about or provide a new service, because they have a track record in the community, have developed trust among community residents, and are the places community members turn to when they need help.

 We’ve Made Strides But There’s Still Work To Do: We have completed our second enrollment period for the Affordable Care Act, and 235,000 Ohioans have taken advantage of coverage on the Marketplace. As a result of the Medicaid expansion over 510,000 new Ohioans are have signed up for Medicaid. However, in spite of our efforts to cover the uninsured, African Americans and Hispanics still experience some of the highest uninsured rates. This makes it particularly important that our efforts reach the uninsured from these communities.

This is where capacity and infrastructure come in. If we want these trusted organizations in African-American and Hispanic communities to be part of our outreach and enrollment strategies, we have to build capacity for them to participate.  As more of these trusted programs understand new coverage opportunities and participate in outreach and enrollment, we build infrastructure. 

What Does This Look Like? 

If we are successful, there will be faith and community-based organizations in many of our urban and rural communities that are able to:

·         provide regular information on how to get covered;

·         provide enrollment assistance; and

·         follow up with those they enrolled to make sure they get covered, learn to use their insurance, and get connected to primary care.  

How Do We Build Infrastructure?

1.       The first step is to identify organizations that are central to the community you want to reach and have an interest in covering the uninsured. For our work, we engaged faith and community-based social service organizations in communities of color. 

2.       Next, think about how they want to be engaged and what support they will need. For our project, we encouraged organizations to become enrollment sites using Certified Application Counselors who provided outreach, enrollment assistance, follow-up, and now health literacy education.  

3.       Host information sessions, build relationships, and educate. We invited churches and community organizations working in African-American, Hispanic, Asian, and African communities to community meetings where we educated them on the Marketplace and Medicaid expansion, the role of a Certified Application Counselor (CAC), and how to become an enrollment site. We also provided information on other ways they could participate in outreach and enrollment.

4.       Finally, provide supports that build their capacity to participate. We provided financial support, which allowed organizations to give small stipends to CACs and conduct outreach.   We also provided training and ongoing technical assistance to the CACs.

The organizations we are working with, their CACs, and those they assist are becoming the infrastructure in their communities who understand coverage under the ACA and can get the word out and help people enroll. This infrastructure can be used in the future to disseminate information on how to use plans, recertify Medicaid coverage, connect to care, and provide other information that will help people retain their coverage and access health care.