Irfan Hasan, Deputy Vice President for Grants, The New York Community Trust
Avital Havusha, Vice President for Programs, New York Health Foundation
Chad Shearer, Senior Vice President for Policy and Program, United Hospital Fund
In March 2020, the United States declared a public health emergency and enacted historic COVID-19 relief legislation. It increased Medicaid funding to states contingent on several conditions, including a “continuous enrollment” requirement that prohibited states from terminating Medicaid enrollees’ coverage until after the public health emergency had ended. How well this worked is a rare silver lining of the pandemic: an estimated 20.2 million people gained coverage since March 2020 and the uninsured rate dropped across the country (Corallo and Moreno 2023). In New York, coverage rates are at a record high, with more than 9.4 million New Yorkers enrolled in public coverage, including more than 1.4 million enrolled for the first time (New York State Department of Health 2023).
In December 2022, Congress’ year-end omnibus spending bill established a firm end date for the “continuous enrollment” requirement, regardless of when the public health emergency declaration ends (Tsai 2023). Therefore, on April 1, 2023, states are resuming the process of reassessing eligibility and ending coverage for those who are no longer eligible, a massive undertaking. Over a 14-month period, known as the “unwind,” states must confirm eligibility for all enrollees. Many people will need to actively reenroll to stay covered. For some enrollees—especially people of color, those with limited literacy or English proficiency, unstable housing, or a host of other challenges—it may mean disenrollment from insurance.
The federal government encouraged states to prepare early, including shoring up their online systems, launching communication plans, and collaborating with health plans and community organizations (Medicaid.gov 2023). National partners, including philanthropic organizations, stepped up to convene partners and to publish resources and toolkits. Despite the scale of action needed, no additional federal dollars are available for this endeavor.
The State of New York must renew eligibility for nearly 9 million New Yorkers or ensure a seamless transition to subsidized coverage options in its marketplace (New York State Department of Health 2023). The New York Department of Health, with decades of experience building arguably the most robust public health insurance programs in the country, embarked on an intensive planning process well in advance. The Department identified neighborhoods where residents are most at risk of losing coverage, prepared its enrollment systems to automate as many renewals as possible, planned training for enrollment assistors, and deployed marketing and public education to urge consumers to act without causing panic. The Department and partners also recognized the health equity implications; the neighborhoods where people are most at-risk are ones that are primarily home to people of color.
Officials understood the need for an “all hands on deck” approach and conditions were right for collaboration. The Department of Health has a long history of partnering with community organizations, providers, health plans, and funders—especially during the Affordable Care Act (ACA) launch. The State funds an extensive Navigator program, a network of more than 100 community organizations that provide enrollment assistance, which has helped hundreds of thousands of New Yorkers enroll in or renew coverage over the past decade. These trusted groups are uniquely positioned to provide culturally- and linguistically-competent enrollment services in a way that best meets community needs.
However, State Navigator grant funds cannot be used for the dedicated community-based outreach activities needed at this critical moment. Together, philanthropic partners and the State quickly identified a clear role for private funders to fill this gap and a public-private partnership emerged. Funders brought deep relationships with community partners, including previous support of a community ambassador program during the ACA rollout and a recent outreach program to reach eligible but uninsured New Yorkers in Western and Central New York. Funders were also primed to work together having proven the power of partnership during the pandemic, such as supporting coordinated COVID-19 vaccine equity campaigns.
Philanthropy in New York is now front and center in the statewide unwind effort, with the support of a consortium of seven health funders (all Grantmakers In Health Funding Partners) from across the State—the Altman Foundation, Greater Rochester Health Foundation, Health Foundation of Western & Central New York, Mother Cabrini Health Foundation, New York Health Foundation, The New York Community Trust, and United Hospital Fund.
This funder consortium worked hand in glove with the State Department of Health and the Community Service Society of New York (CSS), a nonprofit that advocates for the needs of low-income New Yorkers, to devise a coordinated effort to ensure New Yorkers retained health insurance. CSS was a natural partner as it operates New York’s largest Navigator program and a health insurance consumer assistance program. CSS is leading the effort which it has named the Keep New York Covered initiative (KNYC), a multipronged strategy to complement the State’s efforts. The funder consortium has collectively awarded CSS $1.4 million in grants to operate this statewide outreach network.
KNYC is being implemented in two phases. First, knowing that one-size-fits-all messaging is not sufficient, a communications firm engaged communities in listening sessions and developed time-sensitive community-informed messages, data, and tactics. Second, CSS has mobilized a network of community-based organizations to put messages to practical use and reach deep into communities as trusted messengers. It issued a request for proposals to more than 110 eligible community-based enrollment groups that serve consumers from diverse communities (e.g., people who speak a languages other than English, low-income families, communities of color, immigrants, rural areas, people who are LGBTQA+, older adults, or people with disabilities). In response, 28 organizations received a sub-grant of up to $50,000 to lead on-the-ground marketing and outreach campaigns in their communities, reaching 52 of New York’s 62 counties. Sub-grantees are employing a range of tested strategies such as texts and phone calls, door-to-door outreach, presentations, social media and videos, and radio and TV announcements.
CSS is serving as the hub to convene sub-grantees for regular learning and sharing meetings; provide technical assistance and training on outreach strategies and marketing messages; conduct quality assurance; and track and report on outreach activities and enrollment outcomes.
The communications firm ICHOR Strategies will also train grantees to enhance their outreach and coordinate messaging with the Department of Health.
It is still early in the process, but important initial lessons can be drawn from this effort. The first is that collaboration is not only possible, but essential. Foundations are often—perhaps accurately—viewed as lacking speed and shared purpose in grantmaking. But KNYC illustrates how foundations can set aside institutional silos to respond collectively and nimbly – especially in the face of a shared goal to ensure people have access to insurance coverage. This group of funders includes private, health conversion, and community foundations. Some are local, others regional, and a few statewide. All have their own grantmaking processes and relationships. But there was early agreement to communicate with a shared voice to State partners and to allow for a streamlined submission process to minimize CSS’s time on grant applications. At the same time KNYC seamlessly aligns the work of foundations, government, and nonprofits to avoid duplication of resources or effort. This is the second lesson: when government, nonprofits, and philanthropy put forward the best of what each can do—government advancing and operationalizing a policy goal, nonprofits co-designing and carrying out on-the-ground activities to reach the goal, and philanthropy quickly mobilizing resources and advocating for partners—good things can happen. The time is right to act collectively. Preserving insurance coverage gains and maintaining broad insurance coverage are conditions of an equitable health system and central to our missions as health funders.
References
Corallo, Bradley, and Moreno, Sophia. “Analysis of Recent National Trends in Medicaid and CHIP Enrollment.” KFF. March 22, 2023
New York State Department of Health, New York Public Health Emergency and Continuous Coverage Unwind Plan, United Hospital Fund Roundtable: Surviving the Unwinding – New York’s Plan to Maintain Health Coverage When the Continuous Coverage Requirements End. February 16, 2023.
Tsai, Daniel. “Key Dates Related to the Medicaid Continuous Enrollment Condition Provisions in the Consolidated Appropriations Act, 2023.” Center for Medicaid and CHIP Services. January 5, 2023.
Medicaid.gov. “Unwinding and Returning to Regular Operations after COVID-19.” March 2023.