Medicaid Expansion for La Comunidad Latina in North Carolina: Community Health Workers' Role in Outreach.

PURPOSE: The Fostering Insurance Enrollment among Latinos in North Carolina (FIEL-NC) Project evaluated the experiences of Latino/a/e/x or Hispanic individuals (herein referred to as la comunidad Latina, as preferred by the community) with Medicaid enrollment following expansion in North Carolina (NC) to identify successes and areas for improvement. METHODS: The study team recruited community members who self-identified as members of la comunidad Latina and have considered, attempted, or successfully enrolled in Medicaid post-expansion. We recruited community health workers (CHWs) who self-identified as members of la comunidad Latina and conducted insurance outreach post-expansion. Eligible participants completed a Spanish or English survey. Data was analyzed using chi-squared and Fisher's exact tests in STATA. RESULTS: Results of this exploratory analysis demonstrate that among participating community members (n = 44), 30% enrolled in Medicaid post-expansion, 36% attempted but were unsuccessful, and 34% did not attempt. Spanish-speaking, female, and foreign-born community members were more likely to have lower health knowledge and remain uninsured if not enrolled in Medicaid, compared to English-speaking, male, or U.S.-born counterparts. Half of community members reported limited health insurance knowledge. Among CHWs (n = 57), 65% reported above average health knowledge, with more years of experience associated with increased health insurance knowledge. Almost all (98%) CHWs identified as Spanish-speaking, and 100% reported serving Spanish-speaking communities. CONCLUSION: Most community members had limited health insurance knowledge, which is a known barrier to enrollment. CHWs increase language concordance, trust, and engagement with health systems and resources. Expanding CHW health insurance training and CHW-led outreach can improve Medicaid enrollment among all eligible individuals.

Duke Scholars

Author Viviana Sandra Martinez-Bianchi Family Medicine and Community Health, Family Medicine