Increasing Health Insurance Enrollment

Several studies by the National Institute of Medicine conclude that a lack of insurance is hazardous to individual and community health. The Patient Protection and Affordable Care Act, signed into law in 2010, led to historic gains in health insurance coverage. A robust enrollment effort in North Carolina helped reduce the uninsured rate from about 21 percent in 2010 to a little more than 10 percent in 2017. However, from 2017-2019, federal policies eroded some of these coverage gains. In 2019, North Carolina’s uninsured rate of 11.3 percent was still well above the national rate of 9.2 percent due to the failure to expand Medicaid in the state. There is more work to be done to expand access to health services for the more than one million North Carolinians who remain uninsured, including American Indian, Black, and Latinx individuals who are less likely to have health coverage due to historic and systemic inequities.

In the fall of 2021, the Federal government awarded a significant increase in funding for the navigator program to organizations in North Carolina. This funding will lead to greater nonprofit assistance, but outreach and education from trusted community leaders will remain essential to connect with communities that historically experience lower access to health coverage and greater disparities in health outcomes. Groups receiving federal navigator funding will not be eligible for this opportunity.

Our goal is to increase enrollment rates in underserved areas or among groups that have been marginalized to improve access and promote the sustainability of critical health services. Additionally, COVID-19 has underscored the need for access to health coverage and other public programs (such as SNAP, WIC, and Pandemic EBT) that can provide relief to impacted families. According to the Center on Budget and Public Priorities, the impacts of the pandemic and the economic fallout have been widespread, but remain particularly prevalent among Black and Latinx adults, and other people of color. Black and Latinx workers have experienced a far slower jobs recovery than white workers. Nearly eight percent of Black workers and 6.3 percent of Latino workers were unemployed in September 2021, compared to 4.2 percent of white workers. Census survey data from the fall of 2021 shows that Black and Latinx adults were more than twice as likely as white adults to report that their household did not get enough to eat.

An ongoing research project by the UNC Sheps Center provides county-level data on the percent of population that is eligible for Marketplace coverage and corresponding enrollment rates (what percent of eligible individuals in a county enrolled in a Marketplace plan).  Users can see this as a map, chart, or a plot comparing eligibility and enrollment rates. The Trust is interested in providing additional support for counties that currently have enrollment rates of less than 40 percent of the eligible population. At the time of this publication, those counties include:

• Anson
• Bertie
• Camden
• Cleveland
• Chatham
• Cumberland
• Duplin
• Durham
• Edgecombe
• Graham
• Granville
• Greene
• Harnett
• Hertford
• Jackson
• Lee
• Lincoln
• Montgomery
• Nash
• Northampton
• Onslow
• Pitt
• Rockingham
• Sampson
• Scotland
• Surry
• Warren
• Wilkes

**Counties in bold have enrollment rates below 30 percent of the eligible population and will be prioritized**

The Trust will support communications, outreach and enrollment efforts that target one or more of these counties. Preference will be given to organizations that have deep connections to the community they serve. The Trust is interested in proposals that include education about the Medicaid Transformation process in North Carolina and provide referrals for assistance accessing other public programs.

Before applying, consider the following questions and requirements:

• Is your organization or work a good fit with the Trust?
• Are you located or operating in North Carolina?
• Does your work focus on improving quality of life and health for North Carolinians with low incomes?
• Do you primarily support populations experiencing poverty?
  • These populations include: individuals living at or below 200 percent of the federal poverty level; the uninsured; and those eligible for Medicaid and/or the free/reduced school lunch program.
• Are your clients (or focus population) residents of North Carolina? If yes, then you may fit our geographic criteria.

Organizations the Trust WILL fund:

• Nonprofit 501(c)(3) organizations
• Governmental entities

Organizations the Trust WILL NOT fund:

• Individuals
• Faith-based organizations without 501(c)(3)
• Type III supporting organizations
• Organizations providing pass-through funds to an ineligible organization

Eligible? Contact us to schedule a consultation.

Back to all funding opportunities.