1. Coverage & Access for Hispanics in MA JSI Research & Training Institute, Inc. Massachusetts Center for Health Information and Analysis August 14, 2013

2. Research Team JSI Research & Training Institute Jim Maxwell, Karen Schneider, Rodolfo Vega, Clancey Bateman Health Care For All (HCFA) Brian Rosman, María González Albuixech, Francisco Ramos Northeastern University’s Institute for Urban Health Research Dharma E. Cortés, Claudia Santelices, Victor Cabada

3. Importance of Coverage Issues for Hispanics Hispanics are one of the largest remaining groups of uninsured in Massachusetts and experience barriers to maintaining coverage and receiving care in the post-Chapter 58 environment Spanish-speaking Hispanics with low English proficiency are at greater risk of being uninsured, not having a usual care provider, and experiencing cost-related barriers to care. Lack of information about factors contributing to health insurance gaps among Hispanics and best practices for targeting and tailoring outreach and enrollment strategies to their needs

4. Research Objectives 1. To document the barriers to obtaining coverage among the remaining uninsured Hispanics, including cultural, linguistic, financial, and administrative barriers; 2. To document the barriers to maintaining coverage and navigating the health care system among newly insured Hispanics; and 3. To identify best practices among community-based organizations (CBOs) and community health centers (CHCs) that provide services for Hispanics in enrolling, maintaining, and using coverage.

5. Project Overview Mixed method design to capture different perspectives and issues regarding coverage and access for uninsured and newly insured Hispanics in Massachusetts Participatory evaluation design to engage various stakeholders and CBOs across the Commonwealth that work with the Hispanic population in the design and implementation of the project

6. Methods - Quantitative Two (2) complementary cross-sectional surveys of uninsured and newly insured Hispanics from targeted cities in Massachusetts with significant proportions of uninsured Hispanics Participants must meet the following criteria: Hispanic residents of Massachusetts age 18-64 Uninsured or newly insured Uninsured = currently uninsured Newly insured = gained insurance within past 4 months to 2 years ago after being uninsured for at least 4 months Able to take survey in either English or Spanish Recruitment goal: 1,600 participants

7. Methods - Quantitative Town Total population <65 years % population <65 that speaks Spanish at home Total Hispanic population <65 years % of population <65 that is Hispanic % of population <65 that is uninsured % of Hispanic population <65 that is uninsured Waltham53,54113.4%7,81714.6%6.6%23.0% Everett36,89719.1%8,14822.1%12.1%20.1% Lawrence69,55271.1%53,73077.3%11.3%12.3% Chelsea32,22460.0%20,95665.0%11.9%15.6% Holyoke34,25846.0%17,79251.9%5.7% Springfield136,16632.4%58,06142.6%7.5%8.6% Lynn79,72030.6%27,81834.9%8.6%14.7% Revere45,17429.3%14,38131.8%11.3%16.5%

8. Methods - Qualitative Key informant interviews and focus groups with staff at Hispanic-serving community organizations: Health Care for All Community-based organizations Community health centers Faith-based organizations Working with organizations in cities and neighborhoods with a high proportion of Hispanics Participant observation with HCFA HelpLine and staff at other CBOs

9. Potential Policy Implications By identifying promising and best practices in outreach and enrollment for Hispanics, we will be able to formulate specific policy-driven solutions for improving the coverage process for Hispanics in Massachusetts and other states. Develop knowledge and awareness Identify and outreach to populations Enrollment Engagement, navigation, and retention Renewal

10. Current progress Conducted focus group with HCFA Helpline counselors Surveys developed and pretested Identified 18 organizations as potential partners for data collection and key informant interviews 9 CBOs, 7 CHCs, and 2 faith-based organizations in 8 towns: Chelsea, Holyoke, Springfield, Everett, Lawrence, Lynn, Revere, and Waltham Data collection will begin in late August

11. QUESTIONS?

12. CONTACT Jim Maxwell – jim_maxwell@jsi.com Dharma Cortés – decortes@aol.com Brian Rosman – brian@hcfama.org Karen Schneider – kschneider@jsi.com Clancey Bateman – cbateman@jsi.com Rodolfo Vega – rvega@jsi.com Maria Gonzalez – mgonzalez@hcfama.org Francisco Ramos – framos@hcfama.org Claudia Santelices – c.santelices@neu.edu Victor Cabada - cabada05@gmail.com