Enrollment Assister Perspectives of a Private Health Insurance Program for Undocumented Immigrants

In 2023, Colorado implemented the only state-funded marketplace-like US private health insurance program for undocumented immigrants. Community health workers and brokers served as enrollment assisters (EAs) and played a pivotal role in helping clients enroll in insurance plans and navigate the health care system. Understanding the perspectives of EAs is important to inform scalability and implementation as other states consider launching similar state-funded health insurance programs for undocumented immigrants, particularly amid declining federal support for underserved populations.

To explore the experiences of EAs who supported undocumented immigrants in enrolling in and using private health insurance.

This qualitative study included semistructured interviews conducted between December 2024 and March 2025 in both English and Spanish at EA sites across Colorado. Interviews were audio-recorded, translated, transcribed, and analyzed using thematic analysis. EAs who enrolled undocumented immigrants in private health insurance during at least 2 of the enrollment years from 2023 to 2025 were interviewed.

Themes and subthemes.

A total of 24 individuals (16 [67%] female; 8 [33%] male) participated. Four themes were identified: (1) improved health and reduced reliance on emergency services (limited insurance options; improved health and quality of life; reduced need for emergency services), (2) limited spots, high demand, and need for health literacy education (emotional distress from limited spots amid high need; low-level health insurance literacy and need for education), (3) strong rapport with EAs helps to alleviate fears of deportation (perceived risk to future citizenship from insurance enrollment; community relationships, trust, and rapport), and (4) culturally responsive strategies for resources, processes, and policy (building connection through culturally informed preenrollment resources; enhancing postenrollment support for lasting impact; redesigning the allocation process; strategies for policy improvements to strengthen the framework).

In this qualitative study, EAs perceived that the program fills a long-standing gap in health insurance coverage, improving clients' health and quality of life while reducing emergency use. They also identified challenges related to the limited number of spots and client unfamiliarity with insurance. These findings may inform efforts by other states seeking to develop similar programs for undocumented immigrants.