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

Area of Science:

• Health Services Research
• Public Health Policy
• Immigrant Health

Background:

• Colorado launched a state-funded private health insurance program for undocumented immigrants in 2023.
• Enrollment assisters (EAs) are crucial for client enrollment and healthcare navigation.
• Understanding EA perspectives is vital for program scalability and implementation in other states.

Purpose of the Study:

• To explore the experiences of EAs assisting undocumented immigrants with private health insurance enrollment and utilization.
• To identify facilitators and barriers in accessing and using state-funded health insurance for this population.

Main Methods:

• Qualitative study using semistructured interviews with 24 EAs in Colorado.
• Interviews conducted in English and Spanish (December 2024-March 2025).
• Thematic analysis of audio-recorded, translated, and transcribed interviews.

Main Results:

• EAs reported improved client health and reduced emergency service use.
• Challenges included limited program spots, high demand, and low health insurance literacy.
• Culturally responsive strategies and strong EA-client rapport were key to overcoming fears and improving access.

Conclusions:

• The Colorado program addresses a critical gap in health insurance for undocumented immigrants.
• EA insights highlight the need for health literacy education and culturally sensitive support.
• Findings offer valuable lessons for other states considering similar initiatives.