Eligibility Assistance Increases Insurance Enrollment Within Community Health Centers But Not At The State Level

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Abstract
Although ample evidence exists that community health centers lower federal medical expenditures, it has been hypothesized that the eligibility assistance offered by staff at health centers could also increase insurance enrollment and federal costs. We analyzed the effects of eligibility assistance on insurance enrollment at both the health center and state levels. Using multivariate panel analysis with two-way fixed effects, we examined effects of eligibility assistance during the period 2016-23 to determine how insurance enrollment is affected at the health center and state levels. Data sources were administrative data from health centers and state-level enrollment data from Medicaid, the Children's Health Insurance Program (CHIP), and health insurance Marketplaces. Higher levels of eligibility assistance staffing are associated with modest increases in numbers of Medicaid and CHIP enrollees at health centers and modest reductions in numbers of uninsured patients. However, neither eligibility assistance nor overall health center size significantly affect state-level enrollment for any of the programs. Eligibility assistance modestly increases insurance coverage among health center patients, which improves health centers' financial status and patient care capacity. But this assistance does not significantly increase overall Medicaid, CHIP, or Marketplace enrollment, nor does it raise federal expenditures.

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