Covered California should Expand Strategies to Enroll Californians in Health Insurance when they Undergo Life and Work Transitions

Mary June Flores

Initial efforts to enroll Californians in health insurance under the Affordable Care Act (ACA) have been successful. Approximately 1.4 million Californians are now enrolled through the state’s healthcare exchange, Covered California, and several million Californians have newly enrolled in Medi-Cal.

Despite strong sign-ups, approximately 3 million Californians are expected to be uninsured in 2019. Many of them will become uninsured when they lose coverage during work or life transitions. Past research found that losing health coverage is more likely to occur during periods of transitions, like losing a job, changing employers, divorcing, or moving. Regardless of whether one’s loss of coverage is temporary or more permanent, coverage loss can lead to negative health outcomes and put families at significant financial risk.

As the rate of enrollment of the long-term uninsured flattens out, Covered California outreach and enrollment strategies should shift from an emphasis on annual Open Enrollment periods towards Special Enrollment Periods (SEPs). Under the ACA, SEPs allow people to enroll in health coverage through an Exchange when they experience qualifying life events such as losing employer-sponsored coverage or other insurance, getting married, having a child, moving into or within the state, or gaining citizenship or lawful presence. To enroll through an SEP, applicants must generally report changes and select health plans within 60 days of the qualifying life event. Due to this, timely outreach and targeted enrollment efforts are essential to informing individuals of their coverage options and helping them successfully enroll.

A new Labor Center policy brief identifies six groups of individuals undergoing significant transitions in their work or home lives, and provides recommendations on targeting these groups for special outreach in order to maximize their likelihood of enrolling in Covered California during their SEP. Members of these groups already have high rates of uninsurance or higher chances of losing coverage due to the transitions they are experiencing, and they are also likely to be eligible for Covered California subsidies.

Target groups include:

  1. Unemployed individuals with Unemployment Insurance benefits
  2. Job switchers
  3. Workers in certain occupations that are licensed/certified by the State
  4. New Legal Permanent Residents (LPRs)
  5. Movers
  6. Entering and graduating college students

Individuals in these groups encounter a number of public and private institutional connection points; these points of contact can play an essential role in providing information on health care options. For example, the diagrams below illustrate the various institutional touch points that might be accessed by individuals who qualify for unemployment insurance and individuals moving within or into the state.



While California has successfully reduced the ranks of the uninsured, the number of people who signed up for coverage during SEPs in 2014 was lower than projected. Maximizing enrollment in Covered California by minimizing gaps in coverage for those who undergo life transitions should be Covered California’s new focus. To increase the number of SEP enrollees, Covered California will need to target its outreach and enrollment strategies in a way that is unique to the groups of people undergoing various life transitions. Knowing that these groups initially seek, access, and rely on institutional connection points, Covered California should leverage and build upon its existing public partnerships, as well as create mechanisms that support hands-on assistance which is more likely to lead to enrollment.


Mary June Flores is a graduate student researcher at the UC Berkeley Center for Labor Research and Education and a concurrent Master of Public Policy and Master of Public Health student at the Goldman School of Public Policy and School of Public Health at UC Berkeley.