Coverage & Access for Hispanics in MAJSI Research & Training Institute, Inc.

Massachusetts Center for Health Information and AnalysisAugust 14, 2013

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

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

Research Objectives1. 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.

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

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

Methods - Quantitative

TownTotal

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

Waltham 53,541 13.4% 7,817 14.6% 6.6% 23.0%

Everett 36,897 19.1% 8,148 22.1% 12.1% 20.1%

Lawrence 69,552 71.1% 53,730 77.3% 11.3% 12.3%

Chelsea 32,224 60.0% 20,956 65.0% 11.9% 15.6%

Holyoke 34,258 46.0% 17,792 51.9% 5.7% 5.7%

Springfield 136,166 32.4% 58,061 42.6% 7.5% 8.6%

Lynn 79,720 30.6% 27,818 34.9% 8.6% 14.7%

Revere 45,174 29.3% 14,381 31.8% 11.3% 16.5%

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

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.

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

QUESTIONS?

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