New Report on Key Lessons for LGBT Outreach and Enrollment under the Affordable Care Act

Today, Out2Enroll—a nationwide campaign dedicated to connecting LGBT people with their coverage options—released a new report exploring the extent to which this year’s outreach and enrollment efforts met the needs of the lesbian, gay, bisexual, and transgender (LGBT) community. The report, Key Lessons for LGBT Outreach and Enrollment under the Affordable Care Act, reflects Out2Enroll’s experience as well as interviews with key stakeholders such as navigators, state equality organizations, national membership organizations, and marketplace officials in the District of Columbia, New York, and Washington.

What did we find? Regular CHIRblog readers will be unsurprised to learn that the initial open enrollment period offered significant opportunities to reach LGBT consumers, but the visibility and effectiveness of these efforts varied significantly by state. Why the variation? States varied in their level of formal marketplace commitment to LGBT inclusion and the extent to which LGBT community and allied organizations were able to participate in the health reform effort.

Some state-based marketplaces, for example, clearly identified LGBT communities as an underserved population, engaged LGBT organizations in conducting outreach and enrollment, and included LGBT families in marketplace advertisements. In states with a federal marketplace, some state assister coalitions directly included LGBT organizations, and others made specific efforts to engage trusted LGBT organizations to promote outreach and enrollment. Regardless of the state’s approach, we highlight effective efforts to reach LGBT communities, which included:

  • Development of LGBT-specific messaging and education materials;
  • Targeted efforts to engage LGBT people via outreach and enrollment events; and
  • A consistent presence at LGBT community venues.


LGBT outreach was also complicated in many states by uncertainty surrounding outstanding policy issues. Specifically, stakeholders in a variety of states reported significant confusion about:

  • Relationship recognition, including the treatment of legally married same-sex spouses, domestic partners, and people in civil unions;
  • Transgender health needs, including the continued prevalence of transgender-specific insurance exclusions;
  • Discriminatory practices, including insurance carrier practices that discourage enrollment of those with chronic conditions such as HIV; and
  • Plan transparency, including the lack of accessible information providing adequate details on coverage limitations.

Although federal and state officials have taken steps to address some of these issues, outstanding questions remain and have complicated outreach efforts to the LGBT community.

What do the findings mean? Although the initial open enrollment period offered significant opportunities to raise awareness and promote LGBT health equity, more must be done to ensure that LGBT people are able to fully understand and take advantage of their new coverage options. The report includes the following recommendations to promote LGBT outreach and enrollment during the next open enrollment period:

  • Outreach and enrollment efforts in every state should explicitly include LGBT communities.
  • Assisters, including navigators and certified application counselors, should receive LGBT-specific cultural competency training. (Out2Enroll provides free training to those that are interested!)
  • All marketplaces should collect voluntary demographic information on sexual orientation and gender identity.

We hope the report will be helpful for assisters, community organizations (whether LGBT or not), and policymakers as stakeholders prepare for the 2015 open enrollment period and make efforts to engage the LGBT community.

To learn more about Out2Enroll, visit or contact Katie Keith at

Editor’s Note: Katie Keith is a former Research Fellow at Georgetown University’s Center on Health Insurance Reforms. She is currently Director of Research at Trimpa Group and a Steering Committee Member of Out2Enroll.

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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.