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Recent data shows that people of color and low-income populations are adopting mobile technology at a rapid pace and are increasingly using mobile tools to access the Internet. These tools enable new ways of interacting with the government and enrolling in public services.  Instead of standing in line at the DMV, renewing a driver’s license can be done more conveniently from a mobile device, and important notifications, such as status updates from the Department of Homeland Security, can be received through text messages. With mobile phones - particularly smartphones - there is an opportunity to make applying for and retaining health insurance as easy as checking Facebook or buying movie tickets.   And, because these tools can reach families that are disproportionately uninsured, mobile enrollment could help reduce disparities in access to care and health coverage.

Why are mobile phones a good way to help enroll people into MediCal and Healthy Families?

An 87% cell phone ownership rate among people of color demonstrates that mobile phone technology is a routine part of their lives.#  A recent Pew report indicates an increase in smartphone ownership among all racial and income groups, as well.# In fact, one in three cell phone owners has a smartphone, and Latinos and African Americans have overall higher than average adoption levels of smartphone ownership at 44%.#

Meanwhile, Latinos and African Americans are twice as likely (38%) to use their cell phones to access the Internet than Whites (17%).  In addition, in households with incomes under $30,000, 40% of those who own a smartphone report using it as their primary source of access to the Internet.

Given these new realities, states should begin to explore how to use this technology as a way to increase coverage for people of color and low-income families, since enrollment and renewal of subsidized health coverage is increasingly occurring online.  In California, over 75% of the uninsured are people of color, and 3 out of 5 are Latino.# Among them, over half a million have income levels that qualify for the MediCal or Healthy Families Programs, but they are still not enrolled.#  As noted above, these families use cell phones, including smartphones, to send texts, access the Internet and perform other daily tasks.

How can mobile enrollment help families?

Innovative methods of outreach and enrollment through cell phones and smartphones can specifically help unreached populations in several ways – both in the immediate moment, and in the future as these technologies are further developed.  Peter Lee, the Executive Director of the California Health Exchange, recently identified the need to explore smartphone applications, texting, and even social media as new technologies to give consumers more access to health care and enrollment avenues.

The popularity and ease of using text reminders with regular feature cell phones have already been demonstrated.  For example the text4baby program, which provides individualized health information to pregnant women by text message, enrolled 131,000 pregnant users in its first year. In addition, smartphones are being used to start an application for Medicaid and generate follow-up assistance to complete the process. One example is Hudson Health Plan, a New York Medicaid managed care plan, which has a mobile optimized site that even allows users to pay premiums and find doctors from a mobile device.

Furthermore, as smartphones proliferate, along with the access they provide to sophisticated applications and the Internet, more people will use these types of mobile devices for complex tasks like enrolling, renewing, and managing health insurance.  In fact, after health reform is fully implemented in 2014, online enrollment processes will most likely be the norm. With proper incentives and guidance, smartphone ‘apps’ could be developed to enable convenient application, renewal, payment, and communication with MediCal, Healthy Families, and the California Health Benefit Exchange.

How can we make sure to leverage this tool for decreasing disparities?

It is important that California do its utmost to leverage the value of mobile technologies in its development of online enrollment systems, given the high rate of adoption of smartphones and related Internet use among people of color and low-income households that traditionally experience high rates of uninsurance.  To move forward in this effort, California will need to ensure that its online application is designed in a manner that: is mobile accessible across multiple platforms; has adequate security regardless of cell phone provider; and does not cost families more than their current cell plan costs.  Early input from parents and other consumers in underserved populations, as well as usability testing, must guide the process to make sure it works for families.

For more information, see Mobile Technology:  Smart Tools to Increase Participation in Health Coverage <http://www.childrenspartnership.org/>.

This article originally appeared in the CPEHN Health Equity Forum, October 2011 as Reducing Disparities in Health Coverage with Mobile Technology by Terri Shaw.

FOOTNOTES

1. Lenhart, Amanda, Cell Phones and American Adults, Pew Internet & American Life Project, September 2011 (http://pewinternet.org/Reports/2010/Cell-Phones-and-American-Adults/Over...)

2. Smith, Aaron, Smartphone Adoption and Usage, Pew Internet & American Life Project, July 2011 (http://pewinternet.org/Reports/2011/Smartphones/Summary.aspx)

3. Ibid (http://pewinternet.org/Reports/2011/Smartphones/Section-1/Overview-of-sm...)

4. Fronstin, Paul, Snapshot: California's Uninsured 2010, California HealthCare Foundation, December 2011 (http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20CaliforniaUninsured2010.pdf)

5. Source: 2009 California Health Interview Survey data.


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