Provides best practices for hospitals to use in health insurance outreach and enrollment efforts based on interviews with administrators, staff and community representatives at eleven small rural hospitals. Also discusses certified application counselors who help individuals enroll in health insurance and the importance of collaborative partnerships in the community to conduct insurance enrollment outreach and education.

Based on their experiences during the first Affordable Care Act (ACA) open enrollment period, five of 11 surveyed rural hospitals reported positive outcomes likely related to their enrollment success: decreases in proportions of self-pay / uninsured patients, charity care, and/or bad debt. Of the remaining six hospitals, one reported no significant changes and five had not yet begun to assess the consequences of their efforts Key strategies and approaches highlighted by the 11 hospitals included the following:

• Designate a project manager to handle open enrollment who can dedicate time to it.
• Leverage partnerships with local organizations to boost enrollment, resources, and referrals.
• Get involved with planning groups and committees at state and regional levels to see what is and is not working at other facilities.
• Pursue a multi-faceted, targeted approach in outreach and marketing efforts.
• Employ Certified Application Counselors (CACs) and make them as accessible as possible.
• Use names of state marketplaces or generic terms rather than "Obamacare."