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The Tacoma–Pierce County Health Department Plays an Important Role

• The local health department is an important leader in outreach and enrollment efforts in the Tacoma–Pierce County region.

Outreach and Enrollment Efforts Face Challenges

• The Washington Medicaid renewal policy resulted in unanticipated demand for in-person assisters' (IPAs') time and efforts.
• IPAs and the Washington Health Benefit Exchange, the official state health exchange system, had a poor relationship.
• Decreased news coverage and publicity for health care–coverage enrollment required more word-of-mouth efforts from the IPA implementation team.
• More personnel support was needed to address IPAs' concerns.
• Some raised concerns about having a public health department as a lead agency. Organizational rigidity within the health department resulted in delayed contracts and payments. Some implementation-team partners perceived that the proportion of funds that the health department used to administer the grant was too large and left less funding for contracted IPA groups to provide services.
• Some leadership and staff did not feel that reform-related activities were part of the core functions of public health.

Some Factors Help the Local Health Department's Efforts

• Grant support from the Washington Health Benefit Exchange allowed data to be used to select contractors and formal collaboration with the health sector through a steering committee. The exchange grant allowed the health department to hire a full-time equivalent for outreach and enrollment, expanding the health department's capacity for this work.
• The collaborative culture among organizations in Tacoma helped support the health department's role as a lead agency for IPAs.