More About Shelby Gonzales

Shelby Gonzales

Gonzales is a Senior Policy Analyst in the Health Division. She focuses primarily on the implementation of effective outreach and program simplification strategies to promote enrollment and retention in Medicaid and the Children’s Health Insurance Program (CHIP). Gonzales also works on issues related to outreach, eligibility and enrollment in the implementation of the Affordable Care Act. Gonzales was appointed to serve as a member of the Advisory Panel on Outreach and Education (APOE) which among other duties is charged with advising the Secretary of Health and Human Services and the Centers for Medicare and Medicaid Services Administrator on matters related to education and outreach to enroll and retain individuals in Medicaid, Medicare and CHIP.

Full bio and recent public appearances | Research archive at

Obama Budget Would Boost Medicaid, CHIP Enrollment for Children and Adults

February 4, 2015 at 9:00 am

President Obama’s fiscal year 2016 budget would wisely enable states to cut red tape and enroll more eligible children and adults in Medicaid and the Children’s Health Insurance Program (CHIP) by making permanent Express Lane Eligibility (ELE) for children and letting states extend Continuous Eligibility (CE) to adults.

ELE, which is slated to expire at the September 30 end of fiscal year 2015, gives states the option to use the information they’ve already collected and verified to establish eligibility in other programs such as SNAP (food stamps) to streamline enrollment of eligible children into Medicaid and CHIP.  ELE can boost enrollment and reduce administrative costs, according to a recent Government Accountability Office report and a federal evaluation by Mathematica Policy Research.

The President’s budget also proposes to let states provide continuous Medicaid coverage of up to 12 months to adults — which is already an option for children, and which about half of states take up in their Medicaid and/or CHIP programs.

In Medicaid, once individuals are found eligible, they must generally report any change that may affect their eligibility during the year and states must act on these changes.  That’s especially hard for Medicaid beneficiaries and state agencies because peoples’ incomes often fluctuate over the course of a year, sometimes even month to month. Thus, beneficiaries may have to switch back and forth between Medicaid and subsidized marketplace coverage under health reform, and they may experience coverage gaps if the paperwork proves overly burdensome and too difficult to complete.

Moving beneficiaries back and forth repeatedly between Medicaid and the marketplace is costly for state Medicaid agencies, for marketplaces, and for health plans, and it may cause disruptions in care for Medicaid beneficiaries.  As it has for children, continuous eligibility for adults would avoid this unnecessary paperwork and any resulting coverage gaps.

Moms: Getting Their Families the Coverage They Need

May 12, 2014 at 11:52 am

In a new blog post for Moms Rising, I discuss the important role that mothers play in getting their families the health coverage that they need.  Many already have been responsible for more than 8 million people enrolling in private health coverage during the first open enrollment season for health reform’s insurance marketplaces and another 4.8 million individuals enrolling in Medicaid and the Children’s Health Insurance Program (CHIP).

As I explain for Moms Rising, they’ll continue to be instrumental in getting their families enrolled, even between now and November 15, when the next open enrollment period for the marketplaces begins:

Here are three basic points to keep in mind between now and then:

People who are eligible for Medicaid or CHIP can sign up at any time.  Unlike private coverage, Medicaid and CHIP have no limited enrollment period.  Eligibility for these programs varies by state but, in states that have expanded Medicaid under health reform, adults with income up to 138 percent of the poverty line (about $27,000 for a family of three) can enroll.

Some people can get additional time to finish enrolling in marketplace coverage. Some people who started to enroll before the March 31 deadline and experienced problems with or have faced other exceptional circumstances can get additional time to complete the process.  In these cases, they may be able to come back to finish their applications now.  In states with their own marketplaces, the deadlines vary, so people who think they may qualify for extensions should check their state’s marketplace website for details.

Major life changes can allow families to enroll in marketplace coverage.  Many people who lose other coverage (such as Medicaid or job-based coverage) or experience other changes can enroll in marketplace coverage during “special enrollment periods” (SEPs).  Although some significant life changes, such as getting divorced, don’t by themselves trigger a SEP, many major life changes do:

  • Losing other health coverage;
  • Moving to a different state, or even within a state if the move changes which plans are available;
  • Getting married; and
  • Having a baby or adopting a child.

Click here to read the full post.

Enrollment Assistance Under Health Reform Has Roots in Other Successful Programs

May 23, 2013 at 3:13 pm

Starting in October, millions of uninsured Americans will be able to enroll in private health coverage through health reform’s new health insurance marketplaces (also called “exchanges”).  But a program designed to help people apply for and enroll in coverage has come under fire, despite its origins in other successful enrollment efforts.

Under health reform, so-called “navigators” — including community and consumer nonprofits, unions, and trade groups — will help people sign up for insurance through the marketplaces, understand their options, and enroll in the right plan.  Critics contend that these assisters could provide poor-quality services or take business away from insurance agents.  But past experience, coupled with the rules that have been proposed to govern the navigators’ work, shows that those concerns are unfounded.

The exchange model included navigators because similar “helper” programs have worked well to connect people with the programs and services for which they’re eligible, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).  For example, the federally funded and administered State Health Insurance Assistance Program offers one-on-one guidance to Medicare beneficiaries in every state.  And similar assister programs have played a significant role in increasing enrollment in Medicaid and CHIP across the country; some 86 percent of eligible children are now enrolled in Medicaid and CHIP, an all-time high.

The Department of Health and Human Services based the navigator program under health reform on these successes and proposed rules that would help ensure that the assisters will be professional and well-trained.  The proposed rules create robust training standards to prepare navigators to provide high-quality assistance and strong conflict of interest standards to ensure that navigators act in consumers’ best interests.

Contrary to criticisms, the navigator program is well designed.  These assisters will help uninsured people find — and join — the plan that’s right for them.

User-Friendly Applications Will Help Uninsured Gain Coverage

April 30, 2013 at 3:07 pm

The Department of Health and Human Services (HHS) today released the revised forms that people will use to apply for health coverage through the new health insurance marketplaces (also known as exchanges).  These relatively short, easy-to-understand applications are a big improvement over the drafts that HHS released for comment in January.

Applications will be consumers’ first stop to getting the coverage they’ll qualify for, so it’s important that they’re well-designed and simple.

Single adults who are not offered health coverage at work will have the easiest option — a new “short form” that offers a streamlined route to health coverage, similar to the 1040EZ for taxes.  This application will make it easier for the millions of uninsured, single adults without children who meet the income eligibility standards to get help paying for coverage through the marketplaces or Medicaid.

The revised forms incorporate many of the suggestions that we and other organizations provided to improve the draft applications.  The questions and instructions are clearer, unnecessary questions have been dropped, and the overall design should be easier for consumers to follow.

The marketplaces will begin accepting applications on October 1, 2013.

Helping Consumers Choose the Right Health Plan Under Health Reform

April 16, 2013 at 10:12 am

In less than six months, millions of uninsured Americans will be able to enroll in private health coverage through health reform’s new health insurance exchanges.  Health reform requires exchanges to create “navigator” programs to help individuals enroll, but groups representing insurance agents have expressed concern that navigators could take business away from agents and that unqualified navigators could provide poor-quality assistance; some states are considering limiting the kinds of help that navigators can give or even making it difficult for anyone besides an insurance agent to become a navigator.  A proposed rule from the Department of Health and Human Services (HHS) would address some of these issues.

The rule, issued April 5, would prevent states from barring navigators from performing critical functions, including helping people apply for coverage and then educating them on how to select particular health insurance plans in the exchanges that will best meet their needs.  It would also prohibit states from requiring navigators to be licensed insurance agents or brokers — a requirement that would rule out many non-profit organizations with experience in helping qualified people obtain public benefits.

In addition, the rule would create robust training standards to ensure that navigators provide high-quality assistance and strong conflict of interest standards to ensure that navigators act in consumers’ best interests.

HHS also recently announced that it will award $54 million to navigators in 34 states with federal exchanges.  At least two types of entities will serve as navigators in each state, including at least one community- and consumer-focused nonprofit.

Together, the proposed navigator rule and the federal funding will help the navigator program provide needed assistance so people can choose the plan that’s right for them.