Evaluation of the Colorado Health Insurance Affordability Enterprise

Mathematica worked with the Colorado Division of Insurance (DOI) to assess the effectiveness of the HIAE during the first two open enrollment periods when HIAE subsidies were available- 2022 and 2023. Mathematica performed a quantitative analysis of eligibility and enrollment data to assess who was eligible for HIAE subsidies, who enrolled in coverage with HIAE subsidies, potential gaps in enrollment, and trends in enrollment. Mathematica also performed a qualitative analysis, which included performing 33 key informant interviews with state officials, HIAE Board members, staff from partner organizations, and frontline workers. Key informants were asked about perceived strengths and limitations of the HIAE subsidies, what kind of outreach and enrollment activities their organizations undertook, how successful these activities were, what kind of system barriers they faced, their perception of consumers’ experience with enrollment in HIAE coverage, and lessons learned and recommendations for future years of the HIAE and for other states seeking to enroll similar populations. The qualitative evaluation also involved a thorough document review of HIAE Board meeting materials, budget documents, and outreach and enrollment plans, all provided by HIAE staff. 

The evaluation found that more people are enrolled in more affordable health coverage than would be without the HIAE. More advance premium tax credit–eligible individuals enrolled into coverage when HIAE subsidies were available in 2022 and 2023. The OmniSalud program, which provided health insurance for Colorado residents who are not eligible for federal subsidies, was introduced in 2023, and nearly 10,000 qualified individuals enrolled in OmniSalud subsidized plans, which was the maximum number of enrollment slots available for 2023. Mathematica’s evaluation provides recommendations for the HIAE Board and DOI for building on their success in future years including:

• Changing the allocation of limited OmniSalud enrollment slots
• Gathering more data about populations enrolled in HIAE programs
• Enhancing outreach and enrollment efforts 
• Improving health literacy