Paralegal Abdirahman Hussein is one of the longest-serving ProjectCare navigators in Legal Aid’s St. Cloud office. He is doing his best to help central Minnesotans get healthcare coverage, but in over four years as a MNsure navigator he’s never faced challenges like this.

“It’s hard to describe the situation we’re in with the pandemic,” he says. “We serve a community that relies on us to give them correct information, to make things clear. Many of them don’t have a phone, or internet access, or a computer. There is nothing that can replace meeting with a client face-to-face, but we have to find ways to make it work.”

Expanding Outreach in a Pandemic

Outreach is the first challenge. When physical offices — both Legal Aid and host agencies such as libraries, health clinics, and human services organizations — began closing to protect staff and communities, outreach nearly came to a halt.

“We’re worried about people who might not understand the complex maze of options and rules,” says Supervising Attorney Ralonda Mason, who has been shifting outreach efforts to social media and other platforms that don’t rely on face-to-face meetings. “For example, job instability creates special enrollment events. If someone loses their employer health insurance, that’s a qualifying life event. They can enroll, and we can help them.”

Hussein and his colleagues adapted quickly to new ways of giving that help. Appointments are now by phone or online. The standard in-person appointment time was one hour, but remote appointments often take up to two hours. In one case, a navigator spent the first half hour on the phone helping a client turn on the family computer and navigate to the
correct website.

Although MNsure has loosened some restrictions — permitting verbal authorization for some tasks — navigators still cannot start an application or set up an account without a signature. If the client doesn’t have technology access and relies on mail for exchange of paperwork, it can take weeks to even start the enrollment process. If documentation is required from employers that are closed, or from banks with drive-through services only, that adds more layers of difficulty.

Removing Language Barriers

Many of Legal Aid’s clients are immigrants. Dealing with agencies by phone requires double the time and effort when the client doesn’t speak fluent English.

“Yesterday I had a client with limited English who had to call DHS,” Hussein says. “We made the call together, and she gave permission in English for me to speak on her behalf. The DHS worker insisted that I could not interpret, and I told her that I was not interpreting, but rather facilitating the conversation. She finally talked to her supervisor, who explained I was not interpreting and told her to go ahead. It was a difficult exchange for all three of us.”

Navigating the Complexity of Rule Changes

Agencies like DHS and MNsure have seen multiple changes to regulations further complicating advocacy. The rules keep changing, and some questions remain unresolved. In some cases, agencies tell Legal Aid “We cannot give you instructions.” In those cases, Legal Aid navigators do their best to negotiate with the agencies and work within and around the holes in the system to get clients enrolled.

“Our clients are people who were already having a hard time before the pandemic,” says Hussein. “They need information and help now more than ever. They depend on us, and this is not the time to slow down. We need to pull up our socks, work with our partners, and get help to those who need it.”

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