Key Points

To support the implementation of the Affordable Care Act, in 2013 Missouri Foundation for Health launched the Expanding Coverage Initiative. The fiveyear effort sought to reduce Missouri’s uninsured rate from 13% to less than 5% by developing a broad-based state coalition and employing a three-pronged approach of awareness building and outreach, enrollment assistance, and increasing health literacy.

While the initiative did not achieve its rate-reduction goal, the rate of uninsured Missourians dropped to 9% during the ECI’s time frame, a decrease on par with the national average despite the fact that at the time Missouri was one of 17 states that opted out of Medicaid expansion. Coalition members pointed to the value of collaboration, access to expertise, the locally tailored approach of the initiative, and the maintenance of a politically neutral stance in the effort to support implementation of a complex federal policy.

Drawing upon findings from a retrospective evaluation, this article explores the initiative’s lessons and legacy, and shares key insights for other funders looking to support efforts to advance health care coverage.

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