Edilia Quiroz with United Community Health Center discusses the Affordable Care Act with a Green Valley coffee club made up of licensed health-care professionals, case managers and social workers at The 19th Hole Restaurant, 111 S. La Cañada Drive.

Since November, more than 169,000 Arizonans have signed up for health coverage through the Affordable Care Act, exceeding last year’s total by almost 50,000, according to the U.S. Department of Health and Human Services.

But this year, additional efforts are being made by health-care groups across the country to target special populations for whom last year’s enrollment was lacking, such as young adults and people living in rural populations.

Of the more than 6 million people living in Arizona in 2013, about 350,000 resided in rural areas, according to the U.S. Department of Agriculture.

A lack of quality health and health care has been identified for rural communities, with people who live in remote areas tending to be poorer and less likely to have employer-sponsored health coverage than people living in metropolitan areas, according to the Arizona Department of Health Services.

Rural residents also face significant barriers to enrollment and access to care, as they often have to travel longer distances to find providers or facilities and many times don’t have a means of transportation.

During this year’s push for health-care enrollment, connecting rural residents with coverage was made a priority across the country, and many local groups had to go back to basics to figure out the best way to help.

“After the first enrollment period, there were some pretty significant gaps in particular rates of enrollment,” said the director of the University of Arizona Mel and Enid Zuckerman College of Public Health, Dr. Dan Derksen. “One of the lowest enrolled groups were people who live in rural and remote areas.”

Part of the problem, he said, is how the information about insurance gets to rural areas and from there to the individual residents.

“A lot of people in rural areas get information from word of mouth, and last year there was a lot of negative background noise.”

Derksen didn’t expect the conversation to be clouded with negativity this year, partially because there weren’t the technical glitches of last year but also because people have experiences to share this time around.

“Last year, it was new for everyone,” he said. “Now it’s Round 2, and people know people who enrolled last year and they can talk about it.”

And talking about it is exactly what a number of health-care and interest groups did.

“We engaged with new partners this year to reach out to the hard-to-reach populations,” said Pati Urias, Arizona communications lead for Enroll America.

Before open enrollment began, Enroll America held trainings for certified application counselors in Flagstaff, Yuma, Phoenix, Tucson and other parts of the state.

“We had people come from rural communities wanting to be able to help enroll people,” Urias said. “And what’s good about what’s happening now is that there are organizations that are mobile.”

United Community Health Center is made up of community health centers that serve Green Valley, Amado, Arivaca, Vail, Sahuarita and Three Points.

Despite the fact that it provides care to more than 14,000 patients, United became mobile this year.

“We provide free transportation to our clinics for appointments with navigators,” said eligibility specialist Edilia Quiroz. “Even if the person isn’t a patient, we still pick them up. We hope that once they’re covered, they’ll become a patient.”

Among its eight centers, United has three full-time certified assisters, one part-timer and a full-time assister strictly to handle Medicaid.

In addition to helping people enroll, Quiroz and her staff have been busy since October trying to get the word out about open enrollment and about the transportation assistance.

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“We went to businesses, community fairs, food distribution centers and libraries,” she said. “It helped for people to see us out there, because these are small communities and people know us.”

Since enrollment began in November, Quiroz and her staff have still been doing community outreach, trying to educate people about the marketplace and insurance. United’s outreach doesn’t end at educating the public, but also educating providers.

At a recent breakfast in Green Valley, Quiroz reminded a group that there was still time left to get people informed about and enrolled in a health plan.

With just under three weeks remaining until the Feb. 15 enrollment deadline, she said that the busiest stretch is still ahead. Much like tax season, people often wait until the last minute.

“We’re getting more people enrolled in coverage this year than we did last year, but not everyone we’ve helped is going through the marketplace,” she said.

Quiroz said that she and her staff have assisted 179 people in enrolling since the beginning of the period, with 47 of those applications submitted to the marketplace.

“Some are going to Medicaid, and of course others to AHCCCS,” she said.

In December, the Arizona Health Care Cost Containment System reported that its member population increased by almost 7,000 people from Nov. 1 to Dec. 1.

From Nov. 15 to Dec. 15, HHS reported that 18 percent of Americans that enrolled in coverage through the marketplace were residents of rural areas.

“It doesn’t matter if they’re going through the marketplace, Medicaid or AHCCCS; the only thing that matters is that people are getting covered,” Quiroz said.

Contact reporter Caitlin Schmidt at cschmidt@tucson.com or 573-4191. On Twitter: @caitlincschmidt