Implementing the health insurance mandate of the Patient Protection and Affordable Care Act (ACA), signed into law in 2010, will require states to reach, educate, and successfully enroll individuals and families who have had little experience with health coverage. The uninsured are likely to require considerable individualized application and enrollment support. Consumer advocates believe there is a need for ongoing support so that the newly insured retain their coverage, navigate their way effectively through the health care system, and engage in wellness and prevention activities. As many states prepare to enroll millions of low-income uninsured Americans, the experience of Community Health Workers (CHWs) in Massachusetts can inform outreach and enrollment efforts across the country.