Sign Up for the ALL IN For Health Day of Action and Countdown to End of Open Enrollment
On January 24, schools, early learning centers, and after-school sites across the state will launch a 22-day ALL IN For Health campaign to help all eligible families and individuals, connected to the education community, enroll in health coverage before open enrollment ends on February 15, 2015.  

Join us! There are so many activities you can do to connect families to coverage. Can’t join us on January 24? That’s okay, you have until February 15.


Sign up, and tell us how your school/organization will help!

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