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Defining the Role of “Assisters” in California

The Kids Coverage Coalition is engaging various stakeholders (especially consumer advocates) to begin thinking about the role assisters will play in 2014.  Due to the complexity of the Exchange and the target to enroll uninsured individuals in 2014,

Who are Navigators?

ACA established a Navigator program to help explain, educate, assist and successfully enroll consumers into QHPs within the Exchange. A Navigator is defined as an entity that assists consumers with Exchange enrollment. Their duties may include public education, distributing fair and impartial information, assisting in Exchange enrollment, providing culturally and linguistically appropriate information, and providing general health insurance consumer assistance. Specific criteria for navigators are still being developed by HHS.

ACA states that any private or public entity that is selected as a Navigator may receive a Navigator grant. To be eligible, this entity must either have existing relationships with individuals who qualify for the Exchange or must be able to readily form these relationships. Funding for Navigator grantees must come from fees assessed on QHPs and not from federal funding.

Progress on California’s “Assister” Program

According to United Way, On December 27, 2011, California’s Exchange Board released a Request for Proposals (RFP) for “Communications Support for the Outreach and education Campaign Plan and Assisters Program.” The RFP states that “assisters” can include Navigators and individuals/entities who already assist with coverage enrollment (i.e. agents, brokers, representatives of providers, community-based organization, county eligibility workers and many others). The RFP also contemplates the development of a compensation plan. Applications were due to the board by January 31. Another goal of this solicitation is to assist in preparing the apply for the Level II grant, a more robust grant than the Level I one which will fund the Exchange’s operation through the end of January 2014.

Some of the key points in the RFP include plans for:

  • The design and development of a comprehensive Assisters Program Plan (including identifying training curriculum requirements) in order to conduct enrollment, outreach and education efforts for promoting state affordable health insurance programs;
  • The development and design of an Assisters Program that will provide support for enrollment, retention and use of coverage; and
  • The development of the Assisters Program’s functions will be uniquely distinctive compared to the design and development of statewide outreach and education campaigns.

Progress in Other States

According to the Georgetown University Health Policy Institute’s Center for Children and Families, 11 states have established Exchange legislation or executive orders and 29 have received Exchange establishment grants. California is further along than any other state in thinking about Navigators. Two other states, New York and Maryland, have also begun working on Navigator programs. Maryland has commissioned two reports (Manatt and Hilltop) to provide recommendations to inform future legislation. Findings indicate that there should be separate navigator and broker roles in both the individual and small business Exchange (SHOP). The New York Health Foundation commissioned a comprehensive report through their establishment grant, which is slated to be released April 2012.

Other states that are worth tracking include Washington, Rhode Island (long-standing success with CBO enrollment counselors for Medicaid/CHIP) and Massachusetts (strong contractual relationships with CBOs and providers).

The Kids Coverage Coalition will be releasing their final draft of their report, “Scope of the Navigator Role,” in the next few months.

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