The system of federal and state "exchanges" or "marketplaces" that offer health insurance through the Affordable Care Act lean heavily on "navigators" to guide consumers in their choices. Organizations such as community health centers, legal aid societies, social service groups, church groups and even Planned Parenthood chapters have received grants in the past to serve in this capacity. Now the Department of Health and Human Services (HHS) has announced $201 million in grants to be made available for navigators over the next three years.
Until now, grants have been awarded on an annual basis. This time around, HHS is planning to change the "project period" from 12 to 36 months. Tricia Brooks of Georgetown University's Center for Children and Families is enthusiastic about this change. Writing at the Center on Health Insurance Reforms blog (CHIRblog), Brooks says:
But what really excited me about the notice – drumroll please – is that, in the supporting statement, CMS signaled its intent to provide three years of funding in the next round of navigator grants. Extending the length of the funding period is important to build stability in enrollment assistance programs. No longer will individual navigators have to put their resume on the street at the end of the grant year, just in case. Three-year funding periods will enable navigator entities to recruit and retain permanent, professional consumer assisters and assure high quality assistance for consumers.
Brooks also notes that HHS plans to substantially cut weekly and quarterly reporting requirements for navigators while increasing monthly requirements. She urges potential grantees to submit comments to HHS regarding these and other changes.
The grant announcement also provides details of what is expected of all marketplace navigators:
• Conducting public education activities to raise awareness about the Marketplace;
• Maintaining a physical presence in the Marketplace service area
• Facilitating selection of a QHP;
• Providing information in a manner that is culturally and linguistically appropriate to the population served by the Marketplace, including individuals with limited English proficiency and that is accessible to individuals with disabilities;
• Complying with applicable training and conflict of interest standards;
• Obtaining the authorization of applicants for coverage available through a Marketplace application prior to accessing their personally identifiable information;
Also listed are prohibited activities, largely aimed at limiting potential conflicts of interest:
• Charging any applicant for or enrollee in coverage available through the Marketplace for application or other assistance related to Navigator duties;
Compensating individual Navigators on a per-application, per-individual-assisted, or per enrollment basis;
• Providing certain kinds of gifts to any applicant or potential enrollee as an inducement for enrollment;
• Using Marketplace funds to purchase gifts or gift cards, or promotional items that market or promote the products or services of a third party, that would be provided to any applicant for or potential enrollee in coverage available through the Marketplace;
• Soliciting any consumer for application or enrollment assistance by going door-to-door or through other unsolicited means of direct contact, except in cases where the individual
has a pre-existing relationship with the individual Navigator or Navigator entity; and
• Initiating any telephone call to a consumer using an automatic telephone dialing system or an artificial or prerecorded voice, except in cases where the individual Navigator or Navigator entity has a relationship with the consumer.
HHS also stresses the training and certification needed for personnel to be qualified to serve as navigators:
Navigators must complete at least 20 hours of an HHS developed training program and pass an online exam to ensure appropriate understanding of relevant Marketplace-related information and must be federally certified before carrying out any consumer assistance functions.
In spite of the change to a three-year period, HHS notes that "all personnel serving as Navigators must obtain continuing education and be re-certified on at least an annual basis."