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:
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:
• 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:
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:
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.”
