By Joanne Kenen
Navigators. In-person assisters. Volunteers.
Who are they and what do they do?
Getting people to sign up for health coverage under the Affordable Care Act will take more than a few public service ads and some brochures. So the law envisioned having “navigators” and other community organizations and trained individuals help them. Various advocacy groups also will mount volunteer efforts.
Naturally – this being the Health Policy law – there’s some controversy about who or what group can be a navigator. The National Conference of State Legislatures is tracking these bills. Some seem aimed at shoring up consumer protections, given that the navigators will have access to sensitive financial information. Others impose licensing rules that may have the potential to make it hard to get the navigators qualified and into the communities in a timely manner this fall and winter. With the federal government announcing the navigator grants on Aug. 15 and enrollment starting on Oct. 1, this will be a good issue to track.
Most people won’t be able to distinguish – or care – whether they get help from a “navigator” an “assister” a “certified application counselor” or a broker. CMS has put out a four-page explainer – the functions are quite similar, but the funding streams are different and some forms of consumer assistance will be in states that are running their own exchanges and others will be in the states with federally facilitated insurance exchanges.
No matter what they are called, the navigators are groups or individuals who are trained to help consumers understand the new coverage options and find a health plan that meets their needs – with whatever subsidies or government assistance they are eligible for. (There is supposed to be another level of consumer assistance and appeals for people with particularly complicated or difficult situations or who are denied a benefit they may be entitled to but, as of summer of 2013, there were some questions about ongoing funding in Congress. ) The navigator programs are supposed to be able to work in a manner that is culturally and linguistically appropriate.
The government has given community health centers funds to help enroll people and other groups including hospitals and social service agencies can apply to be counselors.
Organizations or businesses that want to “spread the word” can become a CMS “Champion for Coverage” program. There are going to be good local stories in who is stepping up, how well informed they are and how they are doing the outreach.
Of course, there will undoubtedly be opportunists and fraud too – that alas will probably be another rich source of stories.
For a more detailed explanation of the navigator rules, this Health Policy GPS explainer (from the health law program at George Washington University) is helpful, as are a couple of resources from the Centers for Medicaid and Medicare:
Joanne Kenen (@JoanneKenen), AHCJ’s Health Policy topic leader, is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of Health Policy. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
