Health News
By now we know that upwards of 30 million Americans will have new, more affordable health coverage options available to them by January 1, 2014. But what many don?t realize is how incredibly difficult it can be to understand and choose the right health insurance on your own.
The Wizard of Oz?s Dorothy had guides along the way, and the Affordable Care Act (ACA) provides some as well ? hopefully, with fewer pitfalls. But not everyone can counsel people about health insurance. There are complex public and private systems to navigate, and most people who will likely get insurance in the new Health Insurance Exchanges, or Marketplaces, will be more racially diverse, less educated, and earn lower income than people in private insurance now. Most will have a high school education or less, and as many as one in four speak a language other than English at home. So it matters that the people who guide consumers along the path to coverage are trusted members of the community and understand their circumstances.
Luckily, the ACA provides different options for guides along yellow brick road.
Navigators are outlined in the ACA as helpers for people to enroll in coverage through the Exchange, and refer or assist with Medicaid enrollment. Navigators are funded through Exchanges, and regulations from the Department of Health and Human Services (HHS) are clear that anyone who gets payments from insurance companies cannot be a Navigator. Navigators also must meet cultural competency standards and go through training and certification. States running their own Exchanges are developing Navigator programs now and must fund these with state Exchange dollars. For Federal Exchanges and Partnership Exchanges, HHS has said that it will fund Navigators directly through an upcoming RFP process. Be on the lookout for this announcement in the next few weeks.
To add even more help on the ground, HHS recently outlined in regulations another program,Assisters (or, In-Person Assistance). Like Navigators, Assisters must meet training and conflict of interest standards. They could fill in gaps in areas that need more enrollment assistance, or provide outreach and education about the ACA?s new options. Funding for Assisters is a key difference from Navigators. States running Exchanges or opting for the Consumer Assistance Partnership can apply for funds for Assisters through their Exchange Establishment grants. A number of states are applying now for these funds. Unfortunately, Assisters currently are not an option for Federal Exchanges.
And when you thought there were enough new health-related terms, HHS regulations added yet another helper to enroll people, Certified Application Counselors. Every Exchange must have a Certified Application Counselor program, with similar training and privacy standards as Navigators and Assisters. A difference in this program is that there is no funding mechanism. It is unclear who will serve this role ? although the regulation suggests it could be community-based organizations or health care providers. Stay tuned for further clarification on this new option.
But even these multiple types of help will not be enough to spread the word about the ACA. Helping people understand and choose the right health plan, especially given the amount of misinformation in the media and elsewhere, is going to be a huge task. Nevertheless, these resources in the ACA provide a foundation to start building greater understanding of health care options to get people into the right coverage.
- The Aca Is Coming ? How Can I Help Enroll People?
The past few weeks have brought a flurry of activity from the federal and state government agencies who are reaching out to community-based entities to solicit their assistance in Affordable Care Act outreach, education and enrollment. In Illinois, it?s...
- Update On Sb 1194 (the Insurance Navigator Act)
Starting October 2013, an estimated 1.6 million Illinois residents will be eligible for new and affordable forms of public and private health insurance coverage under the Affordable Care Act. But the overwhelming majority of the newly eligible have no...
- Great News For The People Of Illinois...now What?
Yesterday, Governor Quinn announced that Illinois was awarded a $115 Million grant for its Health Insurance Marketplace (the online portal to enroll over a million adults and children into quality health plans). A large portion of this federal funding...
- Finding The Pot Of Gold At The End Of The Navigator Rainbow!
News that a new proposed rule on Navigators is under review at the Office of Management and Budget (OMB) hopefully means it won?t be long before we see model navigator training, conflict of interest and privacy standards. With any luck, release of the...
- What Is The Illinois Partnership Health Insurance Marketplace?
The Affordable Care Act requires each state to have a health insurance marketplace (otherwise known as a "health insurance exchange"). Originally, the plan was for each state to establish its own health insurance marketplace, or default to a federally-run...
Health News
Navigators, Assisters, and Counselors, Oh My!
By now we know that upwards of 30 million Americans will have new, more affordable health coverage options available to them by January 1, 2014. But what many don?t realize is how incredibly difficult it can be to understand and choose the right health insurance on your own.
The Wizard of Oz?s Dorothy had guides along the way, and the Affordable Care Act (ACA) provides some as well ? hopefully, with fewer pitfalls. But not everyone can counsel people about health insurance. There are complex public and private systems to navigate, and most people who will likely get insurance in the new Health Insurance Exchanges, or Marketplaces, will be more racially diverse, less educated, and earn lower income than people in private insurance now. Most will have a high school education or less, and as many as one in four speak a language other than English at home. So it matters that the people who guide consumers along the path to coverage are trusted members of the community and understand their circumstances.
Luckily, the ACA provides different options for guides along yellow brick road.
Navigators are outlined in the ACA as helpers for people to enroll in coverage through the Exchange, and refer or assist with Medicaid enrollment. Navigators are funded through Exchanges, and regulations from the Department of Health and Human Services (HHS) are clear that anyone who gets payments from insurance companies cannot be a Navigator. Navigators also must meet cultural competency standards and go through training and certification. States running their own Exchanges are developing Navigator programs now and must fund these with state Exchange dollars. For Federal Exchanges and Partnership Exchanges, HHS has said that it will fund Navigators directly through an upcoming RFP process. Be on the lookout for this announcement in the next few weeks.
To add even more help on the ground, HHS recently outlined in regulations another program,Assisters (or, In-Person Assistance). Like Navigators, Assisters must meet training and conflict of interest standards. They could fill in gaps in areas that need more enrollment assistance, or provide outreach and education about the ACA?s new options. Funding for Assisters is a key difference from Navigators. States running Exchanges or opting for the Consumer Assistance Partnership can apply for funds for Assisters through their Exchange Establishment grants. A number of states are applying now for these funds. Unfortunately, Assisters currently are not an option for Federal Exchanges.
And when you thought there were enough new health-related terms, HHS regulations added yet another helper to enroll people, Certified Application Counselors. Every Exchange must have a Certified Application Counselor program, with similar training and privacy standards as Navigators and Assisters. A difference in this program is that there is no funding mechanism. It is unclear who will serve this role ? although the regulation suggests it could be community-based organizations or health care providers. Stay tuned for further clarification on this new option.
But even these multiple types of help will not be enough to spread the word about the ACA. Helping people understand and choose the right health plan, especially given the amount of misinformation in the media and elsewhere, is going to be a huge task. Nevertheless, these resources in the ACA provide a foundation to start building greater understanding of health care options to get people into the right coverage.
This post originally appeared on Health Policy Hub's the Community Catalyst Blog.
Written by Christine Barber, Senior Policy Analyst
- The Aca Is Coming ? How Can I Help Enroll People?
The past few weeks have brought a flurry of activity from the federal and state government agencies who are reaching out to community-based entities to solicit their assistance in Affordable Care Act outreach, education and enrollment. In Illinois, it?s...
- Update On Sb 1194 (the Insurance Navigator Act)
Starting October 2013, an estimated 1.6 million Illinois residents will be eligible for new and affordable forms of public and private health insurance coverage under the Affordable Care Act. But the overwhelming majority of the newly eligible have no...
- Great News For The People Of Illinois...now What?
Yesterday, Governor Quinn announced that Illinois was awarded a $115 Million grant for its Health Insurance Marketplace (the online portal to enroll over a million adults and children into quality health plans). A large portion of this federal funding...
- Finding The Pot Of Gold At The End Of The Navigator Rainbow!
News that a new proposed rule on Navigators is under review at the Office of Management and Budget (OMB) hopefully means it won?t be long before we see model navigator training, conflict of interest and privacy standards. With any luck, release of the...
- What Is The Illinois Partnership Health Insurance Marketplace?
The Affordable Care Act requires each state to have a health insurance marketplace (otherwise known as a "health insurance exchange"). Originally, the plan was for each state to establish its own health insurance marketplace, or default to a federally-run...