Navigators & Certified Application Counselors. Alina Batool Health Policy Analyst September 2013

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1 Navigators & Certified Application Counselors Alina Batool Health Policy Analyst September

2 Customer Support in the Marketplace Each Marketplace will offer help through a website, a call center, and community groups, or individuals specifically designated as Navigators to help consumers. In addition to Navigators, certified application counselors will also be assisting consumers. 2

3 Navigator Program Federal grant program administered by each Marketplace that provides funds for Navigator positions Navigators will Maintain expertise in eligibility, enrollment, and program specifications and conduct outreach Distribute fair, accurate, and impartial information about enrollment in Qualified Health Plans (QHP) and other health programs such as Medicaid and CHIP Facilitate selection of a QHP Refer consumers to other programs Provide information in a manner that is culturally and linguistically appropriate and accessible for people with disabilities CMS 3

4 Certification and Examination Navigators must Be certified Must take initial web-based training. 30 hours. Training is available online Be recertified annually Not accept direct or indirect compensation from issuers related to enrollment in QHPs or non-qhps Meet reporting requirements Be associated with an organization approved to certify and participate in enrollment activities 4

5 Certified Application Counselors Provide information to consumers about health coverage options and assist them with applying for and enrolling in QHPs and insurance affordability programs which include Medicaid, CHIP, advance payments of the premium tax credit and cost-sharing reductions in connections with QHPs Not required to conduct outreach Certified application counselor must disclose potential conflicts of interests. Will not receive federal grant through the Marketplace. Be associated with an organization approved to certify and participate in enrollment activities. 5

6 Certification and Examination Certified Application Counselor Application to become a Certified application counselor organization available online. ( An organization must: have processes in place to screen their staff to make sure that they protect consumer information engage in services that position them to help those they serve with health coverage issues have experience providing social services to the community Example: FQHC, hospitals, health care providers, community health centers 6

7 Certification and Examination Certified Application Counselor Organizations can certify their staff/volunteers as Certified application counselors Example: Gateway to Care Web-based training is available on CMS.gov 5 hour training. As part of the training, CACs will have to pass an exam. 7

8 Notable Differences Assist in enrollment, provide information about QHPs and insurance affordability programs Navigators CACs Yes Training and examination Yes (30 hours) Marketplace Grant funded Yes No Yes Yes (5 hours) Adhere to Conflict of Interest Standards Yes Yes (Must disclose) Conduct outreach Yes No Provide Special Accommodations Yes Yes (Direct or by appropriate referral) 8

9 Texas Navigator Grantees Agency Amount Geographic/Population Focus United Way of Tarrant County (17 organization collaborative) Migrant Health Promotion, Inc. National Hispanic Council on Aging $5,889,181 Across the state $589,750 Migrant populations in the Rio Grande Valley of Texas Change Happens $785,000 Houston area $646,825 Uninsured Hispanic population in Dallas County United Way of El Paso County $642,121 El Paso county Southern United Neighborhoods East Texas Behavioral Healthcare Network National Urban League $600,678 AR, LA and TX $1,337, East TX counties $376,800 Low-income, medically underserved, urban residents in Texas TOTAL $10,867,875 Less than $4/exchange eligible person 9

10 Local Navigator Organizations Change Happens Plan Will provide Navigator services in 5 counties (Harris, Fort Bend, Galveston, Brazoria, and Montgomery) Community involvement through presentations, local helpline centers, marketing, tool-kits for business and community partners, online assistance, and outstationed assistance locations. 10

11 Local Navigator Organizations Area Agency on Aging (United Way of Tarrant County) The United Way of Tarrant County s consortium hopes to reach 62,000 Texans in face-to-face meetings and 500,000 through phone calls and community meetings. Has put up job notification as Navigators on their website. City of Houston HHSD will be providing Navigator services in Houston. The Houston Area Urban League will also be providing Marketplace Navigation services. 11

12 Other Enrollment Efforts Enroll America Enroll America is a nonpartisan 501(c)(3) organization. Working to raise awareness and provide guidance on best practices for outreach and enrollment. Not a Navigator/ACA organization Gateway to Care Connecting Kids to Coverage Outreach and Enrollment Application assistance, linking families to medical homes, culturally sensitive outreach. Certified application counselor organization 12

13 Other Enrollment Efforts Young Invincibles Non-partisan, non-profit organizations that engages in education, policy analysis and advocacy. Special enrollment assisters contracted to help uninsured young and healthy people. Performing traditional outreach method, text messaging services, social media, and mobile apps. Not a Navigator/ACA organization 13

14 More Information? Final Rules Outline for Navigator/CAC Questions/Comments: