Building on a Solid Foundation for the Navigator Program

Navigators are an integral part of the Affordable Care Act’s (ACA) ambitious goals of increasing coverage for millions and offering “no wrong door” entry to insurance coverage. NASHP’s recentreport, created with support from the Robert Wood Johnson Foundation‘s State Health Reform Assistance Network program, aims to help states leverage resources and programs they may already have in place to build their navigator program. Exchanges may be a new way for many people to get coverage, but states need not start from scratch on this aspect of the law.
So where should states look?  Based on interviews with state Medicaid, CHIP, and exchange officials, the report examines four types of programs or groups: application assisters, outstationed eligibility workers, enrollment brokers, and insurance agents and brokers. Each program has different target populations and goals, but all can potentially offer lessons, experiences and resources to states as they look to create a navigator program. If you need a refresher on the navigator requirements, check out our blog here.
Application assisters help individuals and families complete and submit their Medicaid (or other social service) applications and are commonly localized in community-based groups, providers and community health centers. Application assisters could provide the navigator program with:

• Experience working with populations in need of public coverage
• Strong experience/ capacity to do outreach
• Community-based and mission driven engagement approaches, with high levels of cultural competency for their target populations
• Heightened familiarity of applicable state and community resources

Minnesota has in place an application assistance program that provides resources to 120 organizations to conduct outreach and application assistance. The state will make a decision about leveraging portions of the program or integrating the program entirely into its navigator design once it develops a clear vision of the navigator program.
Outstationed eligibility workers (OEWs) are a requirement of the Medicaid program: states must have staff at federally qualified health centers (FQHCs) and disproportionate share hospitals (DSH) to receive and handle initial processing of Medicaid applications from pregnant women, children and youth. States with OEWs could potentially leverage:

• Experience working with populations in need of public coverage
• Connection to data sharing system with state and/or insurers through previous work
• Familiarity about other state resources available to assist consumers

Rhode Island has developed a robust OEW program. The state’s Family Resource Counselors(FRCs) conduct outreach, application assistance and case management functions. The state is considering integrating the FRCs with the navigator program and has even included navigator duties in the application for entities applying to become FRCs.
Enrollment brokers facilitate enrollment of applicants into Medicaid and/or CHIP managed care organizations in an unbiased and informed fashion. Their unique characteristics include:

• Familiarity with managed care insurance plans
• Experience guiding populations through plan selection and enrollment
• Established information sharing mechanism with a state and/or insurers
• Experience providing culturally competent, unbiased assistance

California plans to develop a unified eligibility and enrollment system and plans to integrate or adapt its enrollment broker program to work with the exchange.
Insurance agents and brokers are certified or licensed private entities that assist individual consumers and small businesses with selection of and enrollment into private insurance plans. They can offer the navigator program:

• Experience working with small group market populations (small employers)
• Familiarity with how to sort through available private insurance options, including benefits, costs and provider networks
• Established relationships with current consumers for follow-up and coverage renewal

Tennessee has reached out to and engaged agents and brokers in the exchange planning process. The state is considering a requirement for small employers in the SHOP exchange to purchase coverage through an agent for the first two years of the exchange.
What Can States Do Next?
If your state is looking to move forward with creation of the navigator program and is interested in leveraging current resources, here are some key next steps to consider:

• Perform an inventory of programs in your state including programs used to engage consumers in partner agencies, community groups and county and local programs.
• Clearly define a vision for the navigator program. States have discretion in program design, and the goals of the program will impact the types of entities and resources that can be leveraged.
• Communicate with stakeholders and partners to bolster cohesiveness of the program and to effectively engage groups to leverage their existing knowledge and expertise.

Is your state planning to leverage existing state programs to build its navigator program? Tell us in the comments below.