Mapping Out the Role of Navigators

A hot topic for states pursuing their own health insurance exchanges is how to structure the navigator program. With an estimated 25 million-plus people newly eligible for coverage in 2014, navigators will play a major role in helping consumers learn about and choose health coverage. In fact, states running exchanges are required to include navigator programs, which are part of the ACA’s “no wrong door” approach to eligibility and enrollment. States have been facing a number of important questions related to these vital navigator programs: what role will agents and brokers play? How will navigators be compensated? What types of training will navigators need?
Released earlier this week, the final exchange rule lays out clearer expectations for navigator programs (pages 527-532). The rule clarifies the requirements for these programs, and sets out the differences between the roles of brokers and navigators.
Highlighted below are some of the changes the final rule makes to the navigator portions of the proposed rule, as well as new interim final provisions. Look through them, and then share what your state’s plans around navigator programs are so far. What impact will the final rule have on those plans? Tell us in the comments below these final-rule highlights:
Who can serve as a navigator?

• Exchanges cannot require all navigators to be licensed brokers. A broker license is not required to perform navigator duties and exchanges must have at least two entities serve as navigators.
• The final rule requires one of these two entities serving as navigators to be a community or consumer-focused nonprofit.

Conflict of interest provisions

• Exchanges must develop a set of conflict-of-interest standards for navigators. The final rule allows exchanges to set the standards, and recommends they include financial considerations, employment and activities, and disclosures, among other issues.
• The ACA prohibits navigators from receiving compensation of any kind from health insurance issuers for enrolling individuals in health insurance plans. The final rule expands this prohibition to include both qualified health plans (QHPs) and plans sold outside the exchange.

Navigator duties and training

• The ACA and proposed rule stated that navigators will “facilitate enrollment” in QHPs, which generated a lot of confusion about what that meant. This final rule clarifies that navigators will facilitate the choice of a QHP, and the exchange will conduct the eligibility determination and send the necessary information to the QHP to enroll the individual into the plan.
• Exchanges must develop a training program for all individuals that perform navigator functions, including both paid and unpaid staff members of organizations that serve as navigators. The training must ensure navigators are competent in the needs of underserved and vulnerable populations, eligibility and enrollment procedures, and the range of public programs and QHP options available through the exchange. Additionally, navigators must be trained in the proper handling of tax data and other personal information.

Brokers and agents:

• The exchange has flexibility to determine the role of agents and brokers in the exchange. Furthermore, brokers and agents are allowed to help individuals enroll in QHPs through the exchange and help them apply for premium tax credits.
• Brokers must use the exchange’s single, streamlined application. In order to assist individuals in applying for premium tax credits, brokers must register with the exchange, receive training, and comply with privacy and security standards.

These final rules indicate that additional guidance is forthcoming on navigator training, including standards on linguistic and cultural competency. For now, HHS is accepting comments on interim final portions of this rule, including the ability of brokers to assist individuals in applying for premium tax credits.
Weigh in on the rule’s impact on your state’s navigator-program plans: post a comment below.