State Approaches to Consumer Assistance Training

*Chart updated March 6, 2014

With open enrollment underway, exchanges are mobilizing their efforts to provide assistance to individuals who will begin enrolling in coverage options in October. This chart highlights the approaches states have taken to develop education and training for the individuals who will provide enrollment assistance through Navigator, In-Person Assister (IPA) and Certified Application Counselor (CAC) programs.

Like all State Refor(u)m research, this chart is a collaborative effort with you, the user. State Refor(u)m captures the health reform comments, documents, and links submitted by health policy thinkers and doers all over the country. And our team periodically supplements, analyzes, and compiles this key content.

In this chart, we’ve relied heavily on the consumer assistance RFPs issued by exchanges. Know of something we should add to this compilation? Eager to update a fact we’ve included? Your feedback is central to our ongoing, real-time analytical process, so tell us in a comment, or email the author with your suggestion. She can be reached at rdolan@oldsite.nashp.org.

State	Model[1]	Program[2]	Awarded Grants? [9]	Training Entity	Training Format/ Curriculum	Hours	Testing	Other Conditions of Certification	Evaluation	Continuing Education
				(Who is conducting training)	(Online, in-person, computer based)		(What testing requirements are in place)
AL	FFE	Navigator	Yes	CMS	Online Training module standards in final rule[3]	Up to 30 hours	80% score on test
AL	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
AK	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
AK	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
AZ	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
AZ	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
AR	SPE	Navigator Guide Program	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Background check, fee. Enacted SB 1189requires licensure for guides, CACs and navigators.
AR	SPE	IPA Guide Program	Yes	AR Dept. of Higher Education will coordinate training program.	Phase One outreach & education training offered in person through July 2013, then online; Phase Two federal training online only; Phase Three state-specific training TBD. IPA Orientation available	Phase One training approx. 40 hours; Phase Two estimated to be approx. 20 hours, Phase Three TBD	Tests at end of each training phase & a comprehensive final test after all three training phases	Background check, fee. Enacted SB 1189requires licensure for guides, CACs and navigators.	Performance metrics include enrollment, outreach & education measures & administrative & enrollee satisfaction metrics; must be submitted monthly	Ongoing training as required
AR	SPE	CAC	Ongoing	CMS	Online	5 hours	80% score on test	Background check, fee. Enacted SB 1189requires licensure for guides, CACs and navigators.
CA	SBE	Navigator Certified Enrollment Counselors	No		In person, computer based; curriculum available 11/1	2 days
CA	SBE	IPA Certified Enrollment Counselors	No		In person, computer based	3 days	80% pass rate required	Fingerprint and background check
CA	SBE	CAC
CO	SBE	Navigator Connect for Health Assistance Network (CHAN)(Navigators & IPAs both called Health Coverage Guides)	Yes	Training curriculum provided by Connect for Health Colorado (C4HCO) to assistance sites that will hire, train & supervise Health Coverage Guides	Both online and in person; train the trainer model; available summer 2013	TBD, but likely a total of 43 hours	Passing a training assessment	Employment at assistance site; background check	Evaluated based on metrics such as progress toward expected outreach, service & enrollment outcomes, meeting certification requirements & customer satisfaction	Participate in training updates as necessary
CO	SBE	IPA Connect for Health Assistance Network (CHAN)	Yes	Training curriculum provided by Connect for Health Colorado (C4HCO) to assistance sites that will hire, train & supervise Health Coverage Guides	Both online and in person; train the trainer model; available summer 2013	TBD, but likely a total of 43 hours	Passing a training assessment	Employment at assistance site; background check	Evaluated based on metrics such as progress toward expected outreach, service & enrollment outcomes, meeting certification requirements & customer satisfaction	Participate in training updates as necessary
CO	SBE	CAC	Yes				80% or better pass on training	Satisfy standards including disclosure of conflicts of interest
CT	SBE	Navigator	Yes	Training provided by Access Health CT (Exchange)	In person; train the trainer; training will cover a range of topics & will be more intensive than training providing assisters	Up to 40 hours	In person, multiple choice test: 80% pass rate required	Background check	Evaluated based on a range of outcomes related to outreach, enrollment, customer satisfaction, application accuracy & engagement of regional stakeholders & assisters
CT	SBE	IPA Access Health CT Assister Program	Yes	Training provided by Access Health CT (Exchange)	In person; training topics include health coverage, Medicaid, CHIP & other federal benefit programs, handling health & financial information, understanding insurance, customer service, presentation skills & best practices	Up to 30 hours	In person, multiple choice test: 80% pass rate required	Background check	Evaluated based on 5 outcome measures related to outreach & enrollment
CT	SBE	CAC
DC	SBE	Navigator	No
DC	SBE	IPA In-Person Assister Program	Yes	Training & certification provided by DC Health Benefit Exchange	Both online and in person; range of training topics outlined in RFA, such as eligibility & enrollment rules & how to help consumers compare QHP options	Approx. 30 hours	Must pass competency test	Background check	Metrics such as number of applicants assisted, enrolled & referred to other resources; tracked through web portal
DC	SBE	CAC
DE	SPE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
DE	SPE	IPA Marketplace Assister Program	Yes	Training provided by state	In person or online; training modules on a range of topics will be offered & modules specific to eligibility & enrollment to be conducted late summer 2013		Testing will occur at various points throughout training process	Background check	Marketplace assister entities may be regularly evaluated on site & state may request performance monitoring of individual marketplace assisters	Potential recertification after first year & every two years after that
DE	SPE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
FL	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted SB 1842 requires navigators to register with Dept. of Financial Services & pay a fee
FL	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
GA	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted HB 198 establishes license requirements for navigators and CACs, including additional training and examination.
GA	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test	Enacted HB 198 establishes license requirements for navigators and CACs, including additional training and examination.
HI	SBE	Navigator Hi’i Ola Program (Navigators & IPAs both called marketplace assisters/Kokua)	Yes	Hawaii Health Connector			85% pass rate required	Background check	Regular financial & performance reports required related to outreach & enrollment as well as review through on site visits of marketplace assister organizations, audits & customer satisfaction surveys	Ongoing training as required by the Connector; also annual certification
HI	SBE	IPA Hi’i Ola Program	Yes	Hawaii Health Connector			85% pass rate required	Background check	Regular financial & performance reports required related to outreach & enrollment as well as review through on site visits of marketplace assister organizations, audits & customer satisfaction surveys	Ongoing training as required by the Connector; also annual certification
HI	SBE	CAC
ID	SBE	Navigator Consumer Connectors	No
ID	SBE	CAC
IL	SPE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours		Enacted SB 1194 requires certification by the Director of Insurance.
IL	SPE	IPA Illinois Assister Program	Yes	Navigators & In-Person Counselors (IPC) will receive nearly identical training; state-specific training for IPCs will be provided by the University of Illinois-Chicago	Online federal training & in person state training;training curriculum being developed by University of Illinois-Chicago	In person training 2-3 days long	Must pass written test	Fingerprint-based background check	Applicants are required to develop program performance goals related to anticipated enrollment numbers	Continuing education for IPCs required
IL	SPE	CAC	Ongoing	CMS	Online	5 hours	80% score on test	TBD by the Director of Insurance.
IN	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	IN Code 27-19 and HB 1319 establish certification requirements and fees.
IN	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test	IN Code 27-19 and HB 1319 establish certification requirements and fees.
IA	SPE [4]	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted HF 2465 requires licensure and passing a written examination.
IA	SPE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
KS	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
KS	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
KY	SBE	Navigator [5]	No	Delay in implementation of Navigator program
KY	SBE	IPA kynector Program	Yes	Kentucky Health Benefit Exchange			80% pass rate required	Background check	Performance measures related to application completion, outreach, focus on high need populations, operations, cost effectiveness & consumer satisfaction; also potential incentive payments based on percentage of completed applications from uninsured population	Annual recertification & continuing education
KY	SBE	CAC
LA	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Promulgated regulations requires registration and reporting.
LA	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
ME	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted HP 1098 requires background check and a certification and training program.
ME	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
MD	SBE	Navigator Regional Connector Entities	Yes	RFP for training curriculum and delivery contractawarded to GP Strategies Corporation	In person; RFP outlines broad headings of Policies and Procedures, Individual Affordability Programs, & Maryland Health Connection	120 hours	Final exam		Evaluated based on factors such as 1) impact on enrollment 2) enrollment of vulnerable/hard-to-reach populations 3) whether or not steering is occurring 4) consumer satisfaction 5) level of effort required to enroll an individual (bonuses based on enrollment targets)	Yes, annually
MD	SBE	IPA Assisters	Yes	RFP for training curriculum and delivery contractawarded to GP Strategies Corporation	Train the trainer; curriculum for navigators is to be modified for assisters	60-80 hours	Final exam
MD	SBE	CAC			Training curriculum specified in regulations.		Final examination (passing score TBD)	Not be a navigator or assister; be of good character and trustworthy		Certification every two years.
MA	SBE	Navigator	Yes	Building off of existing consumer assistance program, training will be provided to CBO partners by Health Care for All & Health Law Advocates	In person; Phase 1 of training will focus on ACA concepts & policies; Phase 2 will focus on products & plans; Phase 3 expected to address additional system functionality	Phase 1 will be two days; Phase 2 will be three days; Phase 3 TBD
MA	SBE	CAC
MI	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
MI	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
MN	SBE	Navigator	Yes; existing Minnesota Dept. of Human Services (MNCAA) Program
MN	SBE	IPA In-Person Assister Program	Yes		Online	TBD	Final exam, 70% or better score on each course	Background check	Performance metrics that assess outreach, education & enrollment assistance; specific requirements will be outlined in award; grantees may also be subject to monitoring & audits
MN	SBE	CAC	Applications accepted on rolling basis		Online		70% or better score on each course
MS	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
MS	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
MO	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted SB 262 requires passing an exam, licensure and a fee
MO	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
MT	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted HB 250 requires development of navigator training & certification program; includes fee
MT	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test	Enacted HB 250 requires development of CAC training & certification program.
NE	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted LB 568 requires navigator registration & payment of small registration fee
NE	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
NV	SBE	Navigator	Yes	NV Div. of Insurance	Training includes general exchange and health coverage issues as well as topics such as eligibility requirements & appeal & security	20 hours for DOI certification, 4 additional for exchange	Pass certification exam with 80% or better upon completing training	Background check & exchange enrollment facilitator certification (training plus pass exam with 70% or better)	2-5 outcomes that measure success in reducing uninsured individuals & families	Exchange may require annual continuing education
NV	SBE	IPA Enrollment Assisters	Yes	NV Div. of Insurance	Training includes general exchange and health coverage issues as well as topics such as eligibility requirements & appeal & security	Training includes general exchange and health coverage issues as well as topics such as eligibility requirements & appeal & security	Pass certification exam with 80% or better upon completing training	Background check & exchange enrollment facilitator certification (training plus pass exam with 70% or better)	2-5 outcomes that measure success in reducing uninsured individuals & families	Exchange may require annual continuing education
NV	SBE	CAC		NV Div. of Insurance	Training includes general exchange and health coverage issues as well as topics such as eligibility requirements & appeal & security	Training includes general exchange and health coverage issues as well as topics such as eligibility requirements & appeal & security	70% on pre-certification course; 80% on certification exam	Background check
NH	SPE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
NH	SPE	IPA [6]	No
NH	SPE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
NJ	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
NJ	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
NM	SBE	Navigator Healthcare Guides (Navigators and IPAs both called Healthcare Guides)	No	NM Health Insurance Exchange will provide training & certification	Likely to be mostly online; guides will be trained to explain coverage options & refer customers to additional resources	At least 30 hours		Background check
NM	SBE	IPA Healthcare Guides (Navigators and IPAs both called Healthcare Guides)	No	NM Health Insurance Exchange will provide training & certification	Likely to be mostly online; guides will be trained to explain coverage options & refer customers to additional resources	At least 30 hours		Background check
NM	SBE	CAC
NY	SBE	Navigator Facilitated Enroller (Navigators and IPAs both called Facilitated Enroller)	Yes	NY Dept. of Health (DOH)	Online (webinar-based) & in person; may include train the trainer; curriculum under development & training module will include topics such as eligibility & enrollment rules & underserved & vulnerable populations				IPA/Navigator contractor will monitor productivity and submit reports; contractors with substandard performance will not be reimbursed	Potential ongoing training
NY	SBE	IPA Facilitated Enroller	Yes	NY Dept. of Health (DOH)	Online (webinar-based) & in person; may include train the trainer; curriculum under development & training module will include topics such as eligibility & enrollment rules & underserved & vulnerable populations				IPA/Navigator contractor will monitor productivity and submit reports; contractors with substandard performance will not be reimbursed	Potential ongoing training
NY	SBE	CAC
NC	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
NC	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
ND	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
ND	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
OH	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted HB 3 establishes certification requirements, including a background check and fee.
OH	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
OK	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
OK	FFE	CAC	Ongoing	CMS	Online	5 hours	80% score on test
OR	SBE	Navigator Assisters (Navigators, CACs and IPAs are called Assisters)	Yes	OHA or Cover Oregon (Exchange)	Both online and in person	<1 day online, 8 in person	Complete course	Background check and must have liability & auto insurance		Certification & training must be renewed annually
OR	SBE	IPA Assisters	Yes	OHA or Cover Oregon (Exchange)	Both online and in person; online module	<1 day online, 4 in person		Background check and must have liability & auto insurance		Certification & training must be renewed annually
OR	SBE	CAC Assisters	Yes	OHA or Cover Oregon (Exchange)	Both online and in person; online module	<1 day online, 4 in person		Background check and must have liability & auto insurance		Certification & training must be renewed annually
PA	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
PA	FFE	CAC	Ongoing	HHS	Online	5 hours	80% score on test
RI	SBE	Navigator Assisters (Navigators and IPAs are both called Assisters)	No	Network manager entity	In person, train the trainer; exchange will develop most of the core curriculum for assister training		Pass/fail written exam		Performance-based evaluation metrics in process of development but could include enrollment rates of certain demographic groups & customer service	Continuing education will likely be required by the exchange
RI	SBE	IPA Assisters	No	Network manager entity	In person, train the trainer; training will depend on role configuration		Pass/fail written exam		Performance-based evaluation metrics in process of development but could include enrollment rates of certain demographic groups & customer service	Continuing education will likely be required by the exchange
RI	SBE	CAC
SC	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
SC	FFE	CAC	Ongoing	HHS	Online	5 hours	80% score on test
SD	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
SD	FFE	CAC	Ongoing	HHS	Online	5 hours	80% score on test
TN	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted SB 1145 and regulations establish certification and background check requirements.
TN	FFE	CAC	Ongoing	HHS	Online	5 hours	80% score on test	Enacted SB 1145 and regulations establish certification and background check requirements.
TX[7]	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted SB 1795 allows the state to set additional certification and training requirements beyond federal requirements.
TX	FFE	CAC	Ongoing	HHS	Online	5 hours	80% score on test
UT	FFE [8]	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted HB 160 establishes licensure and background check requirements.
UT	FFE	CAC	Ongoing	HHS	Online	5 hours	80% score on test
VT	SBE	Navigator	Yes		Online and in-person	24 hours	Complete training program & pass exam	Must disclose criminal history	Monthly reporting requirements related to engagement & enrollment goals	4-12 hours over course of year
VT	SBE	CAC			Online and in-person	24 hours	Complete training program & pass exam
VA	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted H2246 regulates navigator activities.
VA	FFE	CAC	Ongoing	HHS	Online	5 hours	80% score on test
WA	SBE	Navigator	No	Exchange will provide materials; lead organization trainer staff will conduct training	Course outline covers 6 modules	40-50 hours	Exam		Evaluation measures include assessing the number of actions taken in the appplication & enrollment process
WA	SBE	IPA	Yes	Exchange will provide materials; lead organization trainer staff will conduct training	Self-study, moderated webinars, and/or classroom training; competencies written into RFP; course outline covers 6 modules	40-50 hours	Content-based certification exam	Background check	Enrollment data tracked & reported by key performance measures listed in RFP	Follow up training to communicate new requirements; periodic recertification will be required
WA	SBE	CAC					80% score on qualifying examination	Disclose conflicts of interest; background check
WV	SPE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
WV	SPE	IPA	No						Performance measures include enrollment performance related to vulnerable & hard-to-reach populations & consumer satisfaction
WV	SPE	CAC	Ongoing	HHS	Online	5 hours	80% score on test
WI	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test	Enacted legislation 2013 WI Act 20 establishes licensure and training requirements, including 16 hours of prelicensing training and a written examination.
WI	FFE	CAC	Ongoing	HHS	Online	5 hours	80% score on test	Includes 16 hours of prelicensing training and a written examination.
WY	FFE	Navigator	Yes	CMS	Online Training module standards in final rule	Up to 30 hours	80% score on test
WY	FFE	CAC	Ongoing	HHS	Online	5 hours	80% score on test

Notes:

[1] All exchanges are required to have a Navigator program and a CAC program. An IPA program is required for SPEs that have opted to manage consumer assistance functions, but is optional for state-based exchanges (SBEs). There will be no IPA program in states with FFEs. The Navigator and CAC programs and associated training is managed by the federal government in states with federally facilitated exchanges (FFEs) and partnership exchanges (SPEs). State-based exchanges are designing their own Navigator training. Need help keeping track of all of the different consumer assistance programs and roles of each? Use this CMS resource.
[2] Links to RFP where available. Unless otherwise linked to another source, information is derived from the RFP.
[3] According to final regulations, federal navigator training will include training on QHPs, insurance affordability programs, tax implications of enrollment decisions, basic concepts about health insurance, eligibility and enrollment rules, providing culturally and linguistically appropriate services, ensuring accessibility, understanding differences among health plans, privacy and security, working with individuals with limited English proficiency, customer service standards, outreach and education strategies, and administrative rules.
[4] Iowa is a plan management partnership state and is not taking on any consumer assistance functions.
[5] Due to federal funding rules, some SBEs are delaying the implementation of their Navigator program and are opting to have their IPA program provide the primary consumer assistance functions of the exchange during the initial stages of implementation.
[6] NH has not yet released information about the state’s IPA program; consumer assistance activities are currently on hold due to state-level funding delays.
[7] In September Texas Gov. Perry directed the Texas Department of Insurance to develop additional regulations for federal navigators, such as requiring navigators to complete at least 40 hours of state training in addition to the mandatory federal training, submit to regular background and regulatory checks and other requirements.
[8] In UT the federal government will operate the individual exchange and the state will operate the SHOP exchange as well as a SHOP-specific Navigator program.
[9] Column includes “approved” CACs, even if they do not receive grants. In FFE and partnership states, there is no limit to the number of CAC organizations that can apply and there is no deadline for applications (p.5 and 6 of FAQ).

Produced by Rachel Dolan, Anita Cardwell and Leo Quigley.

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