Tennessee has been allocated an approximately $1.48 million grant to fund “Navigator” programs to help the public understand insurance options available to them under the Patient Protection and Affordable Care Act.
The funds are a portion of $54 million of total national funds available via the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services.
Many health care experts believe Navigators will be essential to getting the ACA up and running in 2014. However, exactly who will take on the Navigator roles throughout the state remains to be seen.
Federal guidelines require at least two types of entities to serve as Navigators, one of which must be a community- and consumer-focused nonprofit. Other groups can include trade and professional organizations, chambers of commerce, resource partners with the Small Business Administration, state and local human services organizations, and licensed insurance agents and brokers, among other public and private entities.
“Given the number of people to be reached, this amount of funding is quite small,” said Beth Uselton (pictured), program officer for ACA outreach and planning at Baptist Healing Trust. “Entities that would jump on the opportunity out of the blue will be less likely to do so, especially given the different requirements for navigators and the prohibition on entities with a conflict of interest.”
Navigators are trained in details of the ACA and expected to distribute fair and impartial information concerning enrollment. They must be versed in availability of premium tax credits, be able to facilitate enrollment into various plans and provide referrals to appropriate agencies. However, they cannot solicit, sell or negotiate insurance contracts, receive commissions, select a health plan for a consumer or make eligibility decisions.
Finally, Navigators can’t have a business relationship with or receive financial consideration from health insurance issuers.
Tennessee turned down the option of a state-run insurance exchange in late December 2012, thus deferring to the federal government to run the exchanges. The Navigator programs are designed for the 26 states that, like Tennessee, decided not to run their own insurance markets.
The Navigator program was modeled after the State Health Insurance Assistance Program, which has offered assistance to Medicare beneficiaries trying to figure out the complexities of Medicare Advantage and Prescription Drug Plan offerings.
“I think that it is absolutely necessary for uninsured Tennesseans to have access to unbiased information and assistance, given the confusion surrounding the new options available to them in 2014.” Uselton said. “As someone who has traveled the state doing public education about the ACA for the last three years, I have met the individuals that desperately want to know their options so they can make informed decisions for their families and businesses.
“They don’t want political spin and they don’t want a marketing pitch," she added. "They want honest information and they want to know where they can get help if they need it. This is the role that Navigators will play.”
According to the ACA, every state must have a competitive health insurance marketplace open for business in 2014. Open enrollment begins Oct. 1 and coverage begins Jan. 1, 2014. For more about the grant, go here.
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