HHS To Unveil Grant Distribution for Navigator Program Next Week

HHS is preparing to announce next week how it will distribute $54 million in grants through the Affordable Care Act's insurance exchange "navigator" program, Modern Healthcare reports (Lee, Modern Healthcare, 8/8). According to the Wall Street Journal, the announcement is expected on Aug. 15, which leaves "just 32 business days" for officials in nearly three dozen states to hire and train thousands of workers (Schatz, Wall Street Journal, 8/7).

Background on the Navigator Program

Under the ACA, exchanges that will be operated solely by or in partnership with the federal government are required to have at least two certified navigator entities, one of which must be a not-for-profit. HHS has allocated $54 million in funding grants to train and pay navigators in the 37 states with federally run exchanges.

Navigator workers must provide "fair, impartial and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions among [qualified health plans] and helping qualified individuals make informed decisions during the health plan selection process." They also must provide additional assistance to:

• Consumers with disabilities, limited proficiency in English; or
•  Consumers who are unfamiliar with health insurance.

Lawmakers in recent months have raised concerns about the workers' level of training and access to consumers' personal and potentially sensitive data. In particular, some GOP leaders have stepped up their scrutiny of the navigator program and a separate "in-person assisters" program in states that will operate their own exchanges. The ACA prohibits federal funding for the assisters program because it does not have to meet the same criteria as the navigators program (California Healthline, 7/15).

Training Issues

According to the Journal, the government earlier this month announced that it would reduce the required number of training hours from 30 to 20 to accommodate the tightened schedule (Wall Street Journal, 8/7). However, HHS has said the Journal report was not accurate, Modern Healthcare reports.

An HHS spokesperson said the workers would need to complete about 20 hours of initial training between Aug. 15 and the Oct. 1 start of the exchanges' open enrollment period, followed by mandatory "refresher" training through the six-month open enrollment period. In an email to Modern Healthcare, the spokesperson added, "We view training as an ongoing process" (Modern Healthcare, 8/8).

Meanwhile, many of the remaining states that are operating their own exchanges have already launched their in-person assisters training programs and a few of them have also established additional requirements for certification, the Journal reports (Wall Street Journal, 8/7).

Insurance Industry, Advocates Clash Over Navigator Program Oversight

Insurance agents and brokers -- concerned that the navigator and in-person assisters programs could encroach on their business -- have waged a three-year effort to enact laws regulating state oversight of the program, the Center for Public Integrity/Kaiser Health News reports.

However, consumer advocates and some health policy experts have countered that such laws could hinder the program and impede consumers' access to insurance. While HHS will have regulatory oversight of the programs in states with federal exchanges, several of the states that are running their own marketplaces have enacted regulations for their in-person assisters program. The regulations require states to conduct background checks on their in-person assisters and prohibit them from recommending specific insurance plans (Kusnetz, Center for Public Integrity/Kaiser Health News, 8/9).