navigators: guiding people through the exchange. community catalyst, inc. 30 winter street, 10th fl....
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Navigators: Guiding People Through the Exchange
Community Catalyst, Inc.
30 Winter Street, 10th Fl.
Boston, MA 02108
617-338-6035
Fax: 617-451-5838
www.communitycatalyst.org
Organizations seeking to distribute or otherwise make widespread use of this publication are asked to notify Community Catalyst.
Community Catalyst is a national non-profit advocacy organization that works with national, state and local consumer organizations, policymakers and foundations to build consumer and community leadership to improve the health care system.
We support consumer advocacy networks that impact state and federal health care policy, and ensure consumers have a seat at the table as health care decisions are made.
© Community Catalyst 2011
About Community Catalyst
© Community Catalyst 2011
Overview
• What are Navigators and why are they important?
• What does the ACA say about Navigators?
• Who will enroll in insurance through the Exchange?
• How are Navigators different from Consumer Assistance
Programs (CAPs)?
• Building strong Navigators
© Community Catalyst 2011
What are Navigators?Why are they important?
Photo: (CC) by Ed Siasoco
© Community Catalyst 2011
• A guide to help you get where you need to go
• ACA: Navigators should help people learn about options and enroll in coverage in Exchange
• 29 million people enroll through Exchanges by 2019
• Help consumers and small businesses understand and choose the best insurance for them
• Build upon federal and state models and focus on private insurance
Navigators
© Community Catalyst 2011
Navigators in the ACASection 1311(i): Community and consumer-focused nonprofit groups; trade, industry, professional associations; commercial fishing industry organizations; ranching and farming organizations; chambers of commerce; unions; partners of the Small Business Administration; licensed insurance agents and brokers; others.
Duties: •Conduct public education •Distribute fair and impartial information on enrollment and tax credits •Facilitate enrollment in qualified health plans•Provide referrals for any grievance, complaint, or question about their health plan •Provide information that is culturally and linguistically appropriate
© Community Catalyst 2011
• Navigators must demonstrate relationships with:• employers and employees • uninsured and underinsured consumers• self-employed individuals
• Navigators may not receive any payments from health insurers. Insurers are explicitly prohibited from being Navigators.
• Navigators are funded through grants provided by state Exchange funds
Navigators in the ACA
© Community Catalyst 2011
Who will enroll through the Exchanges?
• 2/3 subsidized individuals
• 1/6 unsubsidized individuals
• 1/6 small business enrollees
© Community Catalyst 2011
Who will enroll through the Exchanges?
• 65 percent previously uninsured • More than one-third have not had a check-up for more than
two years • Lower income than those currently covered by private
insurance• More racially diverse than the those who currently have private
insurance• One in four Exchange enrollees speak a language other than
English at home• ~77 percent of people enrolled through Exchanges have a high
school diploma or less
It is vital that Navigators are well-prepared to serve people with barriers to insurance
© Community Catalyst 2011
How are Navigators different from Consumer Assistance Programs (CAPs)?
• Consumer Assistance Programs (CAPs) - Section 1002 • 35 states received federal grants in 2010 • CAPs provide assistance to all people with all types of
coverage • Navigators:
• Help people understand and enroll in coverage through Exchanges
• Need to understand public programs and help people get coverage in Medicaid and other state programs
© Community Catalyst 2011
Building strong Navigators
Photo by: (CC) Newtown
© Community Catalyst 2011
Top Priorities
Navigators must:
• Have adequate training on the state Exchange, Medicaid, other public programs and the private insurance market
• Be able to explain eligibility, benefits, cost sharing, and appeals processes to consumers
• Be trusted by the community to provide appropriate, clear and correct information
• Be free from conflicts of interest, including payments and incentives from insurers
© Community Catalyst 2011
Top Priorities
Navigators must:
• Act in the interest of the consumer
• Provide information that can be understood: • in a culturally sensitive manner• for those with low-proficiency English • by people with disabilities with special communication needs
• Be able to serve low-income, disadvantaged, and hard-to-reach populations
• Help people understand how premium tax credits work and their potential impact on the families’ finances
• Represent a diverse set of organizations and entities in a state to serve the people eligible for the Exchange