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Wednesday, May 8, 2013

Q&A for Navigator Grant Opportunities

Elaine Saly

Health Policy Analyst

This post was originally a guest blog for the Abandoned Infants Assistance National Resource Center.

Elaine Saly is a health policy analyst at Families USA and developer of the Navigators and In-Person Assisters Resource Center.  She recently composed a toolkit and presentation on the navigator program, a new grant opportunity for existing organizations to expand their services by conducting outreach and assisting individuals with enrolling in health care coverage through the insurance exchanges.  She discussed the program and this exciting opportunity with us.

Can you briefly describe the role of navigators and the navigator program?

The Affordable Care Act provides for the establishment of navigator programs to conduct outreach and provide assistance with enrollment in coverage through new health insurance marketplaces or “exchanges.” The navigator programs will be established in each state, whether the state is operating its own marketplace, partnering with the federal government to operate the marketplace, or having the federal government operate the marketplace to ensure access to affordable coverage for state residents.

Navigators are individuals or organizations that will help consumers and small employers learn about and enroll in coverage and qualify for assistance with the cost of coverage through the marketplace. Many consumers and small businesses enrolling in new coverage will need assistance understanding their coverage options and completing the enrollment process. A majority of those who will gain coverage will be uninsured and have limited experience with health coverage. This population will also be more racially and ethnically diverse, typically have lower incomes, have lower literacy levels and be more likely to speak a non-English language in their household as compared to those who currently have private insurance. The role of navigators will be to leverage existing relationships with populations that are likely to be eligible for new coverage options and help address personal barriers to ensure successful enrollment and retention of coverage.

How can current case management support services modify their programs to fit criteria for navigators?

Navigators must have existing relationships, or be able to easily establish relationships, with populations likely to be eligible to enroll in new coverage options through the health insurance marketplace. Case management support programs will need to demonstrate that they can reach individuals who are currently uninsured, or only have access to coverage that is not considered comprehensive or affordable, and will need to dedicate staff to conducting outreach and providing enrollment assistance. Navigators can focus on reaching particular populations or serving specific geographic areas, but they must establish procedures for serving any individual or small employer requesting assistance. Programs that become navigators must also be able to record information about their outreach activities and the assistance they provide to consumers and small employers to help marketplaces monitor these programs. In order to be eligible to serve as a navigator, programs also have to demonstrate that they do not have a conflict of interest, that is, they do not have relationships or funding that would incentivize them to enroll an individual or small employer in a particular health insurance plan.

 Where can one find information about applying to become a navigator?

If your program is situated in a state that is operating its own marketplace or exchange, visit your state’s exchange website to find out about how to apply for a navigator grant. States running their own exchanges will have already released information about how to apply for this funding. If your program is in a state for which the federal government will operate the marketplace, the Department of Health and Human Services has released a funding opportunity to apply for navigator grants for which proposals are due on June 7th.