Health Insurance Report™ helps you track and analyze legal, legislative, and regulatory developments affecting the health-insurance industry throughout implementation of the Affordable Care Act...
By Sara Hansard
More than 830 letters of intent to operate “navigator” programs to assist people enrolling in online federal marketplaces have been received by the Department of Health and Human Services, the head of the HHS office in charge of implementing the health care reform law's insurance market reforms told Congress May 21.
“We have received over 830 optional letters of intent from a variety of organizations. We expect to receive a similarly robust number of applications for the navigator cooperative agreements” by the June 7 deadline, Gary Cohen, director of the Center for Consumer Information and Insurance Oversight (CCIIO), told a joint hearing held by two subcommittees of the House Oversight and Government Reform Committee.
The Centers for Medicare & Medicaid Services announced a $54 million funding opportunity April 9 for cooperative agreements to fund navigators in federally facilitated marketplaces (FFMs), including state partnership marketplaces (SPMs) (see previous article). Applicants were encouraged to submit a nonbinding letter of intent to apply by May 1, to enable HHS to plan for the application review process. The grants will be awarded in August, Cohen said.
In addition to the navigator grants for the FFMs, CMS will issue a final rule on navigators and non-navigator assistance personnel “very soon,” Cohen said. A proposed rule outlining requirements for the program to conduct education and outreach on the Affordable Care Act and help people get enrolled was released April 3 (see previous article).
Cohen outlined requirements for navigators and in-person assistance (IPA) programs. Community organizations participating in the programs must demonstrate a past history of expertise in the private health insurance market and a track record of working in the community, he said.
Individual helpers will receive 20 to 30 hours of training in August, timed to begin public outreach shortly before the marketplaces open for enrollment Oct. 1. They must maintain expertise in enrollment eligibility and program specifics; provide consumer-focused information in an impartial, easy-to-understand manner; and help people enroll in qualified health plans (QHPs) in the marketplaces or in Medicaid, Cohen said.
About 20 percent of the uninsured have not completed high school, and nearly 10 percent are in households without an English-speaking adult, Cohen said. Selecting, applying for, and enrolling in health insurance plans may be unfamiliar to them, he said. “To inform them about their new health insurance options, information must be provided by the people connected to the community in a way that they can understand,” he said.
In answer to questions about the expertise and trustworthiness of people hired in the assistance programs, Cohen said the helpers will not give tax advice or select plans, and they will not retain personal information about applicants, he said.
The hearing, “Examining the Concerns about ObamaCare Outreach Campaigning,” was held by the Subcommittee on Energy Policy, Health Care and Entitlements and the Subcommittee on Economic Growth, Job Creation and Regulatory Affairs. A May 6 letter from the two subcommittee chairmen and full committee Chairman Darrell E. Issa (R-Calif.) to HHS Secretary Kathleen Sebelius was released May 21, asking about HHS's statutory authority to fund the state-based marketplace (SBM) assistance programs, as well as other questions about training standards and oversight. The letter requested a response by May 20. Cohen said the agency is working on its reply.
Subcommittee Republicans questioned Cohen about the legality of HHS providing grants for consumer assistance for SBMs.
“Obamacare explicitly prohibited state-based exchanges from using federal grants for navigators,” Rep. James Lankford (R-Okla.), chairman of the energy policy subcommittee, said. “A twin program, called in-person assisters, has been created by HHS funded with federal grants.” He said that during a briefing in April, HHS officials told committee staff that “there is no statutory authority for the assistance program.”
Cohen replied, “The statutory authority is the requirement in the Affordable Care Act that state-based exchanges and all exchanges provide outreach and education and enrollment assistance to people.”
The in-person assistance program for SBMs is separate from the navigator program and is a transitional program until the SBMs are self-sustaining financially, Cohen said. However, “the function that the people will be performing [in the SBMs] is very much the same” as the FFM navigator program, he said.
“State-based marketplaces are required to have a navigator program that they fund. But as a transitional program during the establishment of the exchanges, only in the first year, and before they are financial sustainable, states came to us” and said they do not have enough money to operate the program, Cohen said.
Lankford also questioned Cohen about reports that Sebelius solicited funds from health insurers, pharmaceutical executives, and hospital executives for Enroll America, a group set up to get uninsured people enrolled in coverage under ACA. Health insurers depend on HHS permission to sell QHPs in the 33 FFMs and SPMs.
Cohen said he did not know specifically about the fundraising efforts by Sebelius but said that involving industry groups in conducting public outreach and education about ACA is similar to efforts by the pharmaceutical industry and AARP in educating the public about the Medicare Part D prescription drug benefit when that program took effect in 2006.
Rep. Scott DesJarlais (R-Tenn.) asked Cohen about the impartiality of California's navigator program, which is paying the assistance personnel per enrollee. Giving the assisters an incentive to sign people up may pose a conflict in giving full information since it may be cheaper for people to pay the law's penalty, which is as low as $95 in 2014, than to sign up for coverage, he said.
The assisters “have to provide fair and accurate and impartial information, yes, regardless of what the decision is” on whether to buy coverage, Cohen said. But, he said, “ordinarily people that navigators will be dealing with are going to be people who want health insurance coverage. That's why they're going to find their way to a navigator. I don't know that they're going to say to every person who comes in the door, well if you don't get health insurance you might have to pay a penalty of $95. But if they're asked a question they'll give a truthful answer to the question.”
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