Navigators. Connecting people to health care in 2014

Transcription

1 Navigators Connecting people to health care in 2014 *Includes slides from Navigators: Guiding People Through the Exchange, a PPT prepared by Community Catalyst

2 What is the Affordable Care Act? Most sweeping health legislation since the passage of Medicare Health coverage for 32 million uninsured in the U.S. Protections against bad insurance practices Individual Mandate State Health Benefits Exchanges (or Health Insurance Exchange) Expansion of Medicaid Subsidies for private insurance

3 Health Benefits Exchange Where 1.2 million in MN will purchase health insurance private and public plans including many newly insured Online portal for health coverage for individuals and small businesses MN Exchange development is being led by Commissioner Showalter, as well as Commerce, MDH and DHS Legislation to pass by March 31, 2013

4 What are Navigators? Why are they important?

5 Navigators are people who will: Help people learn about options and enroll in health coverage in the Exchange Help individuals and small businesses understand and choose the best insurance for them

6 What the ACA says about Navigators: Section 1311(i) Navigators must demonstrate relationships with those likely to be qualified to enroll in a qualified health plan particularly 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

7 Who the ACA says Navigators may be : Entities may include: 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.

8 What the ACA says Navigators must do: 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

9 It is vital that Navigators be independent of the insurance industry and well-prepared to serve people with barriers to insurance

10 A New Creature: In-Person Assistors Perform similar functions to the navigator program. Key difference: states can use federal exchange establishment grant funds to develop and operate the IPA MN has applied for IPA funds Standards for IPAs not yet developed in MN

11 Defining and Building Navigators/Assistors in MN

12 Top Consumer Priorities Navigators Must: Be free from conflicts of interest, including payments and incentives from insurers Act in the interest of the consumer Be trusted by the community to provide appropriate, clear, and correct information including to low-income, disadvantaged, and hard to reach populations Be able to explain eligibility, benefits, cost sharing, and appeals processes to consumers Have adequate training on the state Exchange, Medicaid, other public programs, and the private insurance market

13 How is the Navigator Program Getting Designed? A Navigator/Broker workgroup has met for the past year to talk how to design a navigator program in Minnesota. This includes communitybased representatives (TakeAction MN, Community Health Workers, StairStep Foundation) as well as insurance brokers

14 Key Issues for Navigator Design Definition of Services Outreach, Assessment, Application Assistance and Plan Selection Support Training and certification (not licensure) Compensation Grant funded, Pay for P, Hybrid, PMPM Conflict of interest

15 Pitfalls in Navigator Program Design Licensure requirements Restrictive funding mechanisms that create barriers to potential navigator entities Referrals or hand-offs built into system Lack of training, support

16 What Happens Next? By March 31, 2013 Legislature passes Exchange legislation with navigator program included Navigator/Assistor funding flows to train, prepare for enrollment October 2013 Open Enrollment Begins

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