In July 2012, the Crider Group conducted a survey to assess the status of Navigator program developments in various states in order to recommend suggestions and solutions for the development of a navigator program for the District of Columbia Health Benefit Exchange. This survey was unique since the concept of “navigators” continues to remain elusive for most U.S. states, with only a few U.S. states that have gone ahead and drafted recommendations and proposals on how their exchange navigator program will work.
The ACA mandates that every state health insurance exchange must incorporate an area for “navigators”. Navigators are responsible for ensuring that the exchange consumers are aware of the latest health options available to them through an exchange and to show consumers how they can easily enroll in health plans and wellness services of their choice. Only a few states, including Connecticut and Nevada, have drafted plans for navigators into their local state-based exchanges.
As detailed in the federally issued navigator guidelines, an exchange navigator group can comprise of individuals that belong to trade associations, community and non-profit groups, chambers of commerce, or licensed brokers and agents. Navigators will play a critical role in exchange administration, ensuring that a state’s residents are made aware of the presence of an insurance marketplace, the available health plans and benefits, and federal tax credits and subsidies that the consumers can avail. Navigators, therefore, would be responsible for both educating the consumers and assisting them in getting health coverage.
The analysis of the Crider Group survey results indicated that setting up different navigator groups, one for outreach and education and the other for managing enrollments for instance, can help navigators in developing specialized expertise that can prove valuable in assisting health consumers effectively. As navigator groups would comprise of individuals from different fields, it is likely that some individuals would be better suited to interact with specific consumer groups due to familiarity with the groups’ culture, beliefs, and customs.
States have been granted the flexibility in designing their navigator group to meet their local market needs and some really interesting navigator structures have been proposed, where different groups of navigators would be responsible for some executive level types of functions. For instance, in Connecticut, the Health Insurance Exchange Staff recommended setting up two separate groups of exchange navigators – Enrollers & Educators – with no overlapping in the responsibilities of both groups. Nevada’s Silver State Health Insurance Exchange proposed the creation of three separate groups – Navigators, Producers, and Outreach Specialists – with a clearly defined set of responsibilities for outreach, eligibility determination, and enrollment related guidance and assistance.
The time for states to start strategizing their plans for navigators is now. Recently, the U.S. Department of Health and Human Services extended the exchange plan submission deadline to December 14th, only a few more weeks away. With the states’ exchange administrators bound by the healthcare law mandate to incorporate a navigator system into their health insurance exchange design, states that have hitherto ignored this particular federal requirement will need to devise a navigator program strategy before time runs out.