Exchange Navigator Committee moves into recommendations

Yesterday the CT Health Insurance Exchange Brokers, Agents, and Navigators Committee started the hard work of developing a structure and defining roles for the Navigator Program. Navigators will educate and help enroll potential individual and small business exchange, and Medicaid enrollees. Under the ACA and federal regulations, navigators must have demonstrated ability to reach those three audiences, meet licensure and conflict of interest standards (yet to be determined), and meet certification standards set by the Exchange (also yet to be determined). Staff draft recommendations include two tiers of navigators. Tier 1 Educators will focus on raising awareness of the Exchange and Medicaid options, distribute impartial information about options and enrollment, and ensure cultural competence. They would be paid on a grant/lump sum basis. Tier 2 Enrollers will focus on collecting the information needed to determine eligibility for appropriate programs, assisting in enrollment, and follow up. The committee is still discussing how to compensate Tier 2 navigators. Organizations, not individuals, will be designated as navigators and can apply for Tier 1, Tier 2 or both functions, but individuals acting as navigators will have to receive the appropriate training and certifications. The committee is still discussing how to certify SHOP navigators. The committee also discussed providing training/information opportunities for stakeholder organizations and individuals who are not interested in certifying, or being paid, as navigators but want to help in outreach and public education.

The committee also reviewed new data from Thompson Reuters commissioned for the exchange on CT’s uninsured, Medicaid and likely exchange-eligible populations to help target outreach and education efforts. Initial analysis found that current uninsured and Medicaid populations live in the same communities, and a small number of urban zip codes, particularly in Hartford and New Haven, account for a significant part of both populations. Researchers estimate that there are currently 66,000 adults and 18,000 children in CT eligible for the current Medicaid program but not enrolled. They also estimate that 205,000 adults and 11,000 children will be eligible for subsidies in the exchange. There is a lot of information on citizenship, race/ethnicity, income levels, and the proportion having difficulty speaking English.