HHS Secretary Kathleen Sebelius on Thursday announced that 105 groups nationwide—including a handful of hospitals—will receive federal grants totaling $67 million to serve as "navigators" for the health insurance exchanges.
What do navigators do?
Under the Affordable Care Act (ACA), each exchange must have two organizations certified as navigators, one of which must be not-for-profit.
The navigators are expected to provide "fair, impartial, and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions about [qualified health plans], and helping qualified individuals make informed decisions during the health plan selection process." They will also provide additional assistance to consumers who are disabled, do not speak English, or who are unfamiliar with health insurance.
In a final rule released last month, CMS specified that navigator workers must be affiliated with certain community organizations, such as churches, and undergo at least 30 hours of training before they can be qualified as a "certified application counselor." In addition, navigators must not be affiliated with the insurance industry. States with their own exchanges can establish more rigorous selection and training requirements for in-person assisters.
Who are the navigators?
The 105 recipients of the grants include hospitals, Indian tribes, local food banks, patient advocacy groups, and universities.
For example, Ascension Health was granted $202,706 to assist consumers in Alabama and another $165, 683 to help consumers in Kansas; the University of Mississippi Medical Center ($831,986), North Carolina's Randolph Hospital ($352,320), and Wyoming's Memorial Hospital of Laramie ($401,281) were among other hospitals that received grants to do the same in their home states.
Among the largest grants were:
- $5.9 million, to United Way of Metropolitan Tarrant County in Texas;
- $4.2 million, to the University of South Florida in Tampa;
- $2.2 million, to the Structured Employment Economic Development Corporation in Atlanta;
- $2 million, to the North Carolina Community Care Networks;
- $2 million, to the Ohio Association of Foodbanks; and
- $1.3 million, to Michigan Consumers for Healthcare.
Federal officials said the grants were awarded to groups based on the number of uninsured residents in their states. For example, groups in Florida and Texas—which have two of the largest uninsured populations in the country—received grants totaling $7.8 million and $11 million, respectively.
How are the navigators funded?
The Obama administration initially planned to distribute $54 million in grants to the nearly three dozen states with exchanges that will be operated solely by or in partnership with the federal government.
However, an additional $13 million was redirected from the ACA's Prevention and Public Health Fund to boost the navigator program, according to Chiquita Brooks-LaSure, the HHS Center for Consumer Information and Insurance Oversight's deputy center and policy director.
According to the Times, Sebelius previously noted that the administration would be forced to tap the fund—which was established to support wellness and disease-prevention programs—after Congress refused to allocate funding for ACA outreach and education initiatives (Goodnough, New York Times, 8/15; Galewitz, Kaiser Health News, 8/15; Kennedy, USA Today, 8/15; Sun, Washington Post, 8/15).