Transcript Navigators PowerPoint

Navigators:
Guiding People Through the Exchange
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otherwise make widespread use of this
publication are asked to notify Community
Catalyst.
Community Catalyst, Inc.
30 Winter Street, 10th Fl.
Boston, MA 02108
617-338-6035
Fax: 617-451-5838
www.communitycatalyst.org
About Community Catalyst
Community Catalyst is a national non-profit
advocacy organization that works with national,
state and local consumer organizations,
policymakers and foundations to build consumer
and community leadership to improve the health
care system.
We support consumer advocacy networks that
impact state and federal health care policy, and
ensure consumers have a seat at the table as
health care decisions are made.
© Community Catalyst 2011
Overview
• What are Navigators and why are they important?
• What does the ACA say about Navigators?
• Who will enroll in insurance through the Exchange?
• How are Navigators different from Consumer Assistance
Programs (CAPs)?
• Building strong Navigators
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What are Navigators?
Why are they important?
Photo: (CC) by Ed Siasoco
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Navigators
• A guide to help you get where you need to go
• ACA: Navigators should help people learn about
options and enroll in coverage in Exchange
• 29 million people enroll through Exchanges by 2019
• Help consumers and small businesses understand
and choose the best insurance for them
• Build upon federal and state models and focus on
private insurance
© Community Catalyst 2011
Navigators in the ACA
Section 1311(i): 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.
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
© Community Catalyst 2011
Navigators in the ACA
• Navigators must demonstrate relationships with:
• 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
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Who will enroll through the Exchanges?
• 2/3 subsidized individuals
• 1/6 unsubsidized individuals
• 1/6 small business enrollees
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Who will enroll through the Exchanges?
• 65 percent previously uninsured
• More than one-third have not had a check-up for more than
two years
• Lower income than those currently covered by private
insurance
• More racially diverse than the those who currently have private
insurance
• One in four Exchange enrollees speak a language other than
English at home
• ~77 percent of people enrolled through Exchanges have a
high school diploma or less
It is vital that Navigators are well-prepared to serve people
with barriers to insurance
© Community Catalyst 2011
How are Navigators different from
Consumer Assistance Programs (CAPs)?
• Consumer Assistance Programs (CAPs) - Section 1002
• 35 states received federal grants in 2010
• CAPs provide assistance to all people with all types of
coverage
• Navigators:
• Help people understand and enroll in coverage through
Exchanges
• Need to understand public programs and help people get
coverage in Medicaid and other state programs
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Building strong Navigators
Photo by: (CC) Newtown
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Top Priorities
Navigators must:
• Have adequate training on the state Exchange,
Medicaid, other public programs and the private
insurance market
• Be able to explain eligibility, benefits, cost sharing, and
appeals processes to consumers
• Be trusted by the community to provide appropriate,
clear and correct information
• Be free from conflicts of interest, including payments
and incentives from insurers
© Community Catalyst 2011
Top Priorities
Navigators must:
• Act in the interest of the consumer
• Provide information that can be understood:
• in a culturally sensitive manner
• for those with low-proficiency English
• by people with disabilities with special communication needs
• Be able to serve low-income, disadvantaged, and hardto-reach populations
• Help people understand how premium tax credits work
and their potential impact on the families’ finances
• Represent a diverse set of organizations and entities in a
state to serve the people eligible for the Exchange
© Community Catalyst 2011