All Hands on Deck: Helping Consumers Navigate Coverage in 2013

In 2014, millions of Americans will gain access to more affordable health coverage when Exchanges officially open for business and states take advantage of the historic opportunity to provide coverage to more low-income people through Medicaid. Paving the way to these sources of coverage will be a transformation of the eligibility and enrollment process through consumer-friendly online enrollment and electronic verification of eligibility. But as we’ve noted on many occasions, no matter how simple the system, some if not most consumers will need assistance. To this end, navigators can be a trusted source of help for consumers and a key component of an Exchange’s consumer assistance strategy.

I noted in a previous blog that we would be developing additional navigator resources for policymakers and consumer advocates. Here’s the first in our series: “Countdown to 2014: Designing Navigator Programs to Meet the Needs of Consumers.” It provides an overview of the federal requirements regarding navigator programs and discusses key considerations to ensure that navigator services are targeted to meet the needs of consumers.

There is no doubt that consumers want and need assistance. Emerging research suggests that even consumers who believe they can easily navigate the new web-based enrollment system are pleased to know that assistance will be available if needed. Thanks to the Affordable Care Act’s “no wrong door provisions,” states must not only provide multiple paths to enrollment – online, via phone or in-person – but must also provide consumer assistance regardless of how or where people apply.

This is important because one-size consumer assistance does not fit all. This Washington state Exchange study found that consumers are split over consumer assistance with 38% preferring to get help online, 31% over the phone and 30% in person. A different study by Lakes Research Partners for the Robert Wood Johnson Foundation showed that roughly the same number of consumers preferred phone or in-person help (ranging from 43% to 47%) while a smaller number, generally younger consumers, (19% to 28%) favored help online.  Despite the differences in the studies, they both illustrate the importance of multiple modes of assistance.

Navigators can play a key role in assisting consumers, particularly at the community level and for those less likely to manage the online enrollment system independently. But while states can use their federal exchange establishment grants to plan and develop their navigator programs, they must find alternative sources of financing to actually make grants to navigators. This could potentially limit funding for navigators and points to the need for states to be strategic in designing their programs. We hope the key considerations outlined in our new brief helps states and stakeholders design programs that are targeted and effective in meeting the needs of consumers.

Tricia Brooks
Tricia Brooks is a Senior Fellow at the Center for Children and Families