Last call for comments on the HHS proposed navigator standards released last month. Comments are due by 5:00pm ET today, May 6th. The rules outline the conflict of interest and training standards that will apply to federally-funded navigators in 34 states and in-person assisters in states with state-based or consumer partnership exchanges. In addition to our detailed comments on the specific standards, we made a number of suggestions for strengthening and supporting navigators and assisters.
Allow section 1311(a) funds to be used to provide consumer assistance in non-partnership FFE states: Section 1311(a) funds, otherwise known as exchange establishment grants, have been made available to several non-partnership FFE states (OH, NE, KS and MT) to conduct marketplace plan management functions, and recently HHS announced that 1311(a) funds can be used for marketing and outreach with specific conditions. HHS has not indicated that section 1311(a) funds can be tapped by non-partnership states to supplement the strikingly inadequate navigator funding. Yet, the Secretary’s FAQ on exchanges, market reforms and Medicaid dated December 10, 2012 suggests that it is permissible to more broadly use 1311(a) funds in FFE states. It outlines in the answer to question 9, that states may choose to seek section 1311(a) exchange establishment funding for “activities necessary to support the effective operations of a federally-facilitated exchange.” Additionally, the CCIIO Q&A dated February 20, 2012 indicates that states can use 1311(a) funding for evaluation of plan management activities without submitting an exchange blueprint. Extending this funding to consumer assistance activities, including in-person assistance, necessary to support the FFE would enhance the capacity of states with an FFE to assist consumers.
Clarify how private support can leverage federal Medicaid matching funds to provide enrollment assistance. HHS has indicated that state navigator funds can be eligible for Medicaid match. Recently, the California Endowment pledged millions of dollars to support Medicaid enrollment and retention that will leverage federal Medicaid match. It would be helpful for HHS to clearly articulate the circumstances and process for private funds to qualify for federal Medicaid match.
Establish a dedicated technical assistance unit and helpline in the FFE to support navigators and assisters: Highly skilled and knowledgeable eligibility, enrollment and system experts are needed to appropriately support the work of navigators and assisters who uncover more complex issues and barriers to coverage, or who are helping a consumer resolve an eligibility problem. Easily accessible expert technical assistance for assisters is considered a best practice in Medicaid, and Medicare counselors have identified the dedicated counselor line as one of the most important tools they use to assist consumers. Providing access to expert staff who have the ability to resolve eligibility issues has proven to add value by reducing consumer calls to the call center, identifying gaps in training and providing an effective loopback mechanism to pinpoint system issues and other recurring problems early. (HHS has confirmed there will be a dedicated assister line in the FFE call center.)
Establish a web-portal with enhanced functionality for navigators and assisters as quickly as possible. An enhanced portal goes beyond tracking applications by assister. It would allow assisters to check the status of applications and enrollment and provide other functionality such as reporting the birth of a child or other changes in circumstances or checking the status of needed verifications. It could also facilitate reporting of problems directly associated with a specific application or account that would provide a more effective and efficient means of identifying and troubleshooting problems. A dedicated portal for assisters provides a key consumer protection by clearly identifying when data and other changes are submitted by assisters rather than consumers themselves. (We’ve heard that the navigator/assister portal will not be operational on October 1.)
Provide key resources needed by navigators through the FFE so that limited navigator grants can be dedicated to direct consumer assistance. Specifically, the FFE call center will rely on language translation services to supplement bi- or multi-lingual staff. Such services should be directly available to federal navigators so that their grants can be used to provide a higher level of direct services. Furthermore, access to assistive technologies to help individuals with disabilities, including sensory impairments, should be made available. Pooling the purchasing power of the federal government will make these key services more cost-effective and enable federal navigators to use their limited grant funds for personnel to provide direct assistance.
Release final regulations regarding certified application counselors (CACs) as soon as possible and clarify that states are not prohibited from funding CACs. In states where only an FFE will operate, certified application counselors will be a key resource for consumers needing assistance. The sooner the regulations are finalized, the sooner states can begin the implementation process. We also believe that states should not be barred from providing much needed resources to community-based organizations and safety-net providers that can help fill the assistance gap as suggested by proposed regulations released on January 12, 2013. Those proposed rules pointed out that the difference between CACs and navigators and brokers is that CACs are not funded by the exchange, either through grants or directly. While we understand that HHS is not offering the use of federal funds under section 1311(a) or otherwise, we believe clarification will ensure that states are clear that they have the flexibility to fund CACs.
We encourage state partners to submit comments of their own. HHS does take them seriously and when many speak with a unified voice, it can make a difference. In this business, plagiarism is the highest form of flattery….so feel free to copy or adapt our comments in any way you find useful.