We’ve posted several blogs over the past year about how navigators will play a critical role in helping consumers connect to expanded and more affordable health coverage options. In July, we launched a new series of briefs about navigators, the first of which, “Countdown to 2014: Designing Navigator Programs to Meet the Needs of Consumers,” provides a general overview of navigator programs. The latest in the series, “Duties and Competencies,” digs deeper into the actual work that navigators will perform and the kinds of experiences and skills that will ensure their success.
Exchanges are required to set up navigator programs and federal regulations specify a minimum set of duties and competencies required of navigators. However, states have to flexibility to expand the role of navigators to maximize the effectiveness and reach of their programs.
In this new brief, my co-author Jessica Kendall, Outreach Director for Enroll America, and I offer a series of strategic questions that will help Exchanges craft a vision for their navigator programs. In turn, this vision will drive key design and operational decisions going forward, including navigator duties and competencies. This isn’t rocket science. It’s the same process by which a business creates a new job – what work is entailed and what kind of qualifications are needed to get the work done competently and efficiently?
By identifying and focusing on the needs of consumers upfront, Exchanges are better able to define the full scope of work that will help consumers gain coverage. It’s important to point out that not all of the needs of consumers are addressed in the minimum duties outlined in the law. For example, the law and subsequent regulations do not speak to retention of coverage over time. Yet we know from our efforts to maximize coverage in Medicaid and CHIP, as well as the Massachusetts’ health reform experience, consumers often need assistance in retaining coverage. Our brief discusses the importance of retention activities and poses other critical questions for Exchanges to consider as they design their programs.
Once the Exchange determines the full scope of work expected of navigators, the next step is to assess the competencies, skills and experiences that are needed for them to proficiently do the job. Navigators who already possess some or all of the desired competencies can build on their existing knowledge and experience to more quickly master the complexities of the expanded coverage options. Requiring a more robust set of core competencies than minimally required will help ensure that navigators hit the ground running.
Choosing health insurance can be complicated, particularly for lower income families who have never been able to afford coverage. Understanding the tax implications of advance premium tax credits is something new for all of us. While helping consumers with these tasks are at the core of navigator duties, consumers will have other needs. Structuring the navigator program to meet those needs will not only move us closer to our coverage goals but also help ensure that coverage leads to health care access, better health and a more sustainable health care delivery system.