Quietly embedded in the June 29, 2012 update of the exchange establishment grant funding opportunity announcement (FOA) was a new category of consumer assistance – in person assistance (IPA). While federal officials haven’t been completely mum about this announcement, we have yet to see anything in writing (beyond what’s in the FOA and exchange blueprint) to help distinguish the difference, if any, between in-person assisters and navigators. So what do we know?
First, the Affordable Care Act establishes two key differences:
1) States are statutorily required to have a navigator program; in-person assistance programs are optional. Although exchanges must provide consumer assistance and allow consumers to apply in person, the law and regulations stop short of requiring exchanges to provide in-person assistance. In a state-based exchange, operating an IPA program is optional. According to CCIIO, in states where the federally-facilitated exchange (FFE) will be operating, the FFE will establish an IPA program. Partnership states opting to manage the consumer assistance function must operate the IPA program consistent with FFE guidance, policies and procedures.
2) States must finance navigator grants from sources other than their federal exchange establishment grants; in-person assisters can be funded through establishment grants. The availability of federal funding to help consumers connect with coverage is welcomed news and provides a strong incentive for states to boost their plans for consumer assistance. A state still must find funding sources to operate its navigator program as required by law.
Beyond these two primary differences, in-person assisters may look a lot like navigators.
In fact, the current thinking at CCIIO relative to the FFE is that the same scope of duties, training standards, conflict of interest standards, and privacy and security standards will apply to both navigators and IPAs. This makes a lot of sense not only in terms of meeting the needs of consumers but also from the practical perspective of capitalizing on program development efforts.
Will state-based exchanges move in the same direction? According to the exchange establishment grant FOA and exchange blueprint, the IPA program must be distinct from the Navigator program. But it must also comply with requirements similar to those established for navigators to: 1) conduct outreach and education for all of the insurance affordability programs, 2) provide information that is accessible to people with disabilities or limited English proficiency, and 3) refer consumers to other types of consumer assistance or healthcare ombudsman programs that can assist with complaints, grievances or appeals.
There are a number of ways states might distinguish their IPA programs.
- Unlike navigators that must be funded through grants, IPA’s could be funded through contracts (as seems likely, according to CCIIO, in states with an FFE) or through other direct service options a state may have.
- Navigators must be chosen from a list of qualified entities authorized by law; there are no requirements or limitations on IPAs. Ideally, states will build on existing networks of organizations that currently assist low-income families in accessing Medicaid and other public benefits.
- All navigators must perform all the duties outlined by the ACA and exchange regulations; states could take a tiered or tailored approach to IPAs by establishing different levels of assistance or targeting assistance in different ways. For example, a state might choose to have IPAs assist people only through the application and eligibility process be selected to serve a specific constituency.
Regardless of how states approach an IPA program, it is important to reflect on the guiding principles that stakeholders have identified as important for navigators as they apply equally to any type of in-person assistance. Having strong conflict of interest standards; requiring assisters to provide impartial assistance on all of the insurance affordability programs in a manner that is culturally and linguistically competent; and building on the current infrastructure of mission-driven organizations with expertise in community-based outreach and experience in assisting low-income families will be key to success.
 According to the FOA and exchange blueprint, in-person assistance programs must comply with 45 CFR 155.220(c), (d), and (e).