Now that both state-based and the federally-facilitated marketplaces are well on their way to recruiting and selecting navigators, attention turns to training and support.  Effective training is critical to ensuring that the needs of consumers, particularly low-income, hard-to-reach and vulnerable populations, are met. But training is only one element of creating and supporting a high-functioning consumer assistance network. The most comprehensive training curricula and vigorous testing will not guarantee effective assistance. Approaching training and support of assisters more holistically, as suggested below, will yield better results.

As a starting point, it is important to assess the need for consumer assistance, which is not only impacted by the demographics of a state’s uninsured population but also by the policy and implementation decisions a state has made and the status of a state’s eligibility system development. Considerations include:

* How robust and consumer friendly is the IT system?

* Has the system been consumer tested?

* What’s the state’s eligibility verification plan?

* Is your state able to tap good sources of electronic data?

* To what extent will the state rely on self-attestation?

* What’s the state’s definition of reasonable compatibility?

* Is the marketplace determining or assessing Medicaid eligibility?

The answers to these questions impact the relative ease or difficulty that consumers will face in connecting to coverage. The less sophisticated the eligibility and enrollment system and the less streamlined the process, the more consumers will need to rely on assisters to help them. And the more assisters will need to know how to troubleshoot eligibility and enrollment.

1) Training will go further if states select navigators and assisters with some or many of the core competencies. The real starting point is selecting the right navigators; organizations that can hit the ground running to serve either broad or targeted constituencies; organizations that share the state’s vision of coverage and will be mission-oriented. It’s true that training can heighten awareness of the barriers that consumers face, but it takes on-the-ground, hands-on experience to truly connect with consumers, to earn their trust and, more importantly, to understand their plight. For example, cultural competency means much more than connecting with a language line to provide translation. It also means overcoming fear factors that mixed immigration families face.

2) Assisters of all types have a lot to learn; consider a tiered assistance model. Organizations that are experienced in helping families qualify for Medicaid and other work supports such as subsidized childcare or food assistance understand what it takes to qualify for means-tested programs. Brokers and insurance agents understand private health coverage. But neither of these types of assisters has ever dealt with premium tax credits. Tiered levels of training allow a combination of formal and on-the-job training, enabling assisters to advance as their experience and expertise grows. Does your state’s consumer assistance model support tiered assistance – if so, does everyone need to take all modules and pass all training immediately or can it be phased? Even organizations with significant consumer assistance expertise will likely need to gear up and hire new staff with limited knowledge and experience. If your training and certification process can support a tiered approach to learning, based on the actual work that specific assisters will perform, it is worth consideration.

3) Training should not scrimp on Medicaid and CHIP. While it varies by state, the uninsured expected to gain coverage are more or less equally divided between eligibility for Medicaid or exchange-based coverage. Even then, an estimated 75 percent of parents in the exchange will have children who qualify for Medicaid or CHIP. Media, marketing and outreach are more likely to lead them to the marketplace. If the exchange is not making the Medicaid determination, it will be very important for assisters to understand what happens next, particularly if there are concerns about the consumer friendliness of the system and how well real-time eligibility determination will actually work. Without assisters being able to help consumers through enrollment in all of the insurance affordability programs, we lose a valuable opportunity to fulfill the vision of no wrong door access to coverage.

4) Training should be an ongoing, interactive process. Training can be viewed as a discrete activity but it’s certainly not a one shot deal. You can train and test for knowledge but how do you evaluate competency, particularly competency in serving vulnerable populations? Ideally, training will be conducted in person, incorporating case scenarios and role-playing. Involving experienced assisters in the training can help extend your training capacity. Other ideas include:

* Using “train the trainer” models.

* Incorporating regionally-based outreach and training coordinators that can work actively in the field with navigators and assisters.

* Providing routine policy and procedural updates (monthly calls, quarterly forums).

* Bringing assisters together to share best practices, lessons learned and what’s working or not working on the ground level.

5) Dedicate an expert team of IT, eligibility and enrollment specialists to support navigators and assisters. Many assisters will be more knowledgeable than newly hired call center staff. And the best training models will take advantage of all ongoing opportunities to provide “in the moment” training. A unit dedicated to supporting assisters can play this role and identify gaps in knowledge that will inform a state’s ongoing training activities. Such a unit also adds additional value by serving as a conduit for two-way communications, creating a reliable loopback mechanism that provides real-time feedback on systemic issues and recurring problems that need immediate attention.

6) Last, but not least, think long-term. Retaining experienced navigators reduces future training demands and provides the most effective assistance. Unless states want to recruit and train new navigators and assisters on a recurring basis, it’s important to consider how training and technical support will impact the retention of assisters. If assisters are overwhelmed or underprepared, if they do not feel supported, they are not likely to stick around long.