Hats off to navigators and certified application counselors (CACs) across the country who persevered through the rocky rollout of the marketplaces and helped create the late surge that put enrollment over the top. There is much yet to be learned as we reflect back on open enrollment, but we already know there is much that can be done to strengthen and enhance the navigator and CAC programs.
As a starting point, CMS recently proposed a set of regulations that would provide relief from over-reaching state navigator laws that prevent navigators and assisters from fulfilling their duties as required by the Affordable Care Act. Comments on these regulations are due April 21.
Recently, my colleagues at the Asian Pacific Islander American Health Forum, Center on Budget and Policy Priorities, Community Catalyst, Enroll America, Families USA, National Health Law Program and I put our heads together to identify strategies and priorities to enhance the work of navigators and other assisters. We summarized these in a letter to Secretary Sebelius and CCIIO administrators with detailed recommendations to:
- Refine the navigator federal grant application and award process.
- Strengthen the infrastructure that supports assisters.
- Enhance training and continuing education.
The big ask, of course, is for more funding to boost consumer assistance. The grants awarded to navigators and community health centers in 34 states where the federal government runs the marketplace was barely more than twice the combined total that California and New York allocated for consumer assistance funding. In all states that operate a state-based or partnership marketplace, considerably more resources were available for outreach and consumer assistance than in states served by the federal marketplace (FFM). Notably, none of the 12 states showing Medicaid/CHIP enrollment gains of between 10% and 35% were FFM states.
Regardless of how much funding is allotted to support navigator grantees over the next year, there are a number of strategies that would enable navigators and assisters to maximize the number of consumers who can be helped effectively with limited federal dollars:
- Grants should be awarded to organizations that can coordinate the consumer assistance effort in a state or region to ensure that resources are directed at the places and populations most in need. Investing in this level of coordination and oversight minimizes duplication and ensures a holistic approach to assistance across the state or region.
- Navigators should be allowed to provide assistance over the phone, after obtaining written authorization from the consumer. Phone assistance will save time and help ensure that more individuals complete the enrollment or renewal process.
- A unit of system and policy experts should be dedicated to support navigators and assisters. Assisters often have more experience and expertise than call center personnel. Dedicating an expert unit to support them will advance problem resolution and troubleshooting of systemic issues.
- A dedicated assister web portal will enable Navigators and CACs to efficiently provide application assistance, while enabling the marketplace to track enrollment by assister and more readily manage its oversight responsibilities.
The letter to Secretary Sebelius dives more deeply into these priorities and other recommendations, and suggests additional training that would broaden the knowledge of assisters.
The next open enrollment period will likely be much smoother, but marketplaces will also be processing the first round of renewals for more than 7 million people. And if enrollees didn’t like the plan they picked, they will be looking for more help in comparing plans. Equally important, long-time uninsured consumers need help in using their insurance because the ultimate test of the ACA will be whether people are able to access the health care they need and find value in their coverage.
Throughout open enrollment, focus groups and surveys of applicants and the uninsured highlight the direct connection between consumer assistance and enrollment success. Just as marketing and customer service are critical to the ongoing success of a business, so is consumer assistance to achieving the vision of health reform.