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Navigating Obamacare – Part 3

 Editor’s Note: This is the third in a series of quarterly articles for CharityChannel about health care reform in the United States. Read more in the upcoming release of Obamacare for the GENIUS: The Affordable Care Act and YOU, by the author, scheduled for publication by For the GENIUS Press, an imprint of CharityChannel, later this year.

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Love it or hate it, Obamacare is about to take its first true breath of life. As the clock is ticking towards the October 1 st “go-live” date for the Health Insurance Marketplaces—the first major milestone since the legislation was passed three years ago—anxiety and uncertainty are mounting on the streets, in boardrooms, and in Washington, D.C.

What’s the Marketplace? A fundamental component of the health care law, the Marketplace is the forthcoming portal to shop for insurance both public and private coverage. Residents in thirty-four states will use the federal Marketplace, although seven of these states—Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire, and West Virginia—will have hybrid state-federal versions.

The federal Centers for Medicare and Medicaid Services recently invested $67 million to establish “navigators” in the thirty-four states in which it will operate a full or hybrid Marketplace model. What about the other sixteen states and the District of Columbia? Since their legislators decided to set up their own Marketplaces, they’re responsible for establishing state-based assistance initiatives separate from the federal navigator program.

Cooperative Agreements to Support Navigators

The Patient Protection and Affordable Care Act (PPACA, or “Obamacare,” as it’s more ubiquitously termed) stipulates that cooperative agreements should be allocated to states operating federally-facilitated and state partnership marketplaces based on the total number of uninsured people under the age of sixty-five within its borders. It also stipulates that each state must receive at least $600,000. CMS encouraged applications from “trade, industry, and professional associations, commercial fishing industry organizations, ranching and farming organizations, community and consumer-focused nonprofit groups, chambers of commerce, unions, resource partners of the Small Business Administration, other licensed insurance agents and brokers, and other entities.” Applications were due in early June and awards were announced in mid-August.

Universities, hospitals, patient advocacy groups, local food banks, and Indian tribes were among the 105 entities awarded a collective $67 million to help the seven million eligible people sign up for coverage in anticipation of the new mandate requiring everyone (well, most everyone ) to have health insurance by January 1, 2014.

The Navigators

The semantics can be confusing. Federal funds support entities that employ people who will serve as navigators, but the awardees (the entities) are called “navigators” in the eyes of the federal government. The law stipulates that the individuals doing the navigating are expected to provide “fair, impartial, and accurate information” to help the uninsured apply for coverage.

Think of the navigator positions as similar to those of census workers. In both cases, a temporary, relatively low-skilled workforce will be hired to fulfill a federal mandate or project. However, rather than simply counting widgets, navigators will take a much deeper approach in their grassroots efforts.

These workers will be responsible for a wide range of duties ranging from convincing the uninsured to apply for insurance, carefully determining eligibility for public and private health insurance programs and subsidies, and enrolling individuals and families in selected programs.

Wondering how the navigators will be paid? Most will be paid on an hourly basis at an average wage of $15/hour. It’s important to note that they will not be paid on commission.

Navigators must undergo at least 20 hours of training per federal requirements, but some states are tacking on additional requirements. (And if you haven’t noticed, the awardees aren’t exactly regulars in the health insurance industry.) Crunch time for the navigators (and the entities that will employ them) is the open enrollment period for the Marketplace which runs from October 1 through March 31. (Note: This time period is only for the start period. Future open enrollment periods will be only fifty-three days.)

As with any federal program, there are strong critics. Regardless of political orientation, most agree that there can’t possibly be enough time to hire and train a sufficient navigator workforce to hit the ground running (in some areas, quite literally) by October 1.

As if recruiting, training, and deploying a new workforce wasn’t enough of a challenge, the House Committee on Energy and Commerce recently requested a nearly impossible deadline for documentation to guarantee security protections for personal information to be collected. That’s good news for consumers, but an extra headache for awardees.

Will there be another opportunity to apply for a cooperative agreement to establish a navigator program? Probably not, at least not this year. As with so many other aspects of Obamacare, the grassroots navigator approach may be one of many refinements in years to come.

If you see navigators stationed at your local CVS, Walgreens, or Rite Aid, give them a friendly nod. They’re in for an exciting six months.

About the Contributor: Stacie Harting Marsh

Stacie Harting Marsh has over 10 years of experience in grant development for a variety of nonprofit organizations – primarily in the Indianapolis and Washington, DC areas – including hospitals and healthcare systems, social service agencies, elementary and secondary schools, higher education institutions, municipal corporations, and advocacy organizations.

Stacie founded Writing to Win, a grants consulting firm, in February 2006. Over the past four years, Writing to Win has secured nearly $23 million in federal, state, and private foundation grant awards for clients. In addition to researching, writing and managing grants, Writing to Win provides a range of writing and facilitation services, including manuscript development, strategic and program planning, and community needs assessments. Writing to Win currently works with organizations throughout the Midwest, particularly in Indianapolis, Indiana and Louisville, Kentucky.

Stacie is Grant Professional Certified (GPC) and holds a Certificate in Fund Development for Nonprofits from the Indiana University (IU) Center on Philanthropy Fund Raising School. She also holds an MPA degree from the IU School of Public and Environmental Affairs (Bloomington), where she specialized in Nonprofit Management and Public Policy Analysis.

Stacie’s specialty is federal grant applications, primarily to agencies within the U.S. Department of Health & Human Services and U.S. Department of Justice. She regularly serves as a grant reviewer at the federal, state, and private levels.

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