Managers of Covered California — the California Health Benefit Exchange — are trying to control the number of different types of intermediaries that help employers use the state’s health insurance exchange (HIX) system.
California officials are fighting a federal proposal that would require all types of certified exchange helpers to serve both individual consumers and small employers.
Officials want to stick with encouraging licensed agents, licensed brokers, and certified Navigators to serve small employers.
Requiring all types of exchange helpers to serve small employers “would be both costly and duplicative of services provided today by agents,” California exchange officials said in a comment on draft exchange regulations developed by the Centers for Medicare & Medicaid Services (CMS).
Exchange managers included the comments on the draft in a batch of documents to be reviewed at a board meeting.
The Patient Protection and Affordable Care Act of 2010 (2010) requires CMS’ parent, the U.S. Department of Health and Human Services (HHS), to work with state regulators to set up exchanges, or health insurance supermarkets, for individuals and small groups in all 50 states and the District of Columbia by Oct. 1.
California is setting up its own individual exchange and Small Business Health Options Program (SHOP) exchange, rather than letting HHS provide exchange services for its residents.
The California exchange will be open only to employers with two to 50 employees.
PPACA requires exchanges to offer users access to Navigators, or ombudsmen. The Navigators are supposed to be independent sources of information about how the exchange system works. Navigators cannot sell coverage or give users advice about which plans to buy.
HHS is going to let agents and brokers serve both individuals and employers that use the exchanges that HHS runs.
HHS is letting states choose whether to offer users of state-run exchanges access to agents and brokers.
Since PPACA was created, HHS has developed regulations that describe other types of exchange helpers, such as “in-person assisters” and “certified application counselors.”
HHS officials have suggested that in-person assisters will be paid workers who will work with individuals who need face-to-face help with filling out exchange plan paperwork.