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Navigator grant money comes with regulations

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Today the government awarded $67 million to organizations that will serve as Navigators, or those who help people sign up for insurance under the new health care law.

The Department of Health and Human Services (HHS) acted even as insurance agents ramped up their efforts, working through Republican members of Congress, to create high barriers for non-agents to counsel people on how to access health exchanges and benefit from other components of the healthcare law.

The grants made today were to 105 organizations in states that are letting the federal government run their online insurance marketplaces because the leadership in those states are doing everything they can to thwart implementation of the program.

The two laws – introduced as Congress left for its five-week summer recess in early August — were introduced by Rep. Cathy McMorris Rodgers, R-Wash. They are consistent with actions in 34 states aimed at ensuring that their licensed agents are protected by requiring that navigators follow stringent rules in discussing the health care bill with consumers.

The two pieces of legislation effectively seek to require states, mostly large ones with big urban populations, to follow the same rules that agents have been getting legislatures in conservative states to enact.

The bills pertain to the funding of navigator programs, as well as in-person assisters and certified application counselors, as enacted under the Patient Protection and Affordable Care Act, commonly known as “Obamacare.”

H.R. 2980 says that no money can be awarded to potential navigators until the secretary of the HHS confirms that recipients of the funding have certified that they: (1) will not provide advice concerning benefits, terms and features of a particular health plan; (2) will not recommend or endorse a particular health plan or advise consumers about which health plan to choose; (3) will not accept any compensation that is dependent on whether a person enrolls in or purchases a health plan; and (4) will not violate any applicable insurance law or regulation.

Another bill, H.R. 2951, focuses on putting safeguards, certifications and audits in place to guard against the inevitable waste, fraud and abuse created by exchanges, subsidies and navigator programs.

According to officials of the Independent Insurance Agents and Brokers of America, “This is of particular importance since the Administration has announced it will be loosening the verification mechanisms for subsidy eligibility through the new health insurance exchanges.”

Under H.R. 2951, “Only if the certifications and safeguards stipulated in the bill are put in place and enforced can the exchange subsidies be distributed and enrollment assistance funds, including navigator grants, be awarded.”

In June, nine Republican members of the Senate, who are seeking to repeal the law, sent a letter to Kathleen Sebelius, HHS secretary, seeking to accomplish the same thing. Earlier in June, 33 members of the House sent a similar letter to Sebelius.

The letter, written at the request of officials of the National Association of Professional Insurance Agents argues that guidelines proposed for navigators and counselors “provide significantly less protection to patients and consumers than the states have provided through licensed insurance agents for decades.”

Health care professionals say that the navigator program will be particularly important to the health law’s success in some Republican-led states that aren’t doing any state-directed outreach to the uninsured.

The grant winners don’t have much time to hire and train outreach workers. Enrollment for the health law’s new coverage options starts Oct. 1, and benefits kick in Jan. 1.

Navigators must complete a training program developed by the federal government and pass an exam.