The Final Rule for ACA Navigators: Better or Worse and How to Proceed

The Texas Department of Insurance recently finalized rules that require “navigators” to register with the state and take additional training. CPPP chronicled the changes made in the final rule and questions moving forward in a new policy page. Navigators under the Affordable Care Act are organizations and individuals who are trained, certified, and funded by the federal government to help people enroll in coverage options through the Health Insurance Marketplace, including private insurance, Medicaid and CHIP. Insurance is difficult to understand, especially for people who haven’t had it before. Navigators provide in-person help—answering questions, deciphering plan options, and helping people enroll. Their help is crucial in a place like Texas, with more than 6 million uninsured individuals.

Changes in the Final Rule The proposed rules for navigators proved contentious. Advocates raised concerns that the proposal would be expensive and prevent navigators from helping consumers compare the benefits of different plans in the Health Insurance Marketplace. The Texas Department of Insurance (TDI) held two public hearings on the rules and sifted through nearly 300 pages of comments. In the end, the final rule was much improved, but the aggressive timelines in the final rule present challenges for navigators and TDI alike. TDI removed the prohibition related to comparing benefits, took steps to reduce the cost of training, and clarified limits on the use of the term “navigator” (people who serve as patient navigators or cancer navigators will still be able to use the word “navigator” in their job titles without running afoul of the law).

The rule, which took effect on February 10, requires many organizations and individuals who help consumers apply for or enroll in coverage through the Marketplace to:

• Complete registration with the Texas Department of Insurance by March 1. Navigators will undergo fingerprinting and a background check as part of registration.
• Take 20 hours of state mandated training by May 1, 2014. This extra state training is required on top of the 20-30 hours of federal training provided to federally grant-funded navigators

Certified Application Counselors are exempt from the new rule, as are organizations and individuals who are performing application assistance under state law or federal law, other than the Affordable Care Act. The flowchart on page 6 of our report can help organizations and individuals who provide application and enrollment assistance determine whether and how they are subject to the new rule.

Update on Registration Both navigators and the Texas Department of Insurance have been working diligently to ensure navigators come into compliance according to the rule’s very tight timeline. Some navigators reported initial challenges accessing the state’s electronic fingerprinting process. But leading up to March 1, all federally grant-funded navigator organizations report having submitted their organization’s registration materials and registration materials for most or all individual navigators as well. TDI reports quick turnaround times when processing complete applications, and TDI staff worked over the weekend of March 1-2, to help ensure applications submitted near the deadline were not held up.

Next Hurdle TDI’s rule leaves it up to private vendors or navigators themselves to create, get certified through TDI, and deliver training to navigators statewide. The next challenge will be ensuring that training is available to and completed by navigators across the state by May 1, 2014.

Written by Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas blog.