As March 31 approaches, signaling the end of ACA open enrollment in Marketplaces until fall of this year, in-person assistance programs are of critical importance. Navigators and other enrollment assisters have been working hard across the country to help consumers learn about and enroll in new health plans.
The job for assisters and Navigators hasn’t been easy. Despite comprehensive education and certification standards required by HHS, including a robust training process and an exam, 17 states have passed laws regulating the activities and qualifications of Navigators. While many of the states passed the laws under the guise of protecting consumers’ health information, in practice these laws have created barriers that prevent consumers from learning about their insurance options and obtaining needed coverage.
Although the ACA allows states to create their own qualification requirements and even requires Navigators to meet state requirements, it also requires that such laws do not interfere with the implementation of the ACA. It’s clear some of the state laws fail this requirement.
Some state laws create stringent qualifications. In Texas, Navigators must participate in 20 hours of additional training at their own cost. In Iowa, Navigators are required to carry insurance against claims of wrongdoing, even though the HHS regulations prohibit states from requiring Navigators to maintain this type of coverage.
Perhaps even more harmful to consumers are state laws that restrict the speech and actions of Navigators. Maine passed a law that prohibits Navigators from “enrolling” individuals in health plans, though it allows them to “provide assistance” to “facilitate enrollment.” Similarly, Navigators in Ohio are prohibited from providing advice to consumers about whether a particular plan may be better able to meet their health needs. In Georgia, Navigators are prohibited from assisting individuals who are currently insured.
These laws may negatively impact outreach and enrollment efforts and undermine the ACA. Many of the laws have been enacted in states with Federally-Facilitated Marketplaces, where Navigators have received less financial support and provide enrollment assistance with little or no help from state agencies. Navigators in states who have set up their own Marketplace receive almost three times more funding than states with Federally-Facilitated Marketplaces. This lack of funding compounds the existing enrollment challenges in those states.
Complying with restrictive state laws also negatively affects outreach and enrollment because it diverts Navigators’ time, energy and resources toward meeting the extra qualification standards and away from assisting consumers. In fact, several organizations that had been awarded Navigator grants, such as the Cincinnati Children’s Hospital Medical Center and West Virginia Training and Parent Information decided to return their grant money after determining complying with the state laws would be too burdensome. One option for Navigators and their allies is to challenge these laws in court, as groups in Missouri and Tennessee successfully did.
Regardless of how states restrict Navigators, however, these laws mean Navigators are forced to allocate time and resources to activities other than educating, assisting and enrolling individuals into qualified health plans. Although these state laws were enacted under the pretext of protecting consumers, the ways in which they discourage and prevent Navigators from performing their roles only hurts consumers who need health insurance for themselves and their families.
— Rachelle Rubinow, Intern