DCFPI is excited about the District acquiring a new Navigator.
No, not a Lincoln Navigator, the SUV of DC controversy: The Navigator we’re talking about refers to the city’s plan to contract with and train a network of consumer advocates who will help DC residents and businesses shop’or navigate’the options offered through the new health insurance exchange.
As the District’s Dime has written previously, the District is aggressively moving forward with implementation of the Affordable Care Act, known to many as Obamacare. Next week the people in DC charged with governing the District’s health insurance exchange will take important action on the design of such a consumer tool.
The purpose of the Navigator is to provide outreach, education, and guidance to consumers. Those chosen to serve as a Navigator will perform the following:
- Provide education and outreach to consumers on the available health insurance options in the exchange — also known as qualified health plans.
- Distribute fair and impartial information about enrollment, eligibility, and possible subsidies and tax credits available for qualified health plans, and about public programs such as Medicaid and DC Alliance.
- Help businesses or individuals select and enroll in a qualified plan.
- Refer consumers with questions or complaints about their plan to District agencies that provide consumer assistance and oversight.
Navigators will be required to present information in a way that is culturally and linguistically suitable for DC residents and that is accessible to people with disabilities.
By performing these duties, Navigators help to ensure that the exchange has “no wrong door” to accessing health coverage. They will provide services for both individuals and small employers, but planners envision that Navigators will primarily serve individuals seeking health insurance. This is especially true in the case of navigators that are community-based organizations with deep ties to vulnerable and hard-to reach populations. They will exist alongside brokers and agents, with the latter groups likely using their experience and expertise to serve small employers. The District’s small employers can opt to use a Navigator or a broker.
Finally, several consumer protections are built into the proposed structure of the Navigator program. First, Navigators will have to complete training and accreditation requirements to be certified. They will be paid a set amount as opposed to working on a fee-for-enrollment basis. This will incentivize Navigators to provide the wide range of services above instead of just enrollment. Conflict of interest standards will help ensure that Navigators act in the consumer’s best interest and present information in a fair, impartial manner. Lastly, they cannot be paid by a commercial health insurer and must demonstrate an existing or readily obtainable relationship with likely consumers of exchange plans.
The proposed Navigator Program is only in the early stages of design, and more specific requirements for participating entities will come at a later date. However, the exchange board’s decision about the broader program structure will influence how consumers interact with the DC Exchange. We applaud their efforts and we hope they fully consider consumer protections as they continue forward.