Introduction

Starting on October 1, 2013, millions of Americans who currently lack affordable and adequate health insurance will be eligible to enroll in new private or public coverage under the Affordable Care Act. (This new coverage begins on January 1, 2014). The law established health insurance exchanges, where many individuals and small businesses will be able to buy private coverage, often with financial assistance. In these exchanges, individuals and families will also be able to apply for coverage through Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health program (in states that implement this program). Exchanges will make applying for health coverage easier: In addition to using a single application for both private and public coverage, exchanges will provide help with enrollment through consumer-friendly websites, call centers, and in-person assistance, including new ”navigator” programs. Navigators will conduct targeted outreach and will provide one-on-one assistance to help consumers learn about and enroll in new coverage options. The Affordable Care Act also provides states with funding to establish additional in-person assistance programs that can supplement the work of navigator programs.

As states design their navigator and in-person assistance programs, they will need to consider the barriers consumers face when enrolling in health coverage and issues consumers may need help with regarding exchange coverage. The people served by exchanges will need help with many different issues, including assistance in new areas that are unique to the coverage options created by the health care law.

This tool kit begins with an overview of the requirements for navigator programs that were laid out in the Affordable Care Act and in subsequent guidance from the Centers for Medicare and Medicaid Services (CMS, one of the federal agencies responsible for implementing the law). The next section answers some of the key questions facing states as they seek to establish effective navigator programs. These answers are supplemented by lessons that can be learned from State Health Insurance Assistance Programs, or SHIPs, the federally funded programs that help Medicare beneficiaries. SHIPs have extensive experience in conducting community outreach and education and in helping Medicare beneficiaries enroll in public and private coverage, and they are one nationally recognized model for providing consumer assistance.¹

Following the key questions and the lessons from SHIPs, we discuss recommendations advocates can make to help their states implement the best possible navigator programs. In Appendix 1, we offer a useful chart that lists the steps involved in the enrollment process and that shows just what help consumers will need at each stage. And lastly, in Appendix 2, we provide a short list of key resources. While this tool kit focuses on considerations and lessons for setting up navigator programs, most of these recommendations also apply to setting up other in-person assistance programs. 

Navigator programs will be an essential component of the consumer assistance that is provided by exchanges. These programs can tap and build on existing expertise in serving vulnerable populations—expertise that exchanges will need to help newly eligible consumers get, keep, and use health insurance. Successfully preparing navigators and other assisters to provide effective, high-quality enrollment assistance to the diverse populations exchanges will serve requires providing navigator entities with robust training and support resources. We hope that this tool kit gives state advocates and officials the information and resources they need to ensure that navigator programs and other in-person assistance initiatives achieve their mission of helping consumers find and enroll in appropriate, affordable, high-quality health coverage.

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