Key Recommendations for Implementing a Robust Navigator Program
By February 2013, states will have declared whether they will run their exchange, opt for the federal government to operate their exchange, or partner with the federal government to run certain functions of the exchange.68 Below are recommendations that advocates can make to help build robust, consumer-focused navigator programs in any of the three exchange models.
Secure adequate and sustainable funding for navigator programs. Navigator programs will require substantial investment if they are to be successful at increasing enrollment and retention rates, expanding the use of online enrollment tools, and ensuring that consumers enroll in the coverage options that best meet their needs. States should use exchange planning and establishment funds to collect data on the populations that will be eligible for coverage to determine the capacity needed in the program. They should also work with stakeholders to develop appropriate payment for navigator entities, and they should take advantage of the opportunity to use federal Medicaid administrative matching funds for assistance that is provided to people who are eligible for Medicaid or CHIP.
Create a formal process for engaging stakeholders in developing grant requirements for navigators and identifying navigator entities that are well suited to meeting the needs of particular constituencies. Provide ample time for entities interested in becoming navigators to prepare for meeting grant requirements and completing their grant applications before the deadline to apply for funding.
Establish a central entity to provide technical support for navigators—this may be the exchange itself, a state agency, or a nonprofit organization. This technical support may include assisting individual navigator programs; communicating with all navigator programs about system-wide issues and policy updates; providing additional training as needed; developing public education and outreach materials; and organizing forums for information sharing among navigators, such as regularly scheduled calls, webinars, or meetings.
Provide formal mechanisms for communication and data sharing among navigators, the exchange, and state agencies. Navigators will need to have formal relationships with both the exchange and the state agencies that determine eligibility for public coverage. Mechanisms for communicating with these entities should enable individual navigators to get real-time data on eligibility and enrollment status for the consumers they are assisting, and these mechanisms should help them work with exchange and state agency staff who have the ability to resolve consumer issues.
Create structured opportunities for navigator entities to provide feedback to the exchange and state agencies on how new systems are working for consumers and opportunities to collaborate with relevant agencies to improve policies and procedures.
Create a seamless referral system among the entities that are providing consumer assistance, including standard procedures for connecting consumers to the appropriate entity, and mechanisms to promote communication, information sharing, and access to consistent information among entities that provide assistance in person, by phone, and online.
Ensure that the outreach and public education strategies that are used by the exchange and navigator programs are consistent and coordinated and that they include consumer-tested materials and marketing messages.
Provide contact information for the navigator program in all outreach and public education materials, and through a searchable directory on the exchange website. This should include hours of operation and the location of all navigator entities. It should also include descriptions of the particular services the program offers, such as bilingual assisters, access to assistive technologies, or whether consumers can make appointments to get assistance at home or in a community setting.
Provide oversight of navigator entities. This may include periodic review of navigator presentations and counseling sessions; monitoring for conflicts of interest, fraud, or steering of consumers into particular insurance options; and establishing a mechanism for consumers to provide feedback, file complaints, and seek recourse (for example, if they believe they have been misled by a navigator).
Work with navigator entities to develop data collection requirements that enable the exchange to evaluate navigator performance overall and for specific entities, and to analyze trends in data in order to refine program strategies.
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