Key Questions to Consider in Setting Up a Navigator Program

1. How can navigators reach consumers in underserved communities?

The people who will gain coverage under the Affordable Care Act include many individuals and families who have experienced significant barriers to obtaining coverage in the past, including such obstacles as the inability to afford coverage, ineligibility for public programs, being denied coverage based on a pre-existing condition, the complexity of enrollment processes, living in remote areas, low literacy, limited understanding of health insurance, and cultural and linguistic barriers.⁶ Surveys have found that the vast majority—78  percent—of consumers who are currently uninsured do not know about the new coverage options that will be available.⁷

Navigators will be a critical component of efforts to help consumers learn about their coverage options and will provide the targeted outreach, education, and personalized assistance needed to help consumers enroll. Whether navigator programs are successful in reaching those who face the greatest barriers to enrollment will hinge on how well exchanges do in selecting entities that have expertise in working with diverse and underserved constituencies.

Whenever possible, navigators should be chosen from groups that have established relationships with the populations that will be eligible to apply for exchange coverage.

State experiences with similar initiatives to promote enrollment in health coverage show that community-based organizations and local institutions are in the best position to provide outreach and enrollment assistance.⁸ These organizations are trusted resources in their communities, and they are knowledgeable about the unique needs of the vulnerable populations that may be the most difficult for exchanges to reach, such as recent immigrants, seasonal workers or day laborers, the homeless, and individuals with mental health needs. Community-based organizations are therefore well-positioned to identify barriers to enrollment and opportunities to engage the populations they serve, and this information can be used to develop tailored strategies and effective messages for outreach and education.⁹

Navigators will have a broader reach if they are located in organizations that provide a range of services.

Exchanges should be careful to select navigator entities that currently provide a range of services to target populations. Linking enrollment with other services that individuals and families already use, such as free tax preparation assistance, legal services, free or low-cost health care services, and services that help people enroll in public benefits, will help expand a navigator program’s reach and foster continued interaction with consumers. This, in turn, will increase the likelihood that those who are newly enrolled in coverage will maintain that coverage over time and get the health care they need.¹⁰

It is important that the navigator entities that are selected and the locations where enrollment assistance is provided be accessible to the populations that the entity will serve. For example, some navigators may target assistance to lower-income adults without dependent children by conducting enrollment assistance at job training programs, community colleges, and organizations that provide free help with food and housing. Other navigators could provide assistance in primary schools and conduct outreach through faith-based networks that are likely to have more interaction with families at all income levels. 

Navigator programs should provide assistance when and where it is convenient for consumers.

In order to reach newly eligible populations, enrollment assistance must be available when and where consumers can most easily get that help. Approximately 88 percent of people who will be eligible to receive financial assistance to purchase coverage through exchanges, and more than 70 percent of those who will be newly eligible for Medicaid, will come from working families.¹¹ Therefore, navigators will need to provide assistance outside of typical business hours when potential enrollees will be applying for coverage.

Navigator programs will also need to establish community-based sites to make in-person assistance accessible to all enrollees. Programs must ensure that they meet the needs of applicants who have limited access to transportation and those who need access to computers or assistive technologies. These barriers may be even more problematic for those who live in geographically disparate areas, which typically have fewer health care and social service providers that can serve as entry points for enrollment. Therefore, exchanges should pay special attention to the accessibility of in-person enrollment assistance in rural areas when selecting navigator entities.

Navigator selection and outreach efforts should be informed by demographic data.

When designing navigator programs, states should begin by conducting a needs assessment to collect demographic information on uninsured residents or those who are likely to qualify for financial assistance to purchase exchange coverage.¹² Data on where potential enrollees are concentrated geographically, as well as more specific information on such demographics as primary language spoken, disability status, employment status, and family composition, can help an exchange estimate the overall capacity that the program will need and to select navigator entities that can meet the needs identified. Exchanges should regularly collect and share data on the uninsured to help evaluate the effectiveness of their navigator program, refine and update outreach strategies, and fill any gaps in assistance.

SHIP Tips: Outreach and Community Education

• Create a community presence by developing relationships with a broad network of local organizations and groups that can refer consumers to the program.¹³
• Inform respected community leaders who are trusted resources for information and advice about your program. This can help you reach consumers who may not otherwise hear about the program or who may not respond to traditional outreach methods.¹⁴
• Conduct surveys to identify what sources of information and media your consumer demographic use most frequently.¹⁵
• Build relationships with local media outlets and take advantage of free opportunities for publicity, such as appearances on local radio shows or ads in community newsletters.¹⁶
• Use program resources efficiently by dedicating some staff and volunteers to outreach and public education work and by developing a specialized training path for this role.¹⁷
• Establish a state-level outreach and publicity team to develop uniform branding for the program; consistent, simple marketing messages; advertisements that can be used statewide; education and outreach materials written at an accessible reading level; and tools for working with the press that can be tailored by local programs.¹⁸
• While it may be too hectic to provide enrollment assistance at outreach events, take advantage of opportunities at these events to collect contact information for follow up and to schedule appointments for one-on-one assistance.¹⁹ Tell consumers what information they should bring to their appointment and identify any language assistance or accessibility needs in advance to make arrangements for providing appropriate services.
• Schedule and publicize opportunities to receive in-person assistance at easily accessible locations, such as libraries, community centers, schools, and universities, especially during open enrollment periods.²⁰
• Provide information on where consumers can get help on state notices, websites, and educational materials. 
• Establish a toll-free, statewide number that directs callers to programs in their area.

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