Key Questions to Consider in Setting Up a Navigator Program
4. What new areas of expertise will navigators need to develop?
The Affordable Care Act’s new health coverage options and eligibility and enrollment processes will create new consumer assistance needs. The health care law will make it easier for individuals and families to enroll in health coverage by requiring states to use a single application and streamlining the eligibility determination process for both public and private coverage.36 However, many consumers will need assistance with understanding the new options for coverage and financial assistance, the information they’ll need to provide in order to qualify, and their responsibilities after they enroll.
Navigators will require specialized training.
Many of the issues consumers will need help with will be complicated, ranging from understanding how premium tax credits work and determining the amount of a premium tax credit to take in advance to providing information about offers of job-based coverage. Providing assistance with these steps in the enrollment process is a new duty that no existing entity is currently trained to perform. Navigators will therefore need specialized training to develop expertise in new program rules and to learn new skills, such as how to use the exchange’s online application portal, plan comparison tools, and cost calculators; how to help consumers choose the health plans that meet their needs in a manner that is impartial; and procedures for safeguarding consumers’ financial and private information.
Training should include competency testing and require continuing education.
Navigator programs should conduct competency testing to assess how well their individual navigators have learned and understand the topics and skills taught in initial training to ensure that navigators are prepared to put their new knowledge and skills into practice. States that have begun to develop training for navigators have also proposed requirements for continuing training and education, including yearly refresher courses and testing. States may also develop testing techniques that do not involve written testing that may be better suited to assessing skill level, such as observing a mock counseling session or testing use of online tools. This will help navigators learn about specialized topics and changes in policy, provide opportunities to share best practices across programs, and help ensure that they are providing high-quality assistance.
Navigators will need to assist consumers with all the coverage options that are offered through exchanges.
When applying for coverage, many consumers will not know the type of coverage for which they or a family member may be eligible. These options may include a private plan sold through the exchange, Medicaid, CHIP, or a Basic Health program (where applicable). And many families will have members who are eligible for different coverage options.37
In order to truly achieve a “no wrong door” enrollment system (as required by the health care law), navigators will need to help consumers with the enrollment process from start to finish, regardless of whether they are ultimately determined to be eligible to enroll in a qualified health plan or a public coverage program. Community-based assistance programs for Medicaid and CHIP outreach in California have also found that using an “umbrella strategy,” which makes assistance available for multiple coverage options and all members of a family, helps simplify outreach messages and minimize confusion about where consumers should go for help. This has resulted in higher enrollment.38
Navigators must provide assistance with enrollment from start to finish.
Navigators must be able to assist consumers through the entire enrollment process, from completing an application for coverage to activating that coverage, including selecting a health plan and resolving any issues that may arise as their eligibility is verified. Massachusetts’ experience with enrollment in the Connector, the state’s exchange, showed that consumers often do not complete the enrollment process when follow-up actions are required.39 Achieving real-time eligibility determinations through the exchange website is one way to significantly increase enrollment. If online applications cannot be processed in real time, or if a consumer uses a paper application, it will be important for navigators to track consumers’ enrollment status and help them take any additional steps needed to complete enrollment.
Some navigators will need training in assisting small employers.
The Affordable Care Act requires that small businesses and other small employers that buy coverage and apply for tax credits through an exchange also be able to get enrollment assistance from navigators.40 Many small employers are expected to continue to work with insurance agents or brokers to buy exchange coverage. However, to ensure that navigators are able to provide meaningful help to any small employers that need it, navigator programs must provide training on assisting small employers with enrollment, with obtaining tax credits, and with helping employees select a health plan.41
Specific entities, such as trade or business associations and insurance agents or brokers, may be best suited to conducting outreach and providing assistance to certain small employers. In addition, some small employers may have particular needs, such as language assistance. Exchanges should therefore conduct focus groups with diverse small employers to learn about their assistance needs and preferred methods for receiving assistance. Exchanges may also need to evaluate their capacity to adequately serve this population after the first open enrollment period has ended.
SHIP Tips: Training
- Certify counselors through an initial multiple day training, followed by competency testing. To reinforce this training, provide counselors with tools for self-study, require them to participate in refresher or continuing education trainings, and require a period of shadowing or mentorship with an experienced counselor before counselors are allowed to provide assistance independently.42
- Include training on ethics, nondiscrimination, privacy and security standards, and providing unbiased information. These standards of conduct should be included in a written agreement that counselors must sign prior to certification.43
- Provide “task-based” training to help new staff and volunteers develop and practice the skills and competencies needed for specific job responsibilities. For example, training could include interactive exercises to model effective approaches to sample case scenarios or specific tasks, such as how to provide objective information about plan options.44
- Provide training on how to use online enrollment tools, such as how to complete an online application, how to use plan comparison tools, where to find online resources and information, how to submit documents electronically, and how to record data in the program database.45
- Ongoing training and repeat testing are effective ways to reinforce skills and ensure that volunteers and staff keep current on policy and program changes.46 Online training modules can help reach assisters in remote geographic areas and supplement in-person training when staff resources are limited.47
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