Key Questions to Consider in Setting Up a Navigator Program

5. What types of ongoing supervision and support resources will navigators need?

In addition to training, navigators will need ongoing supervision and access to referral resources to ensure that they are able to provide consumers with effective assistance in complex situations and with accurate and impartial information. 

Navigators will need direct supervision and support.

All individual navigators must be associated with an organization or entity that can provide direct supervision and oversight. While the exchange will provide oversight of the entire navigator program, direct supervision by senior staff will be an important resource for navigators as they are assisting individuals. Direct supervision will provide opportunities to reinforce skills, identify issues that can be better addressed in training, and help ensure that navigators are providing quality services even in difficult cases.

Two successful supervisory practices that are currently used by consumer assistance programs are 1) pulling a random sample of cases for review, and 2) holding weekly staff meetings to discuss complex cases and share best practices.⁴⁸ These methods will also enable navigator entities to identify systemic issues early and report them to the exchange.

Navigators will need a mechanism for communicating with the state and with exchange staff.

It will be critical for navigators to be able to contact exchange staff or eligibility workers in state Medicaid and CHIP agencies to help consumers resolve problems related to eligibility and enrollment. Exchanges may want to consider providing a technical support line for navigators and a mechanism for exchanges and state agencies to recognize navigators, such as giving navigators unique identification numbers (this would allow information about an individual’s application or enrollment status to be shared with the permission of the consumer). Exchanges and state agencies will also need mechanisms to disseminate information and resources to navigator programs and to provide valuable opportunities for communication across local programs.

Navigator networks should include programs that provide expert assistance.

“Expert” programs, such as consumer assistance programs and legal services providers, should be among the entities that are selected as navigators or should be part of a navigator program’s extended network. Programs like these are necessary to provide back-up assistance and support when people have complex coverage situations, such as split custody households, households with incarcerated family members, or members of a family who are estranged due to abandonment or domestic abuse. In cases such as these, consumers may need counseling not just about their coverage options, but also about for how they list their family members on tax returns, for example.

In order to make referrals, navigators should have access to a regularly updated directory of other entities that provide assistance on particular issues, as well as established procedures for referral and follow-up to ensure that consumers are able to get the assistance they need.

SHIP Tips: Providing Ongoing Supervision and Access to Resources

• Provide tools that can guide assistance, such as step-by-step guides to helping consumers with applications, checklists of questions to identify consumer needs when helping select plans, reference materials, and a directory of referral resources.⁴⁹ 
• Ensure that senior staff members are accessible to those providing assistance in the field, for example, by providing all staff with cell phones.⁵⁰
• Schedule regular staff meetings to discuss common consumer assistance issues, reinforce how to effectively spot problems, and identify successful strategies for assisting consumers with complex needs or situations.
• Assign each counselor a unique identification number that is recognized by federal and state entities, and by private health plans, which allows counselors to communicate and share information with the appropriate entities to quickly resolve any problems affecting consumers’ enrollment.⁵¹
• Build formal partnerships or strong referral relationships with programs that provide expert assistance with complex consumer problems, legal issues, and access to treatment for particular health conditions.⁵²
• Create strong linkages with county, state, and federal agencies that can help troubleshoot problems in complex cases and resolve eligibility issues quickly.⁵³
• Designate a central hub to provide oversight for program operations, disseminate information statewide, and promote consistent standards for services.⁵⁴
• Organize regularly scheduled opportunities for local programs within and across states to discuss issues faced by consumers, share best practices, recommend helpful partners and resources, and refine marketing and public education strategies.⁵⁵

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