Health Care

September 12, 2013

Affordable Care Act navigators gearing up for open enrollment

As health insurance marketplaces – part of the Affordable Care Act – prepare to go live Oct. 1, health providers across the state have hired “navigators” to help people enroll in health plans.

As health insurance marketplaces – part of the Affordable Care Act – prepare to go live Oct. 1, health providers across the state have hired “navigators” to help people enroll in health plans.

The enrollment process will take place online at, and plans will vary state by state. Most states, including Kansas, have not released information about the cost of plans that will be offered.

The Kansas Association for the Medically Underserved held a training conference Wednesday in Wichita for about 40 navigators to learn the ins and outs of the Affordable Care Act and what to expect once the marketplace opens.

One of the biggest challenges will be that even the navigators won’t know what the new website will look like until open enrollment begins – or the details of the plans, rates and subsidies.

“Visually we don’t know,” said Nick Clasen, a patient care coordinator and navigator-in-training for the Center for Health and Wellness, one of several from Wichita area clinics who attended the training.

“But I do think we all have a pretty good idea of the process. It’s going to be sit down, explain things, help them apply, check eligibility and then it’s about giving them all the information about each option – not guiding them to an option – but making sure the person can make an autonomous decision.”

Juven Nava, GraceMed outreach coordinator and navigator-in-training, started working at the clinic in June 2011 to help patients sign up for Medicaid.

“I do feel prepared on assisting people with it; it’s just not knowing what it’s going to look like is challenging,” Nava said.

The navigators will have about 20 hours of online training through the Centers for Medicare and Medicaid Services and have to pass tests to become certified.

The training Wednesday was a supplement to that, and was also about building a support system and how to work with vulnerable populations, said Cathy Harding, KAMU executive director.

Unlike a typical insurance broker, navigators are not supposed to recommend one plan over another, Harding said.

“The (website) is going to be designed in a way that shows comparisons,” Harding said. “Each of the plans will have different levels – bronze, silver, gold, platinum – side by side, apples to apples, to show what each of those plans look like.”

“A lot will depend on their situation. Is it somebody that wants to pay a higher out-of-pocket cost because they feel like they don’t need more coverage? Or do they want the least amount of out-of-pocket costs? People’s circumstances will help them determine their plan and which makes most sense for them.”

In addition to navigators, there are certified application counselors who undergo about five hours of online training to help people enroll, Harding said. She suggests that people who have questions ask to see a person’s certification before allowing them to help them enroll.

Anyone is able to enroll themselves online, she said, but the navigators will be able to help decipher what the plans mean.

‘Doughnut hole’

For Nava, the biggest challenge will be breaking the news to people in what he called the “gap.” They make too much to qualify for Medicaid but not enough to afford insurance available on the marketplace, even with government subsidies.

“We’re going to see those people who are being left out,” he said.

Because the Affordable Care Act was designed to accompany an expansion of Medicaid, states like Kansas that didn’t expand Medicaid have a “Medicaid doughnut hole,” Harding said, where some people make too much to qualify for Medicaid but not enough to afford insurance.

“Out of everything the navigators will do, the hardest thing they’ll do is to tell somebody they’re too poor to benefit from the health insurance marketplace. And in Kansas, Medicaid eligibility is one of the strictest in the country,” she said. “I think it will be difficult for people to work with someone about their options and look that person in the eye and say, ‘I’m sorry, we can’t help you.’”

Over the summer, the federal government passed a rule that those in the “hole” won’t have to pay penalties if they don’t purchase health insurance under the individual mandate. But that will still leave a portion of the population uninsured.

“If you’re a childless adult in Kansas and you’re not disabled, you don’t qualify for Medicaid. Period. Regardless of how much or how little money you make,” Harding said.

Navigation funds

Separate from Wednesday’s training, KAMU is a part of the Kansas Marketplace Consortium, which has about 170 people throughout the state who have signed up to complete online training through the federal government to be certified navigators.

Last month, the federal government announced more than $886,000 in grants to three Kansas organizations to help people sign up and navigate the marketplace.

KAMU received the largest portion of that grant with $524,846, and is coordinating efforts with more than 400 clinics, health departments, hospitals and mental health centers across the state. That round of grants was part of more than $67 million distributed nationwide.

The grants are in addition to more than $1.6 million awarded to 15 Kansas health centers in July for hiring navigators. That round of grants totaled about $150 million nationwide.

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