Filed Under:Health Insurance, Individual Health

Feds post exchange navigator grant applications

Gary Cohen (CMS photo)
Gary Cohen (CMS photo)

The Center for Consumer Information & Insurance Oversight (CCIIO) has posted a grant application aimed at individuals and organizations that want to be "navigators," or ombudsmen, for "federally facilitated exchanges" (FFEs).

CCIIO, the arm of the Centers for Medicare & Medicaid Services (CMS) overseeing U.S. Department of Health and Human Services (HHS) efforts to implement the insurance provisions in the Patient Protection and Affordable Care Act (PPACA) has about $54 million in navigator grant funding available.

Applications are due June 7.

Each grant would cover a 12-month period that would start Aug. 15.

PPACA calls for HHS and state regulators to open exchanges, or Web-based health insurance supermarkets, in all 50 states and the District of Columbia by Oct. 1.

PPACA also calls for the exchanges to provide navigators who get no compensation from health insurers to help individual consumers use the new exchanges and understand how to shop for health coverage.

Advocates of the navigator program have argued that the navigators will focus mainly on serving low-income people and uninsured people who have not had much contact with commercial insurance agents and brokers in the past.

Some states are setting up their own exchanges and their own navigator programs.

CCIIO -- pronounced "Sih-Sigh-Oh" -- is setting up HHS exchanges and navigator programs in some states, and it is sharing duties by setting up "partnership" exchanges in a few states.

CCIIO has said that it wants the exchanges it runs to work as closely with agents and brokers as state law permits. Agents and brokers would continue to get commissions from health insurers.

CCIIO has described its navigator program as being separate from consumer of agents and brokers.

CCIIO exchange navigators can be licensed as insurance agents or brokers but cannot get commissions or other compensation, including trailing commissions, from health insurers.

CCIIO navigators can get financial support from the exchanges themselves.

Buiilders of state-based exchanges in states such as California, Colorado and Washington state have suggested that navigators might end up getting the equivalent of about $50 to $100 per applicant enrolled.

In Texas, for example, CCIIO says it would like to reach 4.9 million uninsured people and has about $8.2 million in navigator funding, or $2 per uninsured resident.

In Alaska, CCIIO would like to reach 139,421 uninsured people and has $600,000 in navigator funding, or about $5 per uninsured resident.

Health insurers and stop-loss insurers are not eligible to be navigators.

Insurance agents and brokers who earn compensation, including trailing commissions, from health carriers for selling health coverage also are not eligible to apply for navigator grants.

Insurance agents and brokers who earn commissions from selling products other than medical insurance, such as auto insurance, disability insurance and long-term care insurance apparently are eligible to apply for navigator grants.

"The amount of funding awarded to a successful applicant within an FFE/state partnership exchange service area will be based on the scope and breadth of the activities being proposed and the size of the population to be served," officials said. "For example, if an applicant in Oklahoma proposes to serve a small community in a remote area in the panhandle, with the goal of reaching 1,100 consumers, then the budget request must reflect an amount that is reasonable and appropriate with the activity (or activities) being proposed."

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