Healthcare Business News

Reform Update: HHS to award $54 million for navigator training

By Jaimy Lee
Posted: August 8, 2013 - 3:45 pm ET

HHS is preparing to award $54 million in grants to navigators—organizations that will provide impartial information to the public about signing up for coverage on the state health insurance exchanges. Navigators are not allowed to recommend particular health plans. These grants will go to navigator organizations in states where the federal government will operate the exchanges. The states operating their own exchanges are choosing navigator groups on their own.

Navigators and other helpers called in-person assisters are expected to be critical in explaining to consumers—many of whom have never bought health insurance directly—how to apply for private or Medicaid coverage on the exchanges, how to qualify for federal subsidies and how to select a plan. In many states, insurance brokers also will receive training and be able to sell exchange coverage to consumers.

But there are widespread concerns about whether there is enough time before the Oct. 1 launch of the exchanges for adequate training of navigators. There also are concerns about the potential for conflict of interest and fraud.

Navigators could include community not-for-profit groups, chambers of commerce, tribal organizations and labor unions.

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Navigators will receive up to 30 hours of training, according to a final rule released last month by the CMS, which does not set out a minimum training requirement. Some states are requiring that navigators receive additional training.

According to an HHS spokeswoman, navigators must complete about 20 hours of initial base training, which will be conducted online during the six weeks between Aug. 15 and the Oct. 1 start of the open enrollment season. They are then expected to take on “refresher” training through the six-month open enrollment period.

“Our grantees will be organizations who have established records of serving their communities and have pre-existing networks,” HHS' spokeswoman said in an e-mail. “We view training as an ongoing process, and will continue to offer refresher training courses throughout the six-month open enrollment period as we respond to consumers' needs.”

HHS has not yet released the training package that will outline training requirements for navigators. The training is required to include information about qualified health plans, insurance affordability programs, eligibility and enrollment rules and procedures, and privacy and security standards.

HHS said a report in the Wall Street Journal that it was reducing navigator training requirements because of tight timelines before the Oct. 1 launch of the exchanges was not accurate.

Insurers plan to participate in Wisconsin, Ohio exchanges

Despite the ardent opposition of Republican leaders in Wisconsin and Ohio to Obamacare, dozens of health insurers, including several that are provider-owned, say they plan to participate in the federally run health insurance exchanges in those two states. The broad participation of insurers will make them two of the more competitive exchanges in the country.

The Republican governors and legislatures in Wisconsin and Ohio have refused to set up state-run exchanges, choosing to have the federal government run them instead.

The Wisconsin state insurance commissioner said in an Aug. 6 news release that 13 insurers are seeking certification for the individual insurance market, including at least six companies that are owned by hospital systems. Nine companies have requested certification as small-group market insurers, to sell coverage in the state's Small Business Health Options Program.

In Ohio, 12 insurers have been approved by the state to sell plans on the individual market exchange, with six of those insurers also choosing to offer plans to the small business market, according to a spokesman for the Ohio Department of Insurance. At least four of the insurers listed are owned by hospital systems.

Experts say greater participation by insurers in a state's exchange creates more competitive pressure to offer lower premiums.

Some with pre-existing still wary of buying insurance

More than two-thirds of American adults who are both uninsured and have pre-existing conditions remain unsure whether they will buy health insurance next year, according to a survey by

Starting in January, the healthcare reform law requires health insurers to accept all applicants regardless of health status and prohibits them from considering health conditions in setting premiums. President Barack Obama has stressed the benefit of the law to the millions of Americans with pre-existing conditions, who have had a hard time obtaining affordable coverage until now.

About 16% of the 3,000 people surveyed last month reported they are uninsured, and about a third of those individuals said they have pre-existing conditions. Of the adults who were uninsured and had pre-existing conditions, 18% said they are definitely planning to purchase insurance, while 14% said they intend to remain uninsured. The rest said they were undecided.

“Many observers are worried that healthy Americans won't sign up for health insurance next year,” Laura Adams, senior insurance analyst for, said in a news release. “This research suggests that we should also be worried about unhealthy Americans failing to enroll.”

The report also found that about 85% adults surveyed do not think that consumers have generally received enough education about the healthcare reform law to understand how it may impact their own healthcare decisions.

The survey was conducted before states and the federal government had fully geared up their public education campaigns to encourage people to sign up for coverage through the new state insurance exchanges.

Follow Jaimy Lee on Twitter: @MHjlee

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