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As the “NY State of Health” Enters Its Third Week, a Look at the Role of Navigators




by:
Frank J. Fanshawe
Sandy M. McDermott
Wilson Elser Moskowitz Edelman & Dicker LLP - Albany Office

 
October 23, 2013

Previously published on October 18, 2013

New York’s Health Insurance Marketplace, officially called the NY State of Health, has entered its third week of operation, and as of October 8, 2013, had enrolled 40,000 New York residents in health insurance plans offered through the Marketplace. These enrollments have taken place online, over the phone and through the assistance of Affordable Care Act (ACA) Navigators.

By way of background, and in general terms, Navigators are the “public face” of the Marketplace, charged with educating the public concerning the existence of the Marketplace and insurance programs it offers. Under the ACA, entities that meet certain requirements are eligible to receive grants from the Marketplace and act as Navigators.

Navigator Requirements
The federal law and regulations provide that Navigators must, at a minimum:

  • Maintain expertise in eligibility, enrollment and program specifications and conduct public education activities to raise awareness about the Marketplace
  • Provide information (including the existence of other health programs) and services in a fair, accurate and impartial manner
  • Educate consumers as to the available health plans
  • Provide referrals to the applicable agency relative to any grievance, complaint or question regarding a health plan
  • Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Marketplace.

The preamble to the regulations clarifies that Navigators should make consumers aware of the tax implications of their decisions as well as assist with applications for premium tax credits and cost-sharing reductions.

Additionally, the ACA and federal regulations mandate that Navigators must receive basic training so that they understand the:

  • Needs of the underserved and vulnerable populations
  • Rules and procedures for eligibility and enrollment
  • Range of public programs and insurance options available through the Marketplace
  • Manner in which tax information and other personal data must be handled in compliance with privacy and security standards.

It is important to note that the preamble to the regulations also provides that the Marketplace cannot require Navigators to have agent or broker licenses or to maintain errors and omissions coverage.

New York Requirements
While the ACA and federal regulations outline the basic Navigator framework, the Marketplaces are charged with developing their own Navigator programs. In New York, Navigators must be employed by an agency that has been awarded a contract by the New York Department of Health (Department). Additionally, Navigators must be trained and certified according to criteria established by the Department. Once designated by the Department, Navigators provide in-person assistance to individuals, families and small businesses interested in applying for health insurance coverage through the New York Marketplace.

At present, New York has almost 500 Navigators throughout each of the state’s 62 counties, with 48 different languages represented. The NY State of Health website contains a list of Navigators by county.

Benefits of Consulting a Navigator
Navigators were particularly helpful during the first few days of open enrollment when New York’s online enrollment system experienced some technical problems. Navigators were able to meet in person with interested applicants and assist them with questions concerning available health plans, premium subsidies, cost-sharing issues and the application process.

For small businesses interested in offering insurance to their employees through the New York Marketplace, Navigators can be an effective tool for human resources personnel and benefit managers in assessing the types of quality health plans available as well as the economic impact of providing such insurance options to their employees.



 

The views expressed in this document are solely the views of the author and not Martindale-Hubbell. This document is intended for informational purposes only and is not legal advice or a substitute for consultation with a licensed legal professional in a particular case or circumstance.
 

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Author
 
Frank J. Fanshawe
Sandy M. McDermott
Wilson Elser Moskowitz Edelman & Dicker LLP
 
Albany Office
 
Wilson Elser Moskowitz Edelman & Dicker LLP Overview