HealthReformGPS is made possible through generous financial support from the RCHN Community Health Foundation. Visit them at

RWJF publishes navigator resource guide

Posted on November 22, 2013 | Comment (1)

PDF Version
Implementation Briefs
Key Developments

The Robert Wood Johnson Foundation (RWJF), in conjunction with Georgetown University’s Center on Health Insurance Reform, recently published their Navigator Resource Guide.  Navigators are trained to help individuals understand their coverage options under the Affordable Care Act (ACA) and help them select plans most appropriate for their needs.  The Navigator Resource Guide is divided into three sections:

  • Enrollment issues for individuals without coverage options from an employer;
  • Enrollment issues for individuals with coverage options from an employer, but who may want to learn more about additional options under the ACA; and
  • Enrollment issues for small employers.

The 102 page document is designed to provide additional information and supplement the training for navigators working with private insurance under the ACA.

Comment (1)

Federal regulations establish standards governing Navigator and non-Navigator consumer assistance programs. Navigators and non-Navigator assistance personnel must meet federal standards as well as state licensing and certification standards. Our prior update reviewed proposed federal rules that would clarify the criteria the federal government will apply in determining whether a state licensure or certification standard is preempted by federal law. The proposed rules also set additional federal standards governing Navigators and other consumer assistance personnel. Comments are due 30 days from publication of the proposed rule, which was published in the federal register on March 21, 2014.
The ACA (§§1311(d) and (i)) and implementing regulations (45 C.F.R. §155.210) require that all Exchanges establish Navigator programs to provide fair, accurate and impartial information regarding health insurance coverage across Exchanges and state Medicaid and CHIP programs. Navigators also facilitate selection of QHPs and provide referrals for consumers with questions, complaints, or grievances to other consumer assistance and ombudsman programs. The Navigator program requirement applies regardless of whether the Exchange is operated by a state government or by the federal government (known as a “federally-facilitated Exchange”), either with or without a state Consumer Assistance Partnership...
One of the great challenges of our health care system for individuals and small employers is figuring out health insurance. Multiple products are available in the market, and they can differ enormously with respect to benefits and cost-sharing, coverage standards, who – and what – is in or out of provider networks, and how to make the best use of insurance coverage. Insurance agents and brokers – sometimes referred to as “producers” – provide an important service by helping people and small businesses make purchasing choices. But brokers and agents perform a specific task: their primary job is to sell insurance products. Thus, while their role is key to a functioning insurance market, brokers and agents may not be sources of impartial advice on how to select among competing plans, and they may not provide post-enrollment assistance in understanding and using coverage once purchased.
Georgetown University's Center on Health Insurance Reform, in conjunction with the Robert Wood Johnson Foundation, released a navigator resource guide for the Affordable Care Act (ACA). The guide serves as a primer for health insurance reform and is intended to supplement official training documents released by the administration. Topics addressed in the guide include: health insurance marketplaces, benefit standards, cost standards, rating, and premium tax credits.
State Health Reform Assistance Network, a program of the Robert Wood Johnson Foundation, released an issue brief detailing basic information regarding Navigators and In-Person Assistors (IPAs), two programs that will aid individuals enrolling in state insurance marketplaces. The brief specifically discusses policy and operational issues regarding the programs, as well as resources and ideas utilized by states designing their own Navigators and IPAs. This is one of several briefs intended to educate and assist state policy makers in implementing this facet of the Affordable Care Act (ACA).
The Centers for Medicare and Medicaid Services (CMS) released a manual designed to educate Navigators on the standard operating procedures (SOP) of their roles in federally-facilitated Marketplaces. The Affordable Care Act (ACA) enlists Navigators to provide information and guidance on the plans available to consumers within health insurance Marketplaces. The SOP manual, which is 217 pages in length, explains how Navigators should carry out their prescribed duties under the ACA, including procedures regarding:
  • outreach and education;
  • impartial selection, completion and submission of a qualified health plan (QHP); and
  • communication and customer service strategies to meet the needs of the Navigator's target enrollment population.
Additionally, the SOP manual outlines specific means by which Navigators can protect the personally identifiable information of their consumers and prevent fraudulent activities.
Today, the US Department of Health and Human Services (HHS) issued their final rule concerning Navigators and other forms of in-person assisters. These rules apply to navigation personnel in federally-facilitated and partnership Exchanges, as well as non-Navigator assisters in state-based Exchanges funded through federal grants. Below are the key provisions addressed in the final rule:
  • Exchanges must designate certain organizations to train and certify staff and volunteers as application counselors. Application counselors are individuals that assist consumers in completing their Exchange enrollment applications for either public or private insurance.
  • An individual or group with ties to stop loss insurance issuers may not become a Navigator. The rule further states that some of the eligibility criteria utilized to determine whether or not one can be a Navigator may also be applied to individuals aspiring to become other forms of non-Navigator assisters.
  • The rule solidifies Navigator training standards on the following issues: conflicts-of-interest, training and certification, and meaningful access.
  • Any licensing or certification requirements issued by states may not conflict with the provisions laid forth in title I of the Affordable Care Act (ACA).
The Center for Consumer Information and Information Oversight (CCIIO) simultaneously released guidance concerning the Certified Application Counselor Program for federally-facilitated and state-partnership Exchanges. The guidance includes which organizations may be designated Certified Application Counselors, how to go about the designation, and how to remove the designation.
The Center for Consumer Information and Insurance Oversight (CCIIO) issued additional information on navigators and other consumer assistance and outreach programs provided by the Affordable Care Act (ACA). The document expands upon the standards with which these assistors must comply, available grant funding, and the differences between the assistance programs.