Navigators and In-Person Assistors: State Policy and Program Design Considerations
State Health Reform Assistance Network – Shelly Ten Napel and Daniel Eckel
This brief, prepared by State Network staff, outlines important policy issues for states to consider while implementing their Navigator and In-Person Assistor (IPA) programs as well as summarizes the basic information and guidance released to date. The brief concludes with a compilation of resources, program structures, and ideas from leading State Network states. The Affordable Care Act (ACA) and related guidance have established Navigators and IPAs to help individuals enroll in Health Benefit Exchanges (Exchanges). Regardless of the type of Exchange, every state will have Navigator and In-Person Assistor programs and several states have begun to make policy and operational decisions that could be informative to other states.
This brief, part of a developing series of reports related to consumer assistance, reflects an effort to curate the growing number and depth of resources available to state policymakers on this topic. Wakely Consulting Group has produced a brief, What Should Exchanges Know about Call Centers: A Guide for Implementation, which offers states strategies and best practices for call center management. For a high level overview of consumer assistance see the brief prepared by the National Academy for State Health Policy.
At the end of the public health emergency (PHE), people currently enrolled in Medicaid and the Children’s Health Insurance Program are at risk of losing their coverage unless state Medicaid/CHIP agencies take steps to update enrollee mailing addresses and other contact information. This expert perspective examines the information technology system, policy, and operational strategies states can consider to update key enrollee contact information to ensure eligible enrollees are able to keep or transition to new affordable health coverage at the end of the PHE.
On October 7, the U.S. Departments of Health and Human Services (HHS), Treasury, and Labor (DOL) and the Office of Personnel Management (OPM) published a third rule implementing the No Surprises Act (NSA), the comprehensive federal law banning balance bills in emergency and certain non-emergency settings beginning January 1, 2022. This third rule, an interim final rule, provides details on the independent dispute resolution process (IDR), good faith estimates for enrollees on the cost of services, the dispute resolution process for uninsured patients, and external review. This expert perspective summarizes the provisions of the IFR and notes particular implications for state regulators.