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Navigators Under the Affordable Care Act

Over three years have passed since President Obama signed the Affordable Care Act into law. The law is designed to ensure affordable health care to more Americans. A major step in the law will be implemented at the end of this year. The state insurance exchange begins open enrollment October 1, 2013 with health coverage starting January 1, 2014. Ohio elected to have the Federal Government setup its state exchange – click here to view Ohio’s state exchange.

To inform the public about the new state exchanges and the available heath care options, the Affordable Care Act authorized $67 million in grants to more than 100 organizations. Ohio was awarded $3 million in grants to five qualifying organizations on August 15, 2013. The qualifying organizations are referred to as Navigators under the Affordable Care Act.

Navigators will play an important role in the coming months educating Ohioans on the different health coverage plans available on the state exchanges. The Federal Government requires Navigators to meet certain regulations & training. Code of Federal Regulations Section 155.215(b)(1) states the following with regards to training:

  1. Certification and recertification standards. All individuals or entities who carry out consumer assistance functions under §§ 155.205(d) and (e) and 155.210, including Navigators, must meet the following certification and recertification requirements.
  • Obtain certification by the Exchange prior to carrying out any consumer assistance functions under §§ 155.205(d) and (e) or 155.210;
  • Register for and complete a HHS-approved training;
  • Following completion of the HHS-approved training described in paragraph (b)(1)(ii) of this section, complete and achieve a passing score on all approved certification examinations prior to carrying out any consumer assistance functions under §§ 155.205(d) and (e) or 155.210;
  • Obtain continuing education and be certified and/or recertified on at least an annual basis; and
  • Be prepared to serve both the individual Exchange and Small Business Health Options (SHOP) Exchange.

Ohio has additional requirements to be a certified Navigator. Ohio HR Bill 3 Sec. 3905.471 (D) requires Navigators in the State of Ohio to comply with the following:

  1. An individual shall not act in the capacity of an insurance navigator, or perform insurance navigator duties on behalf of an organization serving as an insurance navigator, unless the individual has applied for certification and the superintendent finds that the applicant meets all of the following requirements:
  • Is at least eighteen years of age;
  • Has completed and submitted the application and disclosure form required under division (F)(2) of this section and has declared, under penalty of refusal, suspension, or revocation of the insurance navigator’s certification, that the statements made in the form are true, correct, and complete to the best of the applicant’s knowledge and belief;
  • Has successfully completed a criminal records check under section 3905.051 of the Revised Code, as required by the superintendent;
  • Has successfully completed the certification and training requirements adopted by the superintendent in accordance with division (F) of this section;
  • Has paid all fees required by the superintendent.

Other than background checks and the requirement to meet the Ohio standard of training, the rules for Navigators at both the Federal level and the State level are similar. However, several Ohio non-profits who perform comparable duties as a Navigator did not receive government grants therefore will not be Navigators. The Federal Government has a special designation for these entities called Certified Application Counselors, with Federal standards being substantially less than those of Navigators. The Ohio Bill is silent as to the requirements of a Certified Application Counselors.

The silence in the Ohio Code in regards to Certified Application Counselors could create exposure to non-profits at the state level, even though they are compliant at the Federal Level. Until further state legislation is adopted non-profit organizations receiving the Federal designation of Certified Application Counselors are left wondering what this designation means in the state of Ohio, and what functions they are allowed to perform at the state level.

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