Role of ACA enrollment navigators, assisters continues to evolve

As the Affordable Care Act enters its third open enrollment period, the role of navigators and assisters remains crucial to the health law's success, but it is likely to continue to evolve, according to new Health Affairs policy brief.

In the first open enrollment period, navigators and IPAs--both of which work for nonprofit, community-based organizations funded through government or private grants--helped scores of individuals through the online enrollment process, dealing with pervasive technical issues and often-complex eligibility requirements, according to the brief. They also played a large role in the second enrollment period, a previous Kaiser Family Foundation (KFF) brief explained, helping 5.9 million consumers in 2015.

Yet as KFF pointed out, only 27 percent of assister programs said they are certain they will have adequate funding next year.

These funding concerns have prompted some states to turn to insurance brokers in order to bolster their enrollment efforts, the brief notes. Brokers have the experience to offer expert health plan recommendations, making them good candidates to offer consumer assistance when navigator/IPA funding falls short, the brief states. But it cautions that brokers are not as adept at reaching underserved populations as navigators and IPAs, and also do not offer unbiased advice given that they receive commission from health plans.

In addition, many brokers have voiced concerns about the qualifications of navigators and IPAs, even lobbying states to pass restrictive laws that require them to undergo more training and testing than what is required by the Department of Health and Human Services, according to the brief. Such laws may in fact have impeded consumer outreach efforts, past research has found.

The good news, though, is that Centers for Medicare & Medicaid Services recently announced a $67 million grant for navigators in 2016. The agency issued a $60 million grant for navigators to aid enrollment efforts in 2015.

To learn more:
- read the brief

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