Feds Name ‘Navigators’ to Steer Residents through Insurance Marketplace

Andrew Kitchenman | August 16, 2013 | Health Care
Five organizations chosen to run new ACA exchanges in NJ have lots of work and just seven weeks to do it

eileen henderson
Representatives of the five organizations chosen to guide residents through the process of buying health insurance through the new federal marketplace or exchanges have less than seven weeks to get ready but vowed to be prepared.

The U.S. Department of Health and Human Services announced yesterday that the New Jersey groups would receive $2.02 million, part of $67 million in grants distributed to 105 applicants in states with federal marketplaces or federal-state partnerships.

States that are operating their own exchanges are drawing from a larger pool of money under the 2010 Affordable Care Act.

The organizations must be ready to help uninsured residents buy insurance starting October 1, when enrollment begins for coverage that will start on January 1, 2014.

The so-called “navigators,” who must undergo training, will help people with applications and take part in outreach and education efforts.

“We are prepared,” said Barbara Scholz of FoodBank of Monmouth and Ocean Counties Inc., which received a grant for $137,217. She said her organization already has a program that reaches out to people in need to make sure they’re signed up for programs like the federal food stamp program and utility assistance, as well as disaster assistance in the wake of Hurricane Sandy.

“There’s still a lot of families reeling” from the storm who could use help with health insurance, Scholz said, noting that the amount of food her organization distributes increased from 7 million pounds a year to 8.5 million pounds after the storm. She added that 40 percent of the people her organization serves have unpaid medical bills.

“If you can get health insurance, certainly that puts food on the table,” Scholz said.

The marketplace website will allow residents to buy insurance and also learn whether they are eligible for federal insurance subsidies. The law requires most uninsured people to get insurance, with those who choose not to have coverage required to pay the greater of $95 or 1 percent of their income in 2014, with the penalty rising to the greater of $695 or 2.5 percent of income in 2016.

At least one policy expert expressed concern that the organizations don’t have enough funding to meet the large demand for help in using the new insurance marketplace.

Raymond Castro, senior policy analyst for the nonprofit New Jersey Policy Perspective, said that while having the navigators will be beneficial, they won’t be able to handle the demand.

“They all have the potential of doing a good job,” Castro said. “The problem is, this only scratches the surface in terms of addressing the need.”

He estimated that the grants will pay for roughly 30 navigators in a state where 362,000 more residents are expected to buy individual health insurance – largely through the marketplace – and 234,000 more residents will receive Medicaid.

“We’re going to have problems on the Medicaid side, where we do have agencies that have staff, but we know they’re inadequately staffed,” Castro said, referring to the expansion in eligibility for the Medicaid program. While the navigators are officially designated to help residents with the marketplace, they’re expected to also assist with enrollment for those who are newly eligible for Medicaid.

Subsidies will available for residents with income between 138 and 400 percent of the poverty line, which currently amounts to between $15,856 and $45,960 for single residents and between $32,499 and $94,200 for a family of four. Residents with income below that level will be eligible for Medicaid, which Gov. Chris Christie opted to expand.

Castro remains critical of Christie’s decision to have a federal exchange instead of state exchange, which would have made the state eligible for more money for public outreach.

The navigator grants aren’t the only source of money to help sign up residents. The state’s 20 federally qualified health centers, which serve many uninsured residents, have been awarded $3.3 million to enroll residents in insurance and the state’s Medicaid office has received $1 million to train residents in how to help enroll the uninsured.

However, Castro worries that some people will fall through the cracks, including residents with language barriers. “I’m most concerned about the most vulnerable people and there are a lot of them in our state,” he said.

New Jersey’s funding gap compared with states that will operate their own exchanges must be overcome, said Louise Cohen, vice president of New York City-based Public Health Programs, which was awarded $400,583 to provide navigators in Hudson and Essex counties.

Cohen’s organization already operates a health-insurance enrollment program in New York and plans to hire new navigators in New Jersey.

“Our hope is that we can reach out to as many organizations as possible” to partner with at the local level, including organizations that already provide social services, Cohen said.

Camden-based Center for Family Services received $677,797 to oversee navigators in seven counties. Center Vice President Eileen Henderson said the organization has a plan for reaching residents across the sprawling region, including connecting with people at health fairs and libraries. The organization plans to hire and train additional staff.

“We believe we’ll have a good team of people starting on October 1,” Henderson said. “It’s a vast area and we want to ensure we’re going to be available to all” residents.

The state’s other grant recipients were Wendy Sykes – Orange ACA Navigator Project, which received $239,810, and the Urban League of Hudson County, which received $565,000.