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Navigator Compensation Update

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Proposition 26 Changes

Covered California Legal Counsel recently determined that due to Proposition 26, fees collected by the Exchange cannot be used to fund application assistance for Medi-Cal enrollment as previously recommended. Prop 26 ensures that fees collected by Covered California can only be used to fund Exchange-specific functions, such as enrollment into qualified health plans. Any Navigator providing enrollment assistance services for any public plans would not be compensated by a per-enrollment fee.

The Exchange has two options in addressing the legal concern about use of Exchange QHP revenue for Medi-Cal enrollment.

  1. Require Navigators to complete the eligibility process required for potential enrollment in Medi-Cal and refer eligible individuals to the appropriate entity (to be designated by DHCS or MRMIB) for enrollment.
  2. Require Navigators to both complete the eligibility process required for potential enrollment in Medi-Cal and support the individual’s enrollment in the plans or options relevant to their eligibility.

Covered California staff has recommended adopting option #2 so that even without payment from other sources, Navigators be required to complete eligibility and enrollment processes for Medi-Cal. Covered California will work with Medi-Cal to identify sources of funds and appropriate terms of Navigator entities for those programs.

Use of Grant Funds

The Covered California Education and Outreach Grant Program will be integrated and aligned with the Covered California Navigator Program and will be funded at a newly designated amount of $20 million per year for 2014 and 2015. Some of the grants will be reserved to target and support organizations that demonstrate that they have a robust Navigators network within their organization who would help individuals enroll into coverage. Some of the grants will be reserved for organizations who do not wish to have staff serving as Navigators, but only want to focus on outreach and education.

Eligibility and Certification

Eligible enrollment assisters must be affiliated with an enrollment entity. Individual navigators are not eligible for enrolling individuals in Exchange products. The Assisters Program will require that all organizations or enrollment entities register with the Exchange and meet established eligibility criteria. Registration will be renewed annually.

Certified Enrollment Assisters should complete at a minimum a two-day Assisters Training offered by the Exchange at no cost to the enrollment entity. Project Sponsors may consider an abbreviated version of the training program for currently certified HICAP trained assisters, health insurance agents, and other individuals already trained to enroll consumers in health coverage.

The Project Sponsors, or their designated entity, should recruit and monitor the Assister’s network, including both compensated and non-compensated Certified Enrollment Assisters to ensure that the program maintains geographic, cultural and linguistic access to target markets.

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