Role of Navigators

The Navigator program was designed to reach underserved populations - the poor, people of color, non-english speakers. Their role is outreach, education, and eligibility, as well as enrollment.

Navigator Compensation

Navigators will be paid by the Exchange. While actual compensation has not yet been decided, the Exchange is considering an enrollment fee in the range of $30 to $90 per enrollment.

Training Requirements

All navigators will be required to complete a one to two-day training program to be registered with the Exchange.

Who May be a Navigator in California

The Exchange has not decided on the the exact parameters for Navigators, but are currently discussing these broad groups

  • Any non-profit organization that meets minimum criteria and registers with the Exchange.
  • Only specific types of organizations (i.e., non-profits, 501c3 or public agencies) that meet minimum criteria.

Who May Not be a Navigator in California

Health plans, agents, community medical clinics, providers and hospitals cannot become Navigators and cannot be compensated for assisting enrollments. They are referred to Direct Benefits Assisters (DBA). Brokers are expected to be compensated for both subsidized and unsubsidized qualified health plan enrollments in the Exchange. While providers, community clinics, and hospitals are deemed to have a “business interest” in assisting with enrollments.

A Story About Finding the Right Navigators

This story shows the importance of finding the right exchange navigators. The Massachusetts Fishing Partnership Health Plan offered insurance to commercial fisherman, a very independent group that often is hard to reach because they are at sea working. To overcome these challenges, the plan enlisted some of the fishermen’s spouses as navigators to carry the message to the members. The spouses were a part of the community, they understood the industry and, importantly, they were trusted messengers. As a result of their involvement, the uninsured rate among the fishermen dropped from 43% to 13%.

ACA Discription of Navigator Duties & Responsibilities

According to the Affordable Care Act (ACA), an Exchange must establish a program under which it awards grants to entities called navigators to perform the following duties:

  • Conduct public education activities to raise awareness of the availability of qualified health plans
  • Distribute fair and impartial information concerning enrollment in qualified health plans, and the availability of premium tax credits and cost-sharing reductions in accordance with federal tax laws;
  • Facilitate enrollment in qualified health plans;
  • Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and
  • Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange.

Who Can Be a Navigator?

Navigators may include trade, industry, and professional associations, commercial fishing industry organizations, ranching and farming organizations, community and consumer-focused nonprofit groups, chambers of commerce, unions, resource partners of the Small Business Administration (SBA), licensed insurance agents and brokers, and other entities that are capable of carrying out the required duties, meet the standards established by the Secretary (HHS) and provide information that is fair, accurate, and impartial.

Who Can Receive an Exchange Grant?

To be eligible to receive a grant from the Exchange, an entity must demonstrate to the Exchange that the entity has existing relationships, or could readily establish relationships, with employers and employees, consumers (including uninsured and underinsured consumers), or self-employed individuals likely to be qualified to enroll in a qualified health plan. Grants must be made from the operational funds of the Exchange and not federal funds received by the state to establish the Exchange.

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