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What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Monday, May 6, 2013

The ACA is Coming – How Can I Help Enroll People?

The past few weeks have brought a flurry of activity from the federal and state government agencies who are reaching out to community-based entities to solicit their assistance in Affordable Care Act outreach, education and enrollment. In Illinois, it’s even more confusing because there are three possible “helper” groups: Navigators, In Person Counselors and Certified Application Counselors. 

This blog is intended to answer some of your frequently asked questions about these enrollment helpers and how you can get involved.

What’s a Navigator and How Can I Be One? 
“Navigator” is the term that has been given to people or organizations charged with providing guidance to individuals enrolling in the Health Insurance Marketplaces created by the Affordable Care Act. Many of you have been wondering how you can become one of these entities. Unfortunately, there are no actual “navigator positions” right now. This is because various entities have to apply for funding (grant application due June 7) to become navigators and receive training.

What do you mean by “entity”?

Many types of groups/entities can be Navigators. Self-employed persons and public or private organizations are eligible to apply for funding to operate as Navigators (see the FAQ here). In each Marketplace there must be at least two sub-sets of entities and at least one will be a community and consumer-focused nonprofit. There are some restrictions, however: navigators cannot have conflicts of interest. Therefore, navigators cannot be health insurers, have affiliations with health insurers, or accept any form of payment from insurers that is related to enrollment inside or outside of the marketplaces.

What if I don’t want to or am not eligible to apply for these Navigator grants?
If you don't think you or your organization would qualify for this funding alone, you could consider reaching out to another organization in your area that might be applying. Check out this consumer assistance matchmaking spreadsheet to meet up with other groups. Another option would be to wait until the grants have been decided upon and then reach out to see if the recipient organizations need any additional staff.

What is the In-Person Counselor (IPC) Program?
In-Person Counselors (IPCs) are the same as Navigators, in that they will educate people about the new system, help them understand their health plan choices, and facilitate their selection of the plan that is right for them. They are different than Navigators because funding for these entities comes from the state instead of the federal government and they will receive training directly from the state.

The IPC grant application just came out and applications are due May 30th. Entities in Illinois can apply for these funds and hire new personnel or use existing staff as In-Person Counselors in the community. Find more information and access to the application here. The Illinois Health Insurance Marketplace will be conducting a webinar for those interested in the IPC program on Thursday, May 9 at 10 am. You must register to participate. 

But how is a Navigator and In Person Counselor different from a Certified Application Counselor (CAC)?
CAC's have been defined as “trusted community-based organizations, providers, or other organizations with expertise in social service programs.” CACs allow organizations that would likely aid consumers anyway (such as hospitals or clinics) be involved more formally in the process of finding health coverage. Unlike Navigators and IPCs, CACs are not eligible for public funding but the Marketplace will be required to certify CACs to help people apply for Medicaid and plans sold through the exchange.

So what should I do now if I want to be one of these helpers?
Feel free to email us at info@illinoishealthmatters.org with any questions!

Stephani Becker & Alexa Herzog
Illinois Health Matters


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  2. This is awesome advice - thank you for taking the time to write it! I've bookmarked it! I work in assisted Living in Gilford NH, and have been asked some of these questions before.