CHA News Article

HHS Issues Final Rule for Navigators in Health Insurance Marketplaces

Last week, the U.S. Department of Health and Human Services issued a final rule outlining standards for Navigators — in-person assisters in federally facilitated and state partnership marketplaces. State-based marketplaces (exchanges) have the option to use the guidance or develop their own. Navigators and similar in-person assisters will inform consumers about health insurance, the new health insurance marketplaces, and qualified health plans and public programs, including Medicaid and the Children’s Health Insurance Program. The final rule is attached.

The final rule creates standards for conflict-of-interest, training and certification, and meaningful access; clarifies that any licensing, certification or other standards prescribed by a state or exchange must not prevent applying the provisions of Title I of the Affordable Care Act; adds entities with relationships to issuers of stop-loss insurance to the list of entities ineligible to become Navigators; and clarifies that the same ineligibility criteria that apply to Navigators apply to certain non-Navigator assistance personnel. In addition, the final rule directs each exchange to designate organizations that will certify their staff members and volunteers as application counselors who assist consumers and facilitate enrollment in qualified health plans and insurance affordability programs. The rule also provides standards for that designation.

Covered California’s Enrollment Assistance Program is comprised of the In-Person Assistance Program and the Navigator Program. To learn more about Covered California’s Enrollment Assistance Program, visit www.healthexchange.ca.gov/Pages/EnrollmentAssistanceProgram.aspx.

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