Last week was a busy one for those of us eager for robust consumer assistance to help people enroll in the new health insurance marketplaces, which launch on October 1, 2013. First, the Administration released a set of on-line training materials for certified application counselors (CACs) and in-person assisters. (Note:  if you want to see the materials but you’re not a CAC, agent or broker and don’t want to go through the full registration, you can see screen shots of the training on healthcare.gov). Second, they announced the 105 recipients of navigator grants for the federally facilitated marketplace (FFM) and partnership states. With just 28 working days before the first day of open enrollment, these newly minted grantees will need to hire staff and get them trained right quick.

The big news with the navigator grants was the increased amount available. Originally the Department of Health and Human Services (HHS) had solicited applications for $54 million in available grant funds; the actual awards totaled $67 million. Apparently HHS was able to transfer about $13 million from the ACA’s prevention fund. However, these navigator grantees will still be receiving far less than their counterparts in states running their own marketplaces, which have made big investments in consumer outreach and assistance, thanks in large part to federal funds available under exchange planning grants.

It’s been interesting to review the list of navigator recipients – there are some surprises on it. Many of us expected that navigators would largely be non-profit community-based organizations who work with vulnerable populations to deliver services. At a minimum, I assumed they would be trusted ambassadors in their communities for the new marketplaces. And to be sure, there are many, many navigator grantees that appear to be just that – such as local United Way organizations, Planned Parenthood clinics, Legal Aid societies, and Visiting Nurse Service providers.

It was a surprise, however, to see a significant number of for-profit hospital “recovery” companies receiving grants in several states. These companies, such as Advanced Patient Advocacy LLC, Cardon Healthcare Network LLC, DECO Recovery Management LLC, and R&B Receivables Management Corporation are generally hired by hospitals to try to “recover” payments from uninsured and underinsured patients.  These companies may turn out to be excellent navigators because they are well resourced and can quickly deploy staff to perform the required duties. And they have considerable experience helping people sign up for Medicaid, the Children’s Health Insurance Program and other state and local coverage programs. But in doing so, their primary motivation has historically been to ensure the hospital gets paid, not to act on behalf of the consumer. As a result, they may need to work a little harder to build trust within their communities. It will also be important for HHS to monitor all grantees to guard against potential conflicts of interest..

Guarding against conflicts of interest and acting on behalf of the consumer is an important component of the on-line consumer assister training HHS released last week. I’m working my way through the training modules. These modules are pretty high level, but provide navigators with a basic framework for interacting with consumers, from the initial assessment of the consumers needs, consumer education, the importance of privacy and security of consumers’ personal information, and the eligibility and enrollment process. For a deeper dive, HHS has provided consumer assisters with a 217-page “Standard Operating Procedures” (SOP) manual as a reference guide for just about everything a navigator or CAC would need to know. The SOP covers the consumer encounter from soup to nuts. It’s got “Customer Service Best Practices,” plus step-by-step guides on activities like marketplace account creation and maintenance,  filling out an application, choosing a plan, and assisting consumers with eligibility appeals (“Step 1: Receive consent to assist consumer. Step 2: Determine if consumer has previously started appeal request. Step 3: Discuss next steps for providing supporting documentation….”)

No matter who the consumer assister is, everyone will have a steep learning curve. It remains to be seen whether these resources will fully equip navigators, CACs, and other assisters with the information and tools they need, but it’s certainly a helpful start. And we at Georgetown will be doing our part. Thanks to a grant from the Robert Wood Johnson Foundation, we’ll soon be publishing a quick reference guide on private health insurance and the reforms in the ACA. The guide will complement HHS’ high level training materials and indicate where there may be important differences in state laws or rules. We’ll also have a comprehensive set of frequently asked questions that will be updated to reflect the issues that emerge as navigators and assisters engage directly with consumers. As open enrollment approaches, consumer assisters will need good, up-to-date information and tools to help consumers select the coverage option that’s right for them.