"Navigators” – a buzz word you'll be hearing a lot more about

      UPDATES at end of story about nonprofit "sniffing" and Wash Post report on agents' worries.

        In preparation for the huge changes coming next year in healthcare reform, moves are starting quietly about a small but crucial piece for consumers – the role of people called “navigators.”

      These are the people – funded by the federal government – whose job will be to help consumers negotiate the complicated new world of exchanges, in which virtually everyone will be able to buy insurance at group rates, regardless of age or preexisting conditions.

       Santiago Leon, a Miami health insurance broker who's highly active in healthcare causes, reports that Florida will get about $5.8 million in the first year to fund navigator programs.

       Many consumers will be interested in exploring what exchanges to have to offer and at what price. That's true for the uninsured and for employees who are clinging to jobs they don't like just because they're guaranteed to get health coverage.

        Their questions about the new exchanges are likely to be plentiful, particularly in the first year or two, and the Affordable Care Act has allocated money to helping consumers understand them.

        Florida's Legislature and governor never took action to have a state-controlled exchange, and the state's residents will be signing up for one designed by the federal government.

         Even so, the Florida Association of Health Underwriters is asking the Legislature to craft legislation to deal with navigators.

        “Navigators are not insurance agents and HHS [Health and Human Services] clearly states that states cannot require navigators to hold [an] agent/producer license,” the association said in a press release.

        “With this in mind, we are recommending legislation that addresses the qualifications of the navigator and clearly differentiates their role from that of a licensed insurance agent,” the association said.

         The association's underlying fear is that a navigator might be a company that gets federal funds to direct patients to its own products.

           Leon notes: “There can be more than one navigator for Florida, but at least one of them must be a 'community and consumer- focused nonprofit.'

         At present many Florida nonprofits in the healthcare sector are studying the regs that navigators must meet – but it's unclear how many will make formal bids.

           Leon says federal regs require entities who want to be navigators need to become experts in eligibility and enrollment details, provide information in a fair, accurate and impartial manner and conduct public education campaigns to make people aware of the exchanges.
             

UPDATE: One anonymous insider notes: “There is a lot of sniffing around going on” among major Florida healthcare nonprofits who are thinking of becoming navigators, but none have announced as of yet and all are said to be looking at each other.

Much more on the jockeying for regulations and bids for participation are likely in coming months. The exchanges can start enrolling people in October, for coverage that begins Jan. 1.

UPDATE: The Washington Post reports that the navigators are going to be a huge undertaking, with California expected to need 21,000 advisers for its state alone. The Post reports that some health agents groups are demanding legislation holding navigators liable for bad advice on picking a plan, because the agents fear that navigators may navigate business away from the agents. 
 

           Much more on the jockeying for regulations and bids for participation are likely in coming months. The exchanges can start enrolling people in October, for coverage that begins Jan. 1.