Individual Experience Advisory Group July 24, 2012

2 Agenda Welcome & Introductions10 min Policies70 min –Navigators Consensus from 1 st discussion Funding and Compensation models Training, Certification, and Oversight models Upcoming policy topics5 min Wrap-up 5 min

3 Definitions Navigator Program The state-wide program charged with overseeing the selection, funding, training and oversight of navigator entities. Navigator Entities Organizations in Colorado that meet specific criteria and receive funding through the Navigator Program to carry out education and enrollment activities related to health insurance coverage. Navigators Navigators are persons who work for navigator entities and are authorized to: educate consumers across the state about health coverage options available in Colorado, answer questions related to coverage options, assist people through the application and enrollment process for state medical programs and qualified health plans. Other ideas for navigator names: assistors, education and enrollment specialists

4 Consensus Areas 1.Certified Navigator entities will be expected to have the capacity to provide both education and enrollment services to their target populations. 2. Some organizations should be allowed to provide education/outreach services, and not enrollment, to help facilitate higher enrollment into the Exchange. A distinction should be made between these groups and certified navigators. 3. Under the umbrella of the state-wide Navigator program, COHBE should develop distinct programs for the Individual Exchange and the SHOP Exchange. However, the group said they believed navigator organizations should be able to be certified to provide services to small businesses for SHOP should they want to do so. 4. A competitive grant process would be a good approach to use in the selection of navigator entities. 5. COHBE should conduct a needs assessment to inform the development of the Navigator program that incorporates feedback from stakeholders and the Board.

5 Legal requirements According to federal law, States are to provide grants to entities that will serve as Navigators Navigator grants must come from the operational funds of the Exchange; federal funds received by the State to establish the Exchange cannot be used If a state chooses to permit Navigators to perform or assist with Medicaid and CHIP administrative functions, Medicaid or CHIP agencies may claim Federal Funding for a share of expenditures incurred for such activities

6 Funding Models 1 st phase: Needs assessment, training and certification Federal grant funding Foundations and private sources Leverage existing funding sources targeting education and enrollment 2 nd phase: Outreach and enrollment; ongoing training, certification and oversight Foundations and private sources Revenues generated through Exchange Leverage existing funding sources targeting education and enrollment

7 Compensation models Award grants to certified navigator entities (most states) Broker compensations (different from certified navigators) would be comparable inside and outside Exchange (MA, NC) Pay for enrollment (CA) Flat commission fee per employee per month (Utah)

8 Training models Training programs developed through partnerships between state agencies, nonprofits, universities, foundations Regular training available for new navigator entities and also for continuing education Training models could be delineated between certified navigators (i.e. would require more in-depth training) and education/outreach Organizations Required to pass exam and engage in continuing education

9 Certification models Could be provided through Exchange Could be provided and/or enforced through DOI Could require licensing that is different from broker licensing requirements

10 Oversight models Navigator entities required to report on enrollment activities, outreach efforts and submit self assessments on performance benchmarks semi-annually or annually Regular audits If conflict of interest is identified, navigator entities required to submit documentation

11 Upcoming policy topics Single Streamlined Application Aug Customer Service Center Aug/Sept Consumer Rights & ResponsibilitiesSept