Laura Colbert, executive director of Georgians for a Healthy Future, agreed the issues of drug prices and transparency, coupled with the role PBMs play in the equation, will come up…
Open enrollment into the new health insurance marketplace, or exchange, begins in just under six months (October 1, 2013) for coverage starting in January 2014. Georgia has one of the highest numbers of uninsured in the nation (1.86 million), and many of these uninsured Georgians will be able to access health care coverage for the first time through the marketplace.
According to research from Enroll America, however, more than three-quarters of the uninsured don’t know about the new health insurance marketplace. Multiple surveys have also found that when uninsured individuals learn about the new health insurance options that will become available to them through the marketplace, they say they will need help navigating the process.
That’s why the new navigator program is so important. Last week, the U.S. Department of Health and Human Services (HHS) released a funding opportunity announcement inviting organizations and individuals to apply for the navigator program. Groups may apply individually or as a consortium, although HHS is encouraging the consortium approach. Navigator responsibilities include:
- Maintain expertise in eligibility, enrollment, and program specifications;
- Conduct public education activities to raise awareness about the Exchange;
- Provide information and services in a fair, accurate, and impartial manner. Such information must acknowledge other health programs (such as Medicaid and the Children’s Health Insurance Program (CHIP));
- Facilitate selection of a Qualified Health Plan;
- Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under Section 2793 of the Public Health Service Act, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and
- Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange, including individuals with limited English proficiency, and ensure accessibility and usability of Navigator tools, such as fact sheets, and functions for individuals with disabilities in accordance with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act used in Holistic Drug and Alcohol Treatment centers and other similar types of organizations.
For entities interested in applying for the navigator funds, letters of intent (optional but recommended) are due on May 1, 2013 and applications are due to HHS on June 7, 2013. To learn more about the navigator funding opportunity, click here.
Nearly 100 of you joined us last week for a meeting to begin discussing how consumer and community-focused nonprofit organizations can work collaboratively to maximize enrollment in Georgia. The meeting also was an opportunity for organizations considering applying to HHS for the navigator grants to network with each other and see if there were opportunities to submit joint applications. To those of you who were unable to join us, here are the resources and materials that were shared:
- HHS navigator funding opportunity announcement
- Georgians for a Healthy Future’s navigator fact sheet
- Enroll America’s enrollment assisters fact sheet
- Enroll America’s navigator and in-person assistance programs
- Enroll America’s bridging the enrollment gap: the importance of providing in-person assistance
- Enroll America’s power point presentation
- Seedco’s power point presentation
- Webinar power point presentation