State OKs rules for health insurance navigators

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A new workforce of so-called health insurance “navigators” — called for by the Affordable Care Act — will have to undergo special training and be licensed by Georgia’s insurance department, according to new state rules.

The navigators will help uninsured Georgians make sense of dozens of health plans that will be available through a new online insurance marketplace, called an exchange, that’s set to open Oct. 1. Nearly 900,000 Georgia consumers are expected to shop on the federally run exchange — a key part of the health law’s aim to provide health coverage to millions of Americans.

The exchange will cater to people who don’t get insurance through work, such as students, the unemployed and the self-employed.

The rules stem from a state law passed last spring that’s aimed at ensuring the navigators are knowledgeable about the exchange website and the insurance policies that will be sold on it, as well as the state’s Medicaid and PeachCare for Kids health programs. Navigators also will help consumers determine if they qualify for federal subsidies.

The state will not be hiring navigators, but it has an interest in their abilities.

“I want to make sure that individuals who provide insurance advice to Georgia citizens are qualified to do so,” Georgia Insurance Commissioner Ralph Hudgens said in a statement.

Navigators must complete at least 35 hours of training, be licensed and participate in continuing education classes for license renewal, according to the department. Up to 25 of those hours may come from education provided by the federal government, which also has training requirements for navigators.

They also will be fingerprinted and undergo a criminal background check, as is required of insurance agents and brokers.

Nonprofit and community groups that will be hiring the navigators worry the additional training hours and licensing fees required by the state may hinder their ability to train the new workers.

“We have some concerns that placing too many hoops in the way of navigators can potentially limit their ability to carry out this really important job,” said Cindy Zeldin, executive director of the advocacy group Georgians for a Healthy Future.

Zeldin said that while some state training for navigators makes sense, state officials need to be flexible in how they implement the new rules and gather input from consumer groups.

More than a dozen states, including Tennessee, have added state rules for navigators on top of what’s already required by the federal government. A national survey by CVS Caremark found that 78 percent of consumers who would be eligible for new health coverage under the Affordable Care Act had never heard of the state insurance exchanges.

Federal officials will announce next month $2.8 million in grants to Georgia organizations to hire navigators. The groups will then have six weeks to hire and train the navigators. The exchange will open for business this fall with health plans purchased on it taking effect Jan. 1.

The state insurance department must be ready to communicate with navigators right away about how and where to get training, Zeldin said. The federal grant dollars won’t be enough to hire as many navigators as Georgia will likely need, so it’s critical that navigators are trained and ready to go on Oct. 1.

“It’s going to be a really tight timeline, that’s for sure,” she said. “We can’t lose a day.”