As the March 31 deadline for people to sign up for health plans under the Affordable Care Act (ACA) looms, those charged with helping customers get insurance in Texas are racing against another deadline: the start of regulations for so-called "navigators" that in some ways make Texas, the most uninsured state, one of the hardest places to get coverage.
Navigators are typically nonprofit employees working under federal grants to spread the word about the availability of private coverage and Medicaid on the online insurance exchanges in every state. Under federal law, they’re allowed to explain benefits and help people sign up for coverage, but they’re not allowed to make determinations about eligibility or actually select a plan for people. About three-quarters of the more than $200 million the federal government distributed to navigators last year went to 1,200 community health centers nationwide.
Texas is among the 17 states that have passed laws placing additional requirements on navigators, according to the Commonwealth Fund, a pro-ACA research organization. Most commonly, those laws have included background check and state registration requirements and restrictions on what navigators can tell consumers about benefits, but Florida has gone as far as to bar them from working on county property. A majority of the states with restrictions have also passed additional training requirements, with Texas mandating the most hours. But the Texas Department of Insurance has yet to sign up any vendors to offer the required training courses, worrying some navigators and policy analysts.
In most of the states that have passed regulations, Republicans control at least one branch of the state government. Texas and Florida, which have some of the most restrictive rules and are both uniformly controlled by Republicans, are home to seven of the top 20 most uninsured counties in the country, according to the State Health Access Data Assistance Center. Opponents of stricter navigator laws call them politically motivated and unnecessary, while backers say they’re needed because federal law doesn’t go far enough to protect and ensure competence.
Texas passed a law before the federal government released its training requirements, giving the state's Department of Insurance the authority to craft regulations afterward. In a move that could have broader implications for states enacting navigator regulations, a federal judge temporarily blocked Missouri's law last month.
The federal government requires 20 to 30 hours of training that includes privacy and security, recertification standards and prohibits navigators from being insurance issuers or industry lobbyists. Texas regulations require another 20 hours of state-specific training, registration with the Department of Insurance, background checks that include fingerprinting and the payment of bonds to cover liabilities. Texas' initial rules -- which required 40 hours of additional training, registration fees and heftier bonds -- were scaled back after contentious public hearings, but they still mandate more training than any other state, according to the Texas Center for Public Policy Priorities.
Texas' deadline for registration and presenting background checks is March 1; the deadline to complete additional training is May 1. The end of ACA open enrollment is March 31, after which the uninsured will be subject to tax penalties. For organizers -- many of whom oversee a dozen or more individual nonprofits -- that means submitting paperwork for everyone in the coalition, paying fees and figuring out where they can get their navigators trained.
“Honestly, yes, it’s a distraction,” said Tim McKinney, president and CEO of the United Way of Tarrant County. “But it is what it is. You have to deal with it, and you have to be positive about it.”
Some organizations require background checks and the state-specific training already, but they’ll have to complete those tasks again for the Department of Insurance. In some areas, the Texas Health and Human Services Commission offers free state-specific training, according to Martha Blaine, executive director of the Community Council of Greater Dallas. But in the areas that it doesn't, she'll have to find a vendor to train her navigators. She's not sure how much training will cost, but fingerprinting will cost $500 total for her 12 navigators. “If they don’t process it in a timely manner, the work stops,” she said. “That’s the concern, and that is an immediate concern because March 1 does put us up against [March 31].”
The Department of Insurance is preparing for the deadline crunch by reprioritizing, but it doesn’t yet have any vendors who have signed up to teach the training courses, according to spokesman John Greeley. Navigator groups such as Blaine's can become certified curriculum providers, as can the state health department, which is considering modifying its Medicaid course to fit the insurance department’s requirements, according to a spokeswoman.
Finding companies and groups to provide continuing education to people working with insurance products who aren’t brokers or agents is new terrain for the department, and it’ll be critical to have a wide number of regional offerings and an online presence to meet the needs of the hundreds of navigators in the state, said Stacey Pogue, an analyst at Texas Center for Public Policy Priorities.
“I think it’ll be challenging for any vendor, in-state or otherwise, to do it in that timeline,” she said.