CMS unveils final rule for ACA’s navigator program

Individuals working in the Affordable Care Act’s “navigator” program for the law’s health insurance exchanges must be affiliated with certain community organizations according to a final rule released by CMS. The rule outlines training and certification requirements for the program’s workers. In addition, the workers must undergo at least 30 hours of training to before they can be qualified as a “certified application counselor”.  

Exchanges that operate solely by or in partnership with the federal government are required to have at least two certified navigator entities, one of which must be a not-for-profit. HHS has allocated $54 million in funding grants to train and pay navigators in the 37 states with federally run exchanges.

The final rule states that traditional insurance agents cannot be selected as navigator workers. Navigators can provide information only about specific topics, such as:

  • The exchanges’ qualified health plans and insurance affordability programs;
  • The tax implications of enrollment decisions;
  • Eligibility for premium tax credits; and
  • Cost-sharing reductions.

States with their own exchanges can establish more rigorous selection and training requirements for in-person assisters. For example, Maryland requires such workers to undergo at least 120 hours of training.

2013-07-17T00:00:00+00:00 July 17th, 2013|Advocacy|