This blog was prepared by Mickie Newby, Public Policy intern at United Way and University of Washigton graduate student in the School of Social Work

The Affordable Care Act (ACA) will significantly expand insurance coverage to all Americans through two major mechanisms: the Health Benefit Exchange (HBE) and Medicaid expansion. This much-needed step toward providing more equal access to health care through affordable coverage does not go without challenges.  Many individuals who become eligible for coverage through the ACA may not be aware of their eligibility or know how to apply.  Moreover, some populations, such as the homeless and legal immigrants, face additional barriers to accessing coverage.  Washington’s Navigator program was created to address these challenges.

October through December of this year marks the first open enrollment period for the HBE.  The Navigator program will be responsible for ensuring that all those who are newly eligible, especially hard-to-reach populations, are informed of their eligibility and have assistance with the application process.

Lead Agency and Navigator Organization Responsibilities

Washington’s Navigator program operates on three organizational levels: lead agencies, navigator organizations, and navigator representatives.  Both lead agencies and navigators can deliver services.

The lead agency is responsible for building Navigator networks, coordinating outreach and education efforts, training Navigator staff, monitoring performance and quality, and identifying vulnerable populations.  Lead agencies will be distributed according to geographic location and population.  They will be compensated by the Exchange based on their activity and performance (50%) and on outcomes or enrollments in Medicaid and the HBE (50%). RFP’s for lead agencies will be released in the next few weeks, selections will occur by May and contracting and training will take place in June and July. Public Health Seattle King County will apply as a lead agency for King County.

Navigator Organizations and Navigator Representatives do the groundwork for reaching and enrolling vulnerable populations.  They will be responsible for outreach, community awareness and education, one-on-one application and enrollment assistance, and service coordination.   Public entities, call centers and organizations that already work with target populations are encouraged to apply as navigators.  Navigator organizations must fulfill training and certification requirements.  Apart from offering assistance in traditional service locations, navigators may also go into less traditional sites, such as churches, libraries, and other community areas to do outreach. RFP’s for potential navigator organizations will be available in several weeks.  Navigator Organizations will be selected by lead organizations in June and trained by late September.

For a visual layout of the structure and elements of the Navigator program see slides 4-13 of this presentation prepared by the Washington Health Benefit Exchange.