State in­sur­ance panel: Switch cov­er­age ‘nav­i­ga­tors’

Northwest Arkansas Democrat-Gazette - - NORTHWEST ARKANSAS - ANDY DAVIS

The Arkansas Health In­sur­ance Mar­ket­place should so­licit a new set of con­tracts from or­ga­ni­za­tions that will help peo­ple en­roll for in­di­vid­ual cov­er­age dur­ing the open-en­roll­ment pe­riod that starts Nov. 1, a state panel rec­om­mended Wed­nes­day.

On be­half of the mar­ket­place, the Bos­ton-based Pub­lic Con­sult­ing Group hired two or­ga­ni­za­tions that pro­vided 15 out­reach work­ers, known as nav­i­ga­tors, from Oct. 1 through June 30.

The con­sult­ing firm paid the or­ga­ni­za­tions, En­roll the Ridge of Jones­boro and Fu­ture Builders of Wrightsville, a to­tal of $552,000 and was then re­im­bursed by the mar­ket­place from fees the mar­ket­place be­gan col­lect­ing from in­sur­ers in De­cem­ber.

That ar­range­ment al­lowed the nav­i­ga­tors to start work in time to help peo­ple en­roll dur­ing last year’s en­roll­ment pe­riod, which ran from Nov. 1 through Jan. 31.

Be­fore it started col­lect­ing the fee, the mar­ket­place’s only source of fund­ing was from a fed­eral grant that could not be used to pay the nav­i­ga­tors.

At a meet­ing Tues­day of the mar­ket­place board’s Con­sumer As­sis­tance Com­mit­tee, mar­ket­place spokesman Ali­cia McCoy said that Pub­lic Con­sult­ing Group, which did not charge a fee for ad­min­is­ter­ing the nav­i­ga­tor con­tracts, did not want to con­tinue its role in the ar­range­ment.

“It’s not prof­itable for them,” she said.

The com­mit­tee rec­om­mended that the board so­licit pro­pos­als di­rectly from or­ga­ni­za­tions and award new con­tracts.

The com­mit­tee didn’t say how much money should be spent, but McCoy said af­ter the meet­ing that the mar­ket­place prob­a­bly will try to con­tinue sup­port­ing 15 nav­i­ga­tors.

Jim Miles, founder of En­roll the Ridge, said his or­ga­ni­za­tion plans to sub­mit a pro­posal. Un­der its con­tract that ended June 30, he said, nav­i­ga­tors fielded in­quiries from about 13,000 Arkansans and helped about 10 per­cent of them en­roll.

Of the 1,300 who signed up, he said, about two-thirds qual­i­fied for cov­er­age un­der the state’s ex­panded Med­i­caid pro­gram, known as Arkansas Works. The rest signed up for non-Med­i­caid plans on the state’s health in­sur­ance ex­change.

A call to Fu­ture Builders’ of­fices wasn’t re­turned on Wed­nes­day.

Cre­ated by the state Leg­is­la­ture in 2013, the mar­ket­place set up a state-run ex­change for small-busi­ness health plans in 2015 us­ing money from a $99.9 mil­lion fed­eral grant.

At the re­quest of Gov. Asa Hutchin­son dur­ing his first year in of­fice, the mar­ket­place scrapped its plan to use the re­main­ing grant money to es­tab­lish an en­roll­ment sys­tem for in­di­vid­ual con­sumers.

In­stead, the agency took over re­spon­si­bil­ity for cer­ti­fy­ing the plans sold on the in­di­vid­ual ex­change and pro­vid­ing in­for­ma­tion to con­sumers while con­tin­u­ing to rely on the fed­eral en­roll­ment sys­tem that al­lows con­sumers to sign up through health­care.gov.

The 2010 Pa­tient Pro­tec­tion and Af­ford­able Care Act re­quires ex­changes to have nav­i­ga­tor pro­grams and pro­hibits them from us­ing ex­change grants to pay for their op­er­a­tions.

In ad­di­tion to con­sumers sign­ing up dur­ing the new open-en­roll­ment pe­riod, Arkansans who seek help from nav­i­ga­tors could in­clude about 60,000 peo­ple who would be moved off Arkansas Works un­der a pro­posal by Hutchin­son that was en­dorsed by the Leg­is­la­ture this year.

The change, which has been sub­mit­ted for fed­eral ap­proval, would limit Arkansas Works el­i­gi­bil­ity to adults with in­comes at 100 per­cent of the poverty level, in­stead of 138 per­cent of the poverty level.

Most of those af­fected would be el­i­gi­ble for fed­eral tax cred­its to help them buy cov­er­age on the ex­change. That as­sis­tance is avail­able to many peo­ple who don’t qual­ify for Med­i­caid and have in­comes of up to 400 per­cent of the poverty level.

If the state’s pro­posal is ap­proved, Hu­man Ser­vices Depart­ment of­fi­cials have said they will ter­mi­nate cov­er­age for Arkansas Works re­cip­i­ents at a rate of about 5,000 a month start­ing early next year.

If the com­mit­tee’s rec­om­men­da­tion is ap­proved by the full board at its meet­ing on Fri­day, the mar­ket­place’s plans call for it to is­sue a re­quest for pro­pos­als from nav­i­ga­tor or­ga­ni­za­tions on Mon­day and award con­tracts on Sept. 15.

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