With less than three months to go before open enrollment begins, many Ohioans still lack the help they were promised to learn about their eligibility and options on the state’s federally-run health exchange established under the Affordable Care Act.
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The Affordable Care Act requires state exchanges to establish a “navigator” program that will help people who are eligible to purchase coverage through the state health exchange learn about their new coverage options and enroll.
States will be awarded federal grants to award to entities that will provide these services:
- To conduct public education about the availability of qualified health plans. Qualified health plans must meet certain standards, and they are certified to sell in the exchange. Some qualified plans may be sold both inside and outside of an exchange, depending on state law.
- To distribute fair, impartial information about enrollment in qualified plans and about the availability of premium tax credits and cost-sharing assistance in the exchange.
- To facilitate enrollment in qualified plans.
- To refer people who need help resolving a problem with their health plan or with their premium assistance to a consumer assistance or ombudsman program or to another appropriate agency that can help with a grievance or appeal.
- To provide information in a culturally and linguistically appropriate manner to the population being served by an exchange.
Since Health and Human Services’ Secretary Kathleen Sebelius has not yet established standards for the navigator program, it is not clear whether each entity receiving a navigator grant must perform all five functions, or if, for example, a state might provide some navigator grants that are just for outreach and others that are for enrollment.