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HHS announces Obamacare ‘navigators’


More than 100 groups will split $67 million to help people “navigate” the new Obamacare health insurance exchanges — more money than the administration initially said would be available but short of what advocates say will be needed to help people sign up, especially in states where the governors are hostile.

The grants announced Thursday will go to 105 organizations, including community groups, health care providers, business groups and a handful of Planned Parenthood affiliates. The program, which got an extra $13 million from the health law prevention fund, is for those states that refused to set up their own health insurance exchanges, and the federal government is stepping in.

The “navigators” will have to fill in the outreach gaps in Obamacare-resistant states that are doing little to raise awareness of the law. With just 46 days until Obamacare health insurance exchanges open for enrollment, the timeline is also extremely tight for the groups receiving the grant awards to hire navigators and have them undergo mandatory federal training.

And the navigators program could get caught up in yet more Obamacare politics. At least 19 of these states have enacted their own extra requirements for either more navigator training and licensure requirements beyond those required by Washington, according to a report from the Georgetown University Center on Health Insurance Reforms. That’s prompted concerns among Obamacare advocates of more legal skirmishes about state versus federal rules or implementation delays as the enrollment clock is ticking.

“There are definitely pieces of our state law that appear to constrain a navigator’s ability to give all of the advice and support that they are required to under the federal law,” said Lisa D’Souza, a health policy fellow at Missouri’s Saint Louis University School of Law. Missouri has a Democratic governorm, but the state legislature has been vehemently opposed to the national health law.

States that chose to run their own health insurance exchanges have received far more federal funding for on-the-ground help. For example, Maryland — the 19th most populous state in the country — received $24 million from the feds to help with the enrollment push in a separate round of funding announced earlier.

The grants HHS announced Thursday varied. Texas and Florida — two states that the administration has singled out as key to the law’s success — will receive about $10.9 million and $7.9 million, respectively. The single biggest grant — approximately $5.9 million — went to the United Way of Metropolitan Tarrant County, which serves the Fort Worth and Arlington areas of Texas. The group says it plans to work across the state, according to HHS.

Smaller states received less-generous awards. In Alaska and South Dakota, for example, two groups will split about $600,000.

Three Planned Parenthood branches in Iowa, Montana and New Hampshire received a combined $655,000 to serve as navigators. Some states running their own exchanges have also drawn in Planned Parenthood, where many low-income women get health care.

“Navigators will be among the many resources available to help consumers understand their coverage options in the Marketplace,” HHS Secretary Kathleen Sebelius said in a statement. “A network of volunteers on the ground in every state — health care providers, business leaders, faith leaders, community groups, advocates and local elected officials — can help spread the word and encourage their neighbors to get enrolled.”

The health care law forbids navigators from actually recommending what specific health plan or coverage people should purchase. They’re only allowed to help people understand their options and they’re banned from receive compensation from insurers, as agents or brokers can.

The announcement comes as the health law’s critics have cast doubt on the navigator program’s integrity. They question whether there are enough safeguards to exclude bad candidates — either incompetent or malicious — from the program, where they’ll have access to people’s sensitive financial information.

“As of right now, your agency has no realistic plan to prevent identity theft or to provide recourse to consumers when it inevitably occurs,” 13 state attorneys general wrote to HHS on Wednesday.

The navigator program isn’t the only campaign to sign up the uninsured in states shunning the health law. Enroll America, a group of health care stakeholders with close ties to the Obama administration, is making a big education push this summer and fall. Community health centers are sharing $150 million in federal grants to help enroll people. The Obama administration is also enlisting help from agents and brokers, and it’s signed agreementswith several Web brokers to sell exchange plans online.

Jennifer Haberkorn contributed to this report.

 

The “navigators” will have to fill in the outreach gaps in Obamacare-resistant states that are doing little to raise awareness of the law. With just 46 days until Obamacare health insurance exchanges open for enrollment, the timeline is also extremely tight for the groups receiving the grant awards to hire navigators and have them undergo mandatory federal training.

And the navigators program could get caught up in yet more Obamacare politics. At least 19 of these states have enacted their own extra requirements for either more navigator training and licensure requirements beyond those required by Washington, according to a report from the Georgetown University Center on Health Insurance Reforms. That’s prompted concerns among Obamacare advocates of more legal skirmishes about state versus federal rules or implementation delays as the enrollment clock is ticking.

“There are definitely pieces of our state law that appear to constrain a navigator’s ability to give all of the advice and support that they are required to under the federal law,” said Lisa D’Souza, a health policy fellow at Missouri’s Saint Louis University School of Law. Missouri has a Democratic governorm, but the state legislature has been vehemently opposed to the national health law.

States that chose to run their own health insurance exchanges have received far more federal funding for on-the-ground help. For example, Maryland — the 19th most populous state in the country — received $24 million from the feds to help with the enrollment push in a separate round of funding announced earlier.

The grants HHS announced Thursday varied. Texas and Florida — two states that the administration has singled out as key to the law’s success — will receive about $10.9 million and $7.9 million, respectively. The single biggest grant — approximately $5.9 million — went to the United Way of Metropolitan Tarrant County, which serves the Fort Worth and Arlington areas of Texas. The group says it plans to work across the state, according to HHS.

Smaller states received less-generous awards. In Alaska and South Dakota, for example, two groups will split about $600,000.

Three Planned Parenthood branches in Iowa, Montana and New Hampshire received a combined $655,000 to serve as navigators. Some states running their own exchanges have also drawn in Planned Parenthood, where many low-income women get health care.

“Navigators will be among the many resources available to help consumers understand their coverage options in the Marketplace,” HHS Secretary Kathleen Sebelius said in a statement. “A network of volunteers on the ground in every state — health care providers, business leaders, faith leaders, community groups, advocates and local elected officials — can help spread the word and encourage their neighbors to get enrolled.”

The health care law forbids navigators from actually recommending what specific health plan or coverage people should purchase. They’re only allowed to help people understand their options and they’re banned from receive compensation from insurers, as agents or brokers can.

The announcement comes as the health law’s critics have cast doubt on the navigator program’s integrity. They question whether there are enough safeguards to exclude bad candidates — either incompetent or malicious — from the program, where they’ll have access to people’s sensitive financial information.

“As of right now, your agency has no realistic plan to prevent identity theft or to provide recourse to consumers when it inevitably occurs,” 13 state attorneys general wrote to HHS on Wednesday.

The navigator program isn’t the only campaign to sign up the uninsured in states shunning the health law. Enroll America, a group of health care stakeholders with close ties to the Obama administration, is making a big education push this summer and fall. Community health centers are sharing $150 million in federal grants to help enroll people. The Obama administration is also enlisting help from agents and brokers, and it’s signed agreements with several Web brokers to sell exchange plans online.

Jennifer Haberkorn contributed to this report.



Read more: http://www.politico.com/story/2013/08/hhs-obamacare-navigators-95575.html#ixzz2ciPGZ1aZ













South Dakota Reverses Course on ObamaCare

PIERRE, S.D. – Gov. Dennis Daugaard announced today that the state of South Dakota will not operate a state health insurance exchange but will maintain control of insurance regulation in South Dakota.

Unless the federal healthcare law is repealed, a health insurance exchange must be operated in every state by 2014. The federal government will directly operate and fund exchanges in those states choosing not to operate state-run exchanges. South Dakota joins other states that have chosen not to run their own exchanges.

“After extensive research and analysis, it has become very apparent that operating our own exchange will simply not work for South Dakota,” Gov. Daugaard stated.

A cost analysis completed by an independent company found annual operating costs of such a state exchange would range from $6.3 million to $7.7 million, or $2 to $3 per person, per month.

“The federal law requires exchanges to be self-sustaining by 2015, which means we would either have to charge a fee to South Dakota citizens using the exchange, or increase taxes, neither of which I am willing to do,” the Governor said.

Gov. Daugaard added: “I oppose the federal healthcare law because it is a large expansion of government that does little about the rising cost of health care. My first hope is that the next President and Congress will repeal this ill-advised law. In the absence of that, our state must work to ensure that even as the federal government implements this law, the state retains control over the regulation of health insurance. I believe South Dakotans want our own citizens doing the regulation. We do not want to cede control of that to the federal government.”

Group Health Insurance in South Dakota
  • Eligible applicants may not be refused or charged more for group health coverage.
  • Life changes relating to family or unemployment may provide opportunities for group health coverage.
  • Newborn, adopted, and disabled kids have special provisions for insurance.
  • New employers may require a waiting period for new employees.
  • HMOs may require an affiliation period.
  • Providers may review medical history for the six months prior to new coverage to determine the status of pre-existing conditions.
  • In the case of pre-existing conditions, an exclusion period of up to 12 months may be required.
  • If continuous coverage has been maintained, without a break longer than 63 days, creditable coverage may be available.

Small Business Health Insurance in South Dakota

  • Businesses with fewer than 50 employees may not be denied group coverage and may not be cancelled because of sickness in the employee group.
  • Limits may apply to cost of the plan.

Self-Employed Health Insurance in South Dakota

  • The self-employed may not buy group health insurance.
  • Contact the South Dakota Division of Insurance for clarification of regulations that govern business or professional associations offering group health coverage.

South Dakota Division of Insurance
445 E. Capital Avenue
Pierre, SD 57501

http://www.dlr.sd.gov/insurance/

Individual Health Insurance in South Dakota

  • Applicants may be denied due to health problems.
  • In the case of pre-existing conditions, providers may place an exclusion period of up to 12 months or attach an elimination rider to the policy.
  • If continuous coverage has been maintained without a break longer than 63 days creditable coverage toward exclusion periods are available.
  • The definition of creditable coverage varies between individual and group plans.
  • Pregnancy may be classified as a pre-existing condition but not genetic information.
  • There are cost limits on individual policies, but costs may increase at the time of renewal.
  • Coverage may not be cancelled due to illness.
  • South Dakota Risk Pool is available to those who have problems acquiring insurance.

South Dakota Health Care Programs

Medicaid, Children’s Health Insurance Program, and the All Women Count Program provide assistance with health insurance to low income individuals and families.

Location Status of State Exchange Decision Medicaid Expansion Decision Executive Activity
South Dakota Default to Federal Exchange Weighing Options