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Grants for Insurance Exchange Enrollment Navigators
May 13, 2013

The Department of Health and Human Services Center for Consumer Information and Insurance Oversight (CCIIO) issued a funding opportunity announcement, Cooperative Agreement to Support Navigators in Federally-Facilitated and State Partnership Exchanges with responses due by 1:00 p.m., June 7. Total funding of $54 million is available for an anticipated 100 awards nationwide.

The Affordable Care Act requires health insurance exchanges to award grants to organizations that facilitate education and enrollment in qualified health plans (QHPs). These organizations are known as navigators. This opportunity is open to eligible entities and self-employed individuals. At least two types of navigators must be available in each exchange. One must be a community- and consumer-focused nonprofit. The other may include trade, industry, and professional associations; chambers of commerce; unions; resource partners of the Small Business Administration; licensed insurance agents and brokers; tribal organizations; state or local human services agencies; and other public or private entities. Navigators must not receive any direct or indirect consideration from a health insurance issuer connected to the enrollment of individuals into QHPs or non-QHPs. Those serving as navigators must have expertise in eligibility and enrollment rules and procedures, the range of QHP options and insurance affordability programs, the needs of underserved and vulnerable populations, and privacy and security standards. They must:

  • Maintain expertise in eligibility and enrollment and conduct public education about the exchange;
  • Provide information and services in a fair, accurate, and impartial manner, including information about Medicaid and the Children’s Health Insurance Program;
  • Facilitate selection of a QHP;
  • Provide referrals to any applicable office of health insurance consumer assistance or ombudsman for grievances, complaints, or questions regarding health plans; and
  • Provide information in a manner that is culturally and linguistically appropriate to the needs of the population served.

Services must be provided to individuals seeking assistance, even if they are not members of the community that the navigator expects to serve.

Funding apportioned to Pennsylvania is $2,071,458 to serve an estimated 1,242,351 individuals under age 65. To view the announcement, access http://www.grants.gov and select Find Grant Opportunities, then Basic Search. Enter the funding opportunity number CA-NAV-13-001.

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