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Small Business Employee Benefits and HR Blog

New Frequently Asked Questions FAQ on Health Insurance Exchanges

Last month, the Department of Health & Human Services (HHS) issued a new series of Frequently Asked Questions (FAQs) that are intended to answer questions states may have about Affordable Care Act-related subjects, including state-based and federally facilitated exchanges, Medicaid expansion and market reforms.FAQ Health Insurance Exchanges resized 600

Topics the FAQ document addresses include:

  • Deadlines for a state to apply for a state-based or state partnership exchange;

  • Whether a state can partially expand Medicaid;

  • Whether a state has a deadline to expand Medicaid;

  • Whether a state will be charged fees for using federally managed data services to support an exchange;

  • A state's role in a federally facilitated exchange;

  • The proposed monthly user fee for federally facilitated exchanges;

  • Whether Temporary Federal High-Risk Pools (Pre-existing Condition Insurance Plans) will operate after 2014;

  • HHS's plans for exchange-related consumer outreach activities;

  • The development of a streamlined consumer application for use on exchanges and in Medicaid and CHIP; and

  • The display of qualified health plans on a federally facilitated exchange.

The following two questions and answers (copied and pasted below) stood out to me. Which Q&As did you find most helpful?  

#18. How does HHS plan to operate the Navigator program for the Federally-Facilitated Exchanges? How many and what types of Navigators will there be in a particular state? What will their roles be? Can states require Navigators to hold a producer license? If not, what type of training or certification will they receive?

Section 1311(i) of the Affordable Care Act directs an Exchange – whether a State-Based
Exchange or a Federally-Facilitated Exchange – to establish a program under which it awards grants to Navigators. Section 1311(i) and 45 C.F.R. section 155.210 articulate the required duties of a Navigator. In addition, section 155.210(c)(2) directs that the Exchange select two different types of entities as Navigators, one of which must be a community and consumer-focused non-profit group. This program is further described in the “General Guidance on Federally-facilitated Exchanges.”

The number of Navigators per state served by a Federally-Facilitated Exchange will be contingent upon the total amount of funding available as well as the number of applications that we receive in each state in response to the forthcoming Navigator Grant Funding Opportunity Announcement that we plan to issue early next year to support the Federally-Facilitated Exchanges.

Additionally, a state or Exchange cannot require Navigators to hold a producer license (i.e., a license as an agent or broker) for the purpose of carrying out any of the duties required of Navigators in section 1311(i)(3) of the Affordable Care Act and 45 C.F.R. section 155.210(e). Because the law directs Navigators to carry out all required duties, linking a producer license to any one of those specific duties would have the effect of requiring all Navigator entities, their employees, and their sub-grantees to hold a producer license. As described above, this would prevent the application of the standard set forth in 45 C.F.R. section 155.210(c)(2) that at least two different types of entities must serve as Navigators. As such,and as provided by section 1321(d) of the Affordable Care Act, any state laws which would require all Navigators to hold a producer license would be preempted by 45 C.F.R. section 155.210(c)(2). 

In Federally-Facilitated Exchanges and State Partnership Exchanges, individuals selected to receive Navigator grants or working for entities selected to receive Navigator grants must successfully participate in an HHS-developed and administered training program, which will include a certification examination pursuant to 45 C.F.R. section 155.210(b). In addition, under state law, states may impose Navigator-specific licensing or certification requirements upon individuals and entities seeking to operate as Navigators, so long as such licenses or certifications are not preempted by the requirement to award to different types of entities identified in 45 C.F.R. section 155.210(c)(2), such as producer licenses.

#31. Will low-income residents in states that do not expand Medicaid to 133 percent of the FPL be eligible for cost sharing subsidies and tax credits to purchase coverage through an Exchange?

Yes, in part. Individuals with incomes above 100 percent of the federal poverty level who
are not eligible for Medicaid, the Children’s Health Insurance Program (CHIP) or other
minimum essential coverage will be eligible for premium tax credits and cost sharing
reductions, assuming they also meet other requirements to purchase coverage in the Exchanges.


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