On April 9, 2013, the Center for Medicare & Medicaid Services (CMS) released a Funding Opportunity Announcement for health insurance marketplace navigators. The release came one week after the HHS released proposed rules for navigators. Eligible self-employed individuals and private and public entities can apply to serve as Navigators in the 33 states with a Federally-facilitated or State-Federal Partnership health insurance marketplace. CMS anticipates that each state will be awarded at least two grants.
Federal Navigator Funding Opportunity Summary
The navigators, which CMS envisions as individuals and entities that will provide consumers with unbiased information about exchanges, health insurance plans, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program, are a brand-new role in the healthcare industry.
The CMS announcement states that applicants must be “self-employed individuals and private and public entities" and lists several eligible groups including trade, industry and professional associations, chambers of commerce, unions, licensed insurance agents and brokers, state or local human services agencies, etc. As with other releases, CMS notes that during their term as navigators, individuals and entities are not permitted to receive any direct or indirect consideration from a health insurance issuer connected to the enrollment of individuals into Qualified Health Plans (QHPs) or non-QHPs.
Ineligible entities include health insurance issuers, subsidiaries of health insurance issuers, associations that include members of, or lobbies on behalf of, the insurance industry, or recipients of any direct or indirect consideration from any health insurance issuer in connection with the enrollment of any individuals or employees in a QHP or non-QHP.
CMS anticipates that each state will be awarded at least two grants, one of which will go to a well-established non-profit. Amounts will vary by state population with the largest award expected to go to Texas. The awarded grants will initially provide funding for one year. CMS will train the navigators, but navigators must also comply with state licensing or certification requirements.
Federal Navigator Funding Opportunity - Amounts of Grants
The funding opportunity provides up to $54 million in total funding. Grants will range from $600,000 to $8.1 million based on the number of uninsured lawfully residing residents in the state. Thirteen states will receive the minimum funding level of $600,000 while Florida and Texas will receive a large portion of the funding at $5.8 and $8.1 million respectively.
A list of states with the number of uninsured residents can be found in the application.
Federal Navigator Funding Application
Those who are interested in applying for navigator funds must submit a letter of intent by May 1 with the final application due June 7. Grant award recipients are expected to be announced by August 15, coinciding with the launch of navigator training and the certification process.
As we've discussed previously, it is important to note that health insurance agents and brokers do not need to become navigators to assist their clients with exchange-based coverage. It appears that in many states, agents and brokers will be able to work with their clients and then receive compensation through the health insurance carriers just as they do today. However, final rules have yet to be released for the federally-facilitated marketplace.
To access the funding opportunity announcement, visit www.grants.gov, and search for CFDA #93.750.