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April 2012 St@teside

How States are Addressing the Navigator Program Requirement under the ACA

Under the Patient Protection and Affordable Care Act (ACA), states implementing health insurance exchanges have to meet certain requirements to receive federal certification as a state-based exchange. Among those requirements is the establishment of a Navigator program. Navigators will play a critical role in helping people who will purchase health insurance through a state-based exchange to learn about their options and assist with enrollment. At the same time, for states considering the Partnership Model approach to exchange implementation, the Navigator program may be an area the state wants to assume responsibility. Several states have begun to think through how to set up their Navigator programs:


On April 5, 2012 the Maryland legislature approved HB 443—The Maryland Health Benefit Exchange Act of 20121 which, among other important policies, creates separate Navigator programs for the Small Business Health Options Program (SHOP) exchange and the individual exchanges (See Maryland Takes Next Step Toward Implementation of Exchange).

  • SHOP Exchange: Producers can obtain authorization and training to sell plans in the exchange and be paid commissions by carriers as they do now; navigators must obtain a special SHOP navigator license issued by the insurance commissioner (not a full-blown producer’s license, but subject to training and regulatory authority of commissioner), as well as training and authorization from the exchange.
  • Individual Exchange: Producers can obtain authorization and training to sell plans in the exchange and be paid commissions by carriers as they do now; navigators obtain training and certification from the exchange but are subject to regulatory authority/sanctions by the Insurance Commissioner.


The Minnesota Health Insurance Exchange Advisory Task Force’s (Task Force) Navigators and Brokers Work Group was charged with three key issues to consider and to make recommendations to the larger Task Force on: navigator roles and responsibilities, certification/licensure requirements, and compensation. The work group delivered 10 recommendations including:

  • The Navigator program should support the creation of different navigator roles, with appropriate responsibilities, designed to address the specific needs of the particular populations served by the exchange. This set of roles includes the role played by agents/brokers.
  • The Navigator program should develop certification/training requirements that align with the defined navigator roles and level of service provided. This process should support sufficient navigator capacity and allow for different entities to serve in any of the navigator roles, based on ability to meet the established requirement.
  • Compensation levels for navigators should align with the different types of services being offered within each navigator role and provide flexibility for performance based compensation models.

The work group is still working through operational issues and financing mechanisms related to how navigators and brokers will be compensated. The Task Force’s recommendations made it into introduced legislation at a very high level.


Based on research exploring consumer and stakeholder opinions about the role of navigators developed for the Washington Health Care Authority (HCA), the HCA made recommendations on the ideal qualities or traits for navigators and the types of entities or organizations that are best suited to act as navigators. The HCA recommendations include:

  • Ensure navigators are knowledgeable about all aspects of the exchange, including the benefits and costs of all plans offered and eligibility requirements of tax credits, subsidies, and Medicaid.
  • Navigators must be able to explain options in simple, lay-person terms and be viewed as trustworthy sources of impartial information.
  • Navigators need to offer support in a variety of mediums (online, telephone, and in-person), and be easily accessible to the communities they serve during and after the enrollment process.
  • A diverse array of navigators will be necessary to serve the diverse array of consumers. Residents also reported an interest in getting help from a navigator in places in which they receive their health care, such as a doctor’s office or clinic, or directly from a health insurance plan.

Washington, D.C.

After receiving approval of its exchange bill, the District is now looking for public comment on how to create the Navigator program. A hired consultant has set up a survey to gather opinions on how the program should be designed.

1The bill has been sent to Governor Martin O’Malley, who is expected to sign it.