State’s Navigator Rule Could Impede Health Insurance Enrollment

Last week, the Texas Department of Insurance released proposed rules on “navigators”—community organizations like the United Way that help uninsured people apply for health insurance.  As proposed, the rules could prevent or delay the important work of navigators.  Fort Worth Star Telegram editors agree, noting that the rules will impede insurance enrollment and hinder progress on reducing Texas’ worst-in-the nation uninsured rate.
But, there are many good provisions in the rules as well.  They could work as intended—to increase consumer protections without hindering the vital work of trained and certified navigators—if the department modifies the proposed rules to address the key concerns listed below.
The rule could prevent a navigator from helping consumers understand and compare the benefits so that consumers can make an informed insurance choice.  Explaining and comparing the features of different health plans (the premium, deductible, provider network, covered medications, etc.) is NOT the same thing as recommending a consumer buy a specific plan.  Navigators need to be able to help consumers compare and understand insurance options, without recommending which plan to purchase.
The rule could shut down navigator services as of March 1, when demand will spike in the final month of open enrollment.  As proposed, navigators must comply with the rule by March 1, 2014.  Once the rule is final, navigators could have just a month (or less) to jump through many hoops.  This timeline is too short for navigators to accomplish at least two time-consuming, bureaucratic necessities that are completely outside of navigators’ control:

  1. obtaining advance federal permission to deviate from the navigator’s grant budget finalized back in August (processing takes 30-60 days),  and
  2. getting through TDI’s registration system (processing could take 2-3 weeks).

When you combine these steps with the other hurdles navigators have to clear to come into compliance, the full process could take three months.  The rules should ensure that navigators can continue to provide their vital services while they work in good faith toward compliance.
Nonprofit navigators will have to pay excessive and unnecessary fees for the privilege of providing free application assistance to the poor and uninsured.  TDI estimated some of the various costs imposed for compliance could add up to to $900 per individual navigator, on top of an additional $1,400 per navigator organization.  A navigator organization that oversees 30 navigators could incur about $30,000 in costs in the first year—possibly about enough to support a full-time navigator.  Every dollar diverted from enrollment assistance leaves fewer resources to serve Texas’ 6.4 million uninsured.
The 40-hour state training requirement (on top of the 20-30 hour federal training requirement already fulfilled by Texas navigators) is excessive and unjustified.  TDI’s rules require 60-70 hours of total training for ACA navigators, and the agency says extra state training will cost navigators $200-$800 per person.   ACA navigators will be held to a much different standard than HHSC Medicaid/CHIP navigators and other community-based enrollment assistors, who perform very similar services.  For example, it takes about four hours to complete the free HHSC navigator training that prepares community groups to help people enroll in Medicaid, CHIP and other programs through the Community Partner Program.  Community Medicare counselors in HICAP (also certified by TDI) receive 25 hours of free training.
The rule applies well beyond navigator grantees under the Affordable Care Act.  For example, the proposed rule would require a mother helping her young adult son with an application for insurance to first complete an expensive and time-consuming registration with the state.  The rule would also prevent organizations and individuals who provide basic information on health coverage programs (including the ACA, Medicaid, or CHIP) from using the term “navigator” as a job title if they do not go through the state registration process.  Many health care-related organizations use the term “navigator” today (like patient navigators and cancer navigators) to describe the individuals who help patients understand and connect with health care and coverage.
We have created a flowchart to help organization and individuals determine if TDI’s proposed rules will affect them, and we plan to release additional resources related to the proposed navigator rule over the next few weeks.  Make sure to check our website for these updates.
TDI is accepting public comments on the proposed rule through January 6, 2014.  Written comments submitted via email must be sent to both and  Or you can provide written or oral testimony at either of the two hearings TDI is holding on these rules in Austin on December 20 and January 6.

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