Advocates Question Ohio Health ‘Navigators’ Rules

An Ohio legislative panel has cleared new state rules for professionals guiding people through the insurance marketplaces created by the federal health care law, despite concerns from some consumer groups that the regulations create confusion.

The rules stem from a new state law that governs who can be a so-called insurance navigator and what duties they can perform.

Under Ohio’s law, individuals or businesses can’t act as navigators unless they are certified by the state and receiving federal funding. But the rules grant leeway to food banks, certain health centers, hospitals and others.

The exemption in the rules could complicate efforts by religious organizations and community groups who already assist people with government programs, such as Medicaid, said Kathleen Gmeiner, project director for Ohio Consumers for Health Coverage.

Gmeiner told the Joint Committee on Agency Rule Review that the exemption puts nonprofits and others at risk for penalties and could hurt those providing charitable services aimed at helping people get health care coverage. She says the insurance department should rework the rules so the groups aren’t harmed.

“Nonprofits cannot operate under fear of a fine being imposed while they carry out their routine duties,” she said during a Monday hearing.

Consumers can get private health insurance, subsidized by the government, through the online exchanges. Open enrollment starts Oct. 1 and coverage takes effect in January. Republican Gov. John Kasich opted to let the federal government run Ohio’s exchange.

An official with the state’s insurance department told the panel that as long as the entities weren’t purporting to be navigators, they could continue to provide services under a safe harbor in the rules.

“What we’re saying is, if you do not hold yourself out as a navigator, you will not trigger the statute,” said Michael Farley, the department’s assistant director for legislative affairs. He said the agency also was considering additional exemptions.

The regulations specify the certification and training requirements of the counselors, who also must complete a background check and a comprehensive exam.

Navigators can advise people on whether they’d be eligible for Medicaid. But they are banned from selling, soliciting and negotiating health insurance under the state’s law. They also can’t offer advice about which health benefit plan is better, worse or suitable for a person.

It’s unclear how many navigators Ohio will have.

Gmeiner’s group has estimated federal funding would support 60 to 70 navigators – fewer than one per county.

People can find a plan on their own, without using the services of a navigator. Though some might prefer to have someone walk them through the process.

An estimated 524,000 Ohioans are expected be enrolled in the insurance exchange designed for individuals by 2017, according to a report prepared for the state’s insurance department by the consulting firm Milliman Inc.

Topics Ohio