Expanding health care coverage in the state under the federal Affordable Care Act will be a massive undertaking that will require hiring hundreds of people to help guide thousands of Arkansans through an entirely new system for obtaining health insurance.
Mention has often been made of the "navigators" who will help enroll people in the state’s health insurance exchange, a marketplace where people and small businesses can shop for insurance plans that suit their needs. In fact, the navigators will be just one of four different categories of helpers involved in the process in Arkansas.
The four categories will be:
Navigators will be hired with federal grant money and will educate and assist consumers in the use of the exchange.
"Generally, what they’ll do is outreach education," said Cynthia Crone, who is in charge of planning for the state’s insurance exchange. "They will assist people with enrollment and they will do post-enrollment consumer assistance, like helping people get to complaint resolution or appealing if they need to."
The U.S. Department of Health and Human Services recently announced $54 million in grants for navigator programs in various states including Arkansas, which is eligible for $797,059.
How many navigators will be hired in the state and how much they will be paid are yet to be determined. The federal government will make those decisions.
Guides will perform the same tasks as navigators, but they will be hired by governmental and nongovernmental entities that will contract with the state Insurance Department.
The agency will use federal insurance exchange funding to award the contracts. It has budgeted about $17 million to spend on contracts for the first enrollment period and has budgeted for hourly wages of $12, although the vendors will determine the actual salaries.
Insurance Department officials previously said they expected 535 guides to be hired, but that was before the Arkansas Legislature approved the so-called "private option" for expanding health care coverage.
Under the private option, an estimated 250,000 currently uninsured Arkansans earning up to 138 percent of the federal poverty level —$15,856 for an individual or $32,499 for a family of four — will receive federal subsidies to buy private insurance through the exchange instead of being added to the state Medicaid rolls.
The Insurance Department also expects that during the first enrollment period, which runs Oct. 1, 2013-March 31, 2014, an additional 211,000 people will enroll in the exchange and buy insurance using federal subsidies that are available to people earning between 138 percent and 400 percent of the federal poverty level.
Because adoption of the private option had increased the number of people who will enroll in the exchange, the number of guides who will be needed is now expected to be between 600 and 800, Crone said.
Certified application counselors
Certified application counselors, or CACs, will perform many of the same functions as navigators and guides, but they will be employees of entities such as hospitals, community health centers or consumer nonprofit organizations. They will be paid by their employers.
How many CACs will be involved in the process is not yet known.
Agents and brokers
Insurance agents and insurance brokers will function more or less the way they do now. Of the four categories of helpers, only agents and brokers will be allowed to advise consumers on what specific plans may be best for them. They also will be the only ones allowed to receive commissions from the insurance companies, which will be the only pay they receive.
"I would guess at least 1,000 licensed agents will want to do this across the state, but we don’t know yet," Crone said.
Training for all four categories of helpers will be provided through the state’s two-year colleges, under an inter-agency agreement between the Department of Higher Education and the Insurance Department. Federal grant money will pay for the training.
The training will vary according to category, with agents and brokers needing the least extensive training because they already work in the insurance field and receive continuing education. All four types of helpers will be licensed by the Insurance Department and will receive competency testing.
Some have questioned whether the work of the navigators and guides will go as smoothly as Insurance Department officials hope.
"I’m interested to see how the navigators and guides are going to be received by the general public," said Rep. Bruce Westerman, R-Hot Springs, who opposed health care expansion in the Legislature.
"My understanding is they’ll more or less go door to door and sign people up," he said. "The Affordable Care Act is still not too popular here in this state."
Crone said she has heard concerns that some may be suspicious of the navigators and guides and reluctant to give them personal information. She said the information will be kept confidential.
"But that doesn’t keep people from being skeptical, and we’ll do everything we can to educate the consumer on who’s the real deal, who can you trust," she said.
Westerman also said the program sounds "extremely bureaucratic."
"It sounds like just another part of big government to me," he said.
State Insurance Commissioner Jay Bradford said hiring people to help Arkansans enroll in the exchange is not creating a new bureaucracy.
"It’s going to be privatized," he said. "It’s going to be necessary if we’re going to educate the people how to connect with the process and navigate all these different facets."
Having everything in place to begin enrollment by Oct. 1 and enrolling hundreds of thousands of Arkansans by March 31 of next year may seem a daunting task, but Crone said she is confident it will happen.
"I have no qualms about telling you it is very hard," she said. "It’s going to be an uphill battle, it’s going to be difficult to train, it’s going to be not perfect in year one. But it will get better."