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Health Care Advocates Question Ohio’s Navigator Rules

In preparation for the health care exchange element of the federal Affordable Care Act, the government will designate groups as navigators to help guide people through the system. But as Ohio Public Radio's Andy Chow reports in the final installment of his two-part series, there are non-profit groups who say an Ohio law leaves them out of the process.

Soon the federal government will announce which groups can operate as navigators in Ohio, these are people who will help answer consumer questions about the Affordable Care Act and the health plans Ohioans can choose.  Navigators are different from insurance agents and brokers because they can’t promote or sell insurance plans.

But the rules for navigators in Ohio are being called into question.

Kathleen Gmeiner, project director with Ohio Consumers for Health Coverage, says there are going to be non-profit organizations that already perform work similar to that of navigators but won’t receive this federal designation.

Congress created a special designation for such a situation. Groups that want to help people find coverage but will not receive funding as a navigator can become Certified Application Counselors.

KG:  We know that they have solid status under federal law as long as they go through the federal training and get approved. But right now—their status under state law is ambiguous.

Gmeiner is talking about the certification process created by the Ohio General Assembly earlier this year. The law requires navigators to be trained and to undergo a background check. It also exempts hopsitals, foodbanks, and community health centers.

But Gmeiner fears that other non-profits that seek to be Certified Application Counselors might be in violation of the law since their role isn’t clearly defined in the navigator rules.

Lieutenant Governor Mary Taylor, who’s also head of the Ohio Department of Insurance, says the Certified Application Counselor designation is brand new. How new? It just went into effect Monday.

MT:  Our approach at this point is not to just jump in and immediately say we need to regulate them but more say—we’re going to take a step back—we’re going to carefully monitor the environment in Ohio and make sure we don’t have concerns or issue from a consumer protection perspective.

So Taylor says it’s up to the federal government to certify these application counselors and urged again that the state does not have any specific regulations for this designation.

However, Taylor adds that the state has an ability to create regulations if needed.

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