CCIIO is trying to clear any confusion on navigators, in-person assistors, application counselors and agents and brokers; small government advocates are making continued arguments against state HIXs; and California gets set to hire 500 for a call center.
Four kinds of consumer help
Amid concerns over public understanding of the Affordable Care Act, CMS' Center for Consumer Information and Insurance Oversight (CCIIO) has been assuring lawmakers and the industry that no matter where consumers live and no matter what government body is running the exchange in their state, there will be ample help in deciding on a health plan.
But there's been some confusion after the HIX consumer assistance policy -- contentious to begin with among traditional brokers and agents -- evolved into several categories of help: navigators, in-person assisters and certified application guides.
In a fact sheet published recently, CCIIO has explained all of these roles and their funding mechanisms, while reassuring brokers and agents that there is still a place for them.
Working for federal, state and state-federal partnership exchanges, navigators will help with enrollment assistance, as well as outreach, and will also refer consumers to insurance ombudsman and consumer assistance programs. They'll be funded through state and federal grant programs.
In-person assistance personnel (IPAs) are "also known as non-Navigator assistance personnel," CCIIO said, and "will perform generally the same functions as Navigators." In state-based exchanges, in-person assisters, or IPAs, will be a part of an optional, transitional program states can set up before their exchanges are financially self-sustaining and before their navigator programs are fully functional. IPAs will also be funded through a separate grants administered through states.
Certified application counselors, meanwhile, are another consumer helper that came out of a proposed rule from CMS. They would "perform many of the same functions as Navigators and in-person assistance personnel," CCIIO said, although "they would not receive funding from the state or federal government for consumer assistance." These counselors would most likely be staff at community health centers, hospitals or nonprofits.
Arkansas group argues against state HIX
While CCIIO and many state health officials forge ahead with exchange implementation and prepare for a summer of education and outreach -- HHS recently inked an $8 million PR contract, on top of two other PR deals totaling $23 million -- some conservative and free market groups are still arguing that exchanges will not be successful and shouldn't be pursued.
In Arkansas, the Governor is expected to sign a bill expanding Medicaid though the HIX, basically extending premium support to people below 138 percent of the federal poverty level, and he is also still pursuing a state-based exchange with the legislature.
A conservative think tank called the Advance Arkansas Institute is one of the groups opposing both those ideas, which are still controversial among state Republicans.
"A state exchange will not increase local policymakers' control over insurance providers or create better customer service," wrote Institute president, Dan Greenberg, a former Republican state representative and the policy director for former Republican Governor Mike Huckabee.
"A state exchange will burden state taxpayers and state budgeters. Unlike a federal exchange, a state exchange will eventually have to be paid for by state taxpayers and consumers," Greenberg said, citing estimates by his group that a state exchange would cost "somewhere in the neighborhood of $50 million yearly."
Also, he argued, as a matter of political strategy, a state exchange "will divert blame onto state officials for rules they did not write and cannot change." If the ACA misses some of its coverage and cost-reduction goals in Arkansas, he said, "it is reasonable to predict attacks launched through town meetings and television commercials which blame state officials for problems they didn't cause, but exchanges did."
California hiring 500 for one of three call centers
While Arkansas and other conservative-leaning states mull the costs and benefits of exchanges and expanded insurance for their low-income residents, California will be one of the states to watch in 2014 for indications of HIX policy, management and enrollment -- with an aim of 5.3 million enrollees.
In preparation for October enrollment, Covered California recently announced that Fresno would be the site of one of three call centers used for consumer assistance. The exchange will be hiring 500 workers for the Fresno call center, which will offer support in English, Spanish, Mandarin, Cantonese, Vietnamese and Armenian.
"We need to have skilled customer care representatives helping individuals and small employers sort through the benefits and federal support, and help them understand the new rules," Covered California executive director Peter Lee said in a media release. "Fresno is a great location for one of our service centers because its diverse workforce mirrors the diversity of the State we need to serve."
The call centers are being funded by federal grants, at least initially, and the other two will be located in Contra Costa County, in the greater Bay Area, and in just outside Sacramento.