Assistance for Health Insurance Enrollment

The Affordable Care Act’s (ACA’s) requirement that all individuals have health insurance coverage by the end of March 2014 prompts the current widespread search for health insurance coverage. Recent changes in Medicaid eligibility requirements, state-to-state variation in Medicaid coverage, and new health insurance marketplaces create a daunting environment as parents embark on their search to find the appropriate health insurance for themselves and their children. In anticipation of this challenge, the ACA and some states are funding a variety of consumer assistance programs to help families navigate the plethora of health insurance changes.

The ACA provides health insurance consumer assistance via navigators, in-person assisters (IPAs), certified application counselors (CACs), and federally qualified health centers (FQHCs).  The assistance programs vary from state to state based upon which marketplace model the state has chosen and which additional consumer assistance programs the state chooses to implement. The federal government requires that assisters receive specified training (federal training for navigators and CACs) before they can assist consumers with enrollment in Medicaid, the Children’s Health Insurance Program (CHIP), or Marketplace plans.  States may add additional training requirements for their designated assisters. The goal is to provide a knowledge base for all assisters to correctly direct consumers to the appropriate health insurance agency or Marketplace regardless of where the consumer first seeks coverage. Assisters within Medicaid agencies and the Marketplace will have training in both Medicaid and Marketplace coverage program requirements, will screen consumers for eligibility in both programs, then make the appropriate referral. This will hopefully allow quick enrollment for families and children and expedite access to healthcare. For more information on assistance programs and individual state initiatives to educate the public, providers, and assisters on eligibility requirements see the article from State Health Policy, “Medicaid Agency Training for Consumer Assisters in Federally Facilitated Marketplace States.” 

by Shae Anderson, MD


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