HHS Awards Navigator Grants

On August 15, 2013, the Department of Health and Human Services (“HHS”)  awarded $67 million in Navigator grants to 105 Navigator groups, which was $13 million more than HHS initially stated it would award.  Indiana received a total of $2,043,596 in grants split between the following four (4) groups: (1) Affiliated Service Providers of Indiana, Inc. ($897,150); (2) Plus One Enterprises, Ltd, LLC ($130,875); (3) Health and Hospital Corporation of Marion County ($590,985); and (4) United Way Worldwide ($424,586).  Illinois received a total of $3,060,471 in grants split between eleven (11) Navigator groups.  A complete list of the Navigators awarded grants is available here.

Navigators are the [entities or individuals] organizations that facilitate education about and enrollment in qualified health plans (“QHPs”) through Exchanges.  Pursuant to Section 1311(i) and 1321(c)(1) of the Patient Protection and Affordable Care Act (“PPACA”), the grant awards were distributed exclusively in those States that chose not to operate a state-based Exchange and will instead participate in the Federally-facilitated Exchanges or State Partnership Exchanges. 

As described in the Initial Announcement of the funding opportunity for federal Navigators, issued back on April 9, 2013, the total number of awards was going to depend on the number of consumers each applicant proposed to service.  The total funding apportioned to each State with a Federally Facilitated Exchange or State Partnership Exchange would be no less than $600,000.  The Initial Announcement anticipated at least two types of applicants in each Exchange would receive an award, with at least one award being given to a community and  consumer-focused nonprofit.  

The regulation implementing PPACA §1311(i) requires that entities or individuals serving as Navigators have expertise in eligibility and enrollment rules and procedures; the range of QHP options and insurance affordability programs; the needs of underserved and vulnerable populations; and privacy and security standards.  In addition, the Initial Announcement required that in order to be eligible to apply for the Navigator grant, entities or individuals “must be capable of carrying out, at a minimum, certain required duties to include maintaining expertise in eligibility, enrollment, and program specifications; conducting public education activities to raise awareness about Exchanges; facilitating selection of a QHP; providing information and services in a fair, accurate, and impartial manner; providing referrals to any applicable office of health insurance consumer assistance or ombudsman established under Section 2793 of the Public Health Service Act to address consumer grievances, complaints, or questions about their health plan, coverage, or a determination; and providing information in a manner that is culturally and linguistically appropriate to diverse communities and accessible to individuals with disabilities.”  In addition to these duties, the Initial Announcement also requires award recipients to assist any consumer seeking assistance, even if that consumer is not a member of the community(ies) or group the applicant expects to serve. 

The awards are structured as Cooperative Agreements, which is defined in 31 U.S.C. 6301 as an alternative assistance instrument to be used in lieu of a grant whenever substantial Federal involvement with the recipient during performance is anticipated.  HHS intends to work with each Navigator award recipient to evaluate its progress relative to its Navigator Work Plan and may condition funding based on progress and adherence to Federal guidance and Exchange requirements including training, conflict of interest and adherence to Culturally and Linguistically Appropriate Services (CLAS) standards.  The period of performance is the 12 months beginning on the date of the award, August 15, 2013.   

If you have any questions on Navigators or Navigator grants please contact Meghan Linvill McNab at mmcnab@kdlegal.com.