Starting in 2014, many of your patients will have new options to receive health coverage through new systems in their state. Some of your patients will soon have the option to enroll in new Qualified Health Plans in the State Insurance Exchange (Marketplaces).
As an HIV care provider, you may be able to identify a member of your staff become certified as an enrollment counselor, and receive training to assist patient enrollment among your patients.
Many systems have been set up to assist in Patient Enrollment nation-wide. The Affordable Care Act established new opportunities to play a direct role in patient enrollment by helping patients understand their new health coverage options and to assisting them in applying for and enrolling in appropriate coverage.
Three of these programs that may be applicable to an HIV care provider team, are the In-Person Assisters, Patient Navigators and Certified Enrollment Counselors.
“Non-Navigator assistance personnel” (also known as “In-person Assisters”) will perform generally the same functions as Navigators but will exist in either a State-based Exchanges or a State-Federal Partnership Exchanges. In-person Assisters will be funded through separate grants or contracts administered by a state. They must also complete comprehensive training.
Certified Application Counselors
The Federally-facilitated Exchanges will designate organizations to certify application counselors who perform many of the same functions as Navigators and In-person Assisters, including educating consumers and helping them complete an application for coverage.
A State-based Exchange may choose to certify application counselors directly rather than designate organizations to do so.
Certified application counselors and Exchange-designated organizations won’t receive new federal grant money through the Exchanges. The counselors and organizations could, however, receive federal funding through other grant programs or Medicaid to help support their consumer assistance and enrollment activities.
Examples of possible certified application counselors include staff at Ryan White clinics, community health centers, hospitals, other health care providers, or social service agencies.
In states that already have their own certification programs, staff at consumer non-profit organizations may also be certified as application counselors by Exchange-designated organizations. All certified application counselors are required to complete comprehensive training.