Enrollment Counselors

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).

My Patients & Enrollment

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.

Enrollment Counselors

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.

Patient Navigators

Patient Navigators are single entities that will be funded through state and federal grant programs, and must complete comprehensive training. In August 2013 the Centers for Medicare & Medicaid Services (CMS) announced its grant awards to fund Navigator programs in both state partnership and federally –facilitated insurance marketplaces. Grants were awarded to public organizations (national, regional, or state-based), private entities, and self-employed individuals to serve as Navigators.

Navigators will be responsible for guiding consumers through all coverage options offered through exchanges and the entire enrollment process. They will help consumers prepare electronic and paper applications to establish eligibility and enroll in coverage through the Exchange. This includes steps to help consumers find out if they qualify for insurance affordability programs (including a premium tax credit, cost sharing reductions, Medicaid and the Children’s Health Insurance Program), and if they’re eligible, to get enrolled.

The Navigators in federally-run Exchanges will complete federal training and certification. In a State-based Exchange, Navigators will be required to have state training and certification, though federal training may also be used. Under the state-federal Partnership Exchanges option federal training are required and may be supplemented by the state.

In-Person Assisters

“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.