County Health Departments – Possible “Navigators” in Health Care?

During a MACo meeting with key legislators last week, MACo Board member and Baltimore City Councilwoman Rikki Spector asked Delegate Pendergrass, Vice-Chair Health and Government Operations Committee, about the local role in the new Maryland Health Benefit Exchange.  Specifically, Councilwoman Spector asked if a local health entity would be the place where consumers come to obtain coverage through the Exchange, called a “navigator” in the new system.

Delegate Pendergrass recently followed up on that question with information provided by the Department of Legislative Services on the structure of the system, the responsibilities of a navigator in the system, and the potential funding implications of becoming a navigator.

The structure of the navigator system was recently defined by the Maryland Health Benefits Exchange (MHBE) Board of Directors.  As described by the Department of Legislative Services,

At its Nov. 13, 2012 meeting, the MHBE Board of Directors decided on a regional distribution of navigator entities in the Individual Exchange.  One navigator entity will be appointed in each of 6 regions in the State.  A navigator entity may be a single organization or a partnership of organizations.  Funding for the navigator entities will be through a block grant with performance incentives.  MHBE is still figuring out the details on this but expects to issue a grant solicitation in December 2012 and award grants in April 2013.

Referencing the Maryland Health Benefit Exchange Act of 2012, the Department of Legislative Services describes that navigators must “have expertise in working with vulnerable and hard-to-reach populations; and conduct outreach and provide enrollment support for these populations.”  The specific responsibilities of a navigator may be more flexible, however.  As described by the Department of Legislative Services,

The Exchange has flexibility under the law to authorize an Individual Exchange navigator entity to carry out all of the responsibilities under the navigator program or to limit the authorization just to certain services.  Also, the Exchange may require an Individual Exchange navigator entity, under a contractual agreement, to provide education, outreach, and other consumer assistance services in addition to the services provided under the authorization.  The Exchange may not authorize an Individual Exchange navigator entity to provide services that result in a consumer’s enrollment in Medicaid or the Maryland Children’s Health Program without the approval of the Department of Health and Mental Hygiene (DHMH).

DHMH foresees funding local health departments who become navigators through the Maryland Health Benefits Exchange.  To receive funding, a local health department would need to give up any existing Medicaid eligibility grant, however.  As described by the Department of Legislative Services,

With regard to local health departments, the Department of Health and Mental Hygiene is taking the position that, if a local health department becomes a navigator entity, the local health department would be funded through the MHBE to provide eligibility and enrollment for Medicaid but would have to give up its existing Medicaid eligibility grant.  If a local health department does not become a navigator entity, it could keep its existing Medicaid grant for providing Medicaid eligibility services and would be expected also to support the navigator entity in providing individuals a seamless entry into coverage.  DHMH will meet with the local health officers to discuss the issue, before making a final decision.

Last week’s meeting took place as a part of a larger series of meetings between MACo’s Board and leadership in General Assembly and Governor’s Administration.  MACo’s meeting with House leadership was an opportunity to share MACo’s legislative initiatives and ask for the support of the Delegates on issues affecting local governments.  Other participants in the meeting included Norman Conway, Chair House Appropriations Committee, Dereck Davis, Chair House Economic Matters, Sheila Hixson, Chair House Ways and Means Committee and James Malone, Vice Chair House Environmental Matters Committee.

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