Taking Stock and Taking Steps: A Report from the Field after the First Year of Marketplace Consumer Assistance under the ACA

Appendix 1. A Typology of Marketplaces and Marketplace Assisters

As the insurance reforms created by the Affordable Care Act (ACA) were being implemented, a variety of categories emerged for both the insurance Marketplaces through which insurance policies were purchased and the infrastructure created to assist consumers on the Marketplaces.


Marketplaces have established territories, one for each state or territory, and fall into three groups

State-Based Marketplaces (SBMs) in which the Marketplace operates under state auspices and the assistance infrastructure is the responsibility of state government or — in some jurisdictions — delegated to a nonprofit entity that governs the Marketplace. SBMs were established in 16 states and the District of Columbia.

Federally-Facilitated Marketplaces (FFMs) in which the Marketplace operates under the auspices of the federal government (overseen by CMS, the Center for Medicare and Medicaid Services) and the assistance infrastructure remains under federal authority, but implemented through grants to private organizations and government agencies working within each state. Marketplaces in 29 states operated as FFMs.

Consumer Assistance Partnership Marketplaces (FPMs) in which the Marketplace operates under federal auspices, but the consumer assistance infrastructure is under state authority. FPMs were established in five states.

Assisters and Their Financial Support

Navigators have their roles and responsibilities defined under the ACA to conduct outreach to inform state residents about assisters’ availability, to assist participants on the Marketplaces with insurance enrollment, help them to make better informed choices about their health plan options, and to refer all enrollees who subsequently have disputes about insurance coverage or benefits to Consumer Assistance Programs (CAPs), established under a separate section of the legislation. Navigators are to be funded through revenues generated by the Marketplaces. Because there were no revenues in the initial year, Navigators in FFMs and FPMs were funded through grants from CMS; the equivalent assisters in SBMs were funded through Marketplace establishment grants and referred to as In Person Assisters (IPAs). All told, these represented 29% of the Assister Programs operating during the first year of enrollment in the Marketplaces.1

Certified Application Counselors (CACs) operated under a less stringent set of expectations and with less advanced training than did their navigator counterparts. Nor were they funded through the Marketplaces – about half ran entirely on funds diverted from the budget of their parent organization (typically a health care facility or community-based organization), others received financial support from state or local government or through foundation grants. These represented 45% of all Assister Programs during the first year of enrollment.

Assisters in Federally Qualified Health Centers (FQHCs) work out of the 1,159 FQHCs throughout the US. Roughly three-quarters of the FQHC assisters trained as CACs, one-fifth as navigators. They are funded by the Health Resources and Services Administration (HRSA) in the federal Department of Health and Human Services. These represented 26% of all Assister Programs during the first year.

Appendix 2. Roundtable Participants

Representatives of the following agencies and organizations participated in the 2014 Consumer Assistance Roundtable:


Altarum Institute
American Cancer Society
Asian & Pacific Islander American Health Forum
California Health Care Foundation
California Wellness Foundation
Care Share Health Alliance North Carolina
Center for Public Policy Priorities
Center on Budget and Policy Priorities
Center on Children and Families
Colorado Connect for Health Assistance Network
Community Catalyst
Community Services Society, NY
Cone Health Foundation
Consumer Health Foundation
Consumers for Affordable Health Care, Maine
Consumers Union
District of Columbia Health Benefits Exchange
Enroll America
Families USA
Georgetown Center for Children and Families
Georgetown Center on Health InsuranceResearch
Get Covered Illinois
Grantmakers in Health
H&R Block
Health Care Access Maryland
Healthcare Georgia Foundation
Illinois Ever Thrive
In the Loop
Jewish Healthcare Foundation
Kaiser Family Foundation
Kentucky Equal Justice Center
Kentucky Voices for Health
Maine Health Access Foundation
Missouri Foundation for Health
NAACPNational Disability Navigator Resource Collaborative, American Association on Health and Disability
National Immigration Law Center
New York State Health Foundation
National Health Law Program
New Jersey Citizen Action
North Carolina Justice Center
Northern Virginia Family Services
Office of Healthcare Advocate, Connecticut
Pennsylvania Health Access Network
Planned Parenthood
Princeton University
RI Parent Information Network
Robert Wood Johnson Foundation
SRA International
St. Luke’s Initiative (AZ)
The Colorado Health Foundation
The Health Foundation of Greater Indianapolis, Inc.
The Healthcare Foundation of New Jersey
The Mt. Sinai Health Care Foundation
University of WisconsinU.S. Center on Consumer Information andInsurance Oversight
U.S. Center for Medicaid and CHIP Services
U.S. Center for Medicare and Medicaid Services,Office of Communications
U.S. Health Resources and Services AdministrationUtah Health Policy Project
Vermont Health Connect
Williamsburg Health Foundation
Yale University
Young Invincibles

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