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
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 | |||
Cognosante | |||
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 | |||
SEEDCO | |||
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 |