Thursday, October 18, 2012

Some thoughts about the Health Benefit Exchange Navigator Program

I had a flashback to the early 2000s while reading The Crider Group's District of Columbia Health Benefit Exchange Navigator Program Analysis: The Role of Navigators in the District of Columbia Health Benefit Exchange (PDF).   Several themes in this Crider report for the Department of Health Care Finance mimic those in the Robert Wood Johnson Foundation-funded Covering Kids (CK) and later Covering Kids & Families (CKF) program.   Consider the Crider recommendations:
  • We suggest that the role of Navigators be limited to the functions identified in the Act initially. Since community based organizations (CBOs) are required to be one of the Navigator entities, additional services such as case management and social service support are currently being provided by some of these entities. These entities are best qualified to continue to provide these services and are already trusted by the community to do so. Additionally adding these services to the Navigator functions will not only result in duplicated services but is also likely to increase the cost of the Navigator Program.
  • The District would also benefit from allowing Navigators to target their services to specialized populations. Allowing Navigators to specialize in serving specific populations would allow Navigators to serve populations they are comfortable with and reduce the "learning curve" related to serving populations they are not familiar with.

DC's Covering Kids and Covering Kids & Families, part of a national movement to successfully implement the State Children's Health Insurance Program (SCHIP or CHIP), part of the Balanced Budget Act of 1997.   According to a 1997 analysis by the Center for Budget and Policy Priorities,

The legislation establishes a new child health block grant, through which $20.3 billion in new federal funds will be made available to states over the next five years for the purpose of reducing the number of uninsured low-income children... In addition, states may use the block grant funds to expand coverage under their state Medicaid programs to reach additional low-income children. (Emphasis added)

The District took advantage of the ability to expand access and chose to provide insurance in a Medicaid-like program, DC Healthy Families, to children and adults in the household up to 200% of poverty.   So how did Crider mimic CK/CKF?   The core of DC's Covering Kids program were the pilots, housed at community-based organizations.   Organizations were selected for their expertise with a target population.   Mary's Center, for example, was chosen to house the Immigrant Populations Pilot.   Mary's Center had experience with Spanish and Amharic-speaking residents.

The District is home to a diverse mix of immigrants from Central and South America, Africa, the Middle East and Asia. The District's immigrant community was selected as a Covering Kids pilot community because of its unique barriers to social services in general and health care services in particular. Some barriers are as simple as inability to communicate with Medicaid caseworkers or read relevant materials because of language differences. (Southern Institute summary of DC pilots)

It was during the early days of implementing CHIP and the myriad improvements in the application and application process that the Economic Security Administration (then the Income Maintenance Administration, IMA) in the Department of Human Services promoted the "Medicaid first" idea.   And while the Health Benefit Exchange is not promoting Medicaid first, community-based Navigators and their home agencies will, for sure, promote "health insurance first."

I hope the lessons learned from DC's Covering Kids and Covering Kids & Families will contribute to the development of the Navigator program for DC's implementation of health care reform.   A lot of money and a great deal of effort went into making DC a leader in CHIP enrollment.

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