Aug. 19—Eight hospitals and health Systems qualified for federal funding to serve as "navigators" steering the uninsured to insurance coverage.

The U.S. Department of Health and Human Services (HHS) awarded 105 navigator grants Aug. 15 to organizations in the 34 states in which the federal government will operate all or part of coming health insurance marketplaces.

Awardees included a range of community and advocacy organizations, including four health systems and four hospitals.

Navigator grants to health systems totaled $368,389 for Ascension Health (total of two states), $265,713 for Genesis Health System (two states), $157,271 for Sinai Health System, and $590,985 for Health and Hospital Corporation of Marion County. The HHS navigator grants to hospitals totaled $452,590 for Mercy Hospital and Medical Center, $352,320 for Randolph Hospital Inc., $124,419 for Children's Hospital Medical Center, and $401,281 for Memorial Hospital of Laramie County.

The Role of Navigators

Navigators funded by the Affordable Care Act will help uninsured people obtain coverage through either Medicaid or the individual and small group marketplaces. They will receive training and salaries through the grants to explain coverage options without encouraging applicants to select any specific option.The federal government provided separate funding for similar assistors in states establishing their marketplaces.

Hospitals and other providers that perform navigator functions will not be prevented from receiving payment for medical services or grants for unrelated purposes, according to an HFMA analysis of rules governing the navigators. However, hospitals will need to disclose these payments to the marketplaces and to consumers receiving application assistance.

Application Counselors Needed

In July, HHS began accepting applications for organizations to certify application counselors, which will perform many of the same functions at navigators for applicants to both the state operated and so called partnership marketplaces. Hospitals are among the providers qualified to serve in application counselor certification role.

Hospitals or health systems with health plans within their corporate structure are not prohibited from participating as certified application counselors as long as employees of the health plan are not involved and they disclose the conflict of interest to the marketplace and potential enrollees, according to the HFMA analysis.

The navigators and other types of enrollment assisters are subject to federal privacy and fraud statutes, in addition to penalties and restrictions established by some states.

Publication Date: Monday, August 19, 2013