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Austin - Today (Monday), Senator Sylvia R. Garcia (D- Houston) testified before the Texas Department of Insurance (TDI) regarding the agency’s proposed navigator rules.  Navigators help people sign up for health insurance under the Affordable Care Act.

“While many of the proposed rules provide important consumer protections and appropriate regulation of navigators, I am very concerned that some of the rules create unnecessary, bureaucratic, and financial obstacles for navigators to do their job.  This will result in roadblocks to health care coverage for those who need it most.”

“The fees navigators will have to pay under the rules are excessive.  By my calculation, the City of Houston will have to spend as much as $14,300 for registrations, fingerprinting and training its 16 navigators.”

“In addition to unnecessary fees, I fear the Spanish speaking community will be at a disadvantage.  I would like to see TDI collaborate with Health and Human Services (HHS) to improve Spanish-language training, which I understand is not fully functional.”

“Our ultimate goal, regardless of your party affiliation, should be to ensure that we allow navigators the chance to help eliminate our shamefully high uninsured rate in Texas.”

Statement by State Senator Sylvia R. Garcia

Commissioner Rathgeber, thank you for the opportunity to provide my comments on the proposed rules for regulation of Navigators for Health Benefit Exchanges.

The purpose of the Navigator Legislation, Senate Bill 1795, by Senator Watson (and which I co-authored) is, "to provide a state solution to ensure that Texans are able to find and apply for affordable health coverage under any federally run health benefit exchange, while helping consumers in this state." Navigators and the community-based organizations that received navigator grants are playing a critical role in helping Texans learn about their different health care options and enroll for coverage. While many of the proposed rules provide important consumer protections and appropriate regulation of navigators, I am very concerned that some of the rules you are proposing create unnecessary and bureaucratic obstacles for navigators to do their job and this will result in roadblocks to health care coverage for those who need it most.

Allow me to highlight some of my specific concerns.

  • §19.4014 (5) prohibits navigators from providing advice regarding substantive benefits or comparative benefits of different health plans. This rule will prevent navigators from fulfilling their primary responsibility, which is to advise and guide consumers in understanding and comparing benefits so they can make an informed decision. Insurance is complicated. Consumers need help navigating their options. That is what navigators are intended to do. This is not the same as making a recommendation to a consumer to buy a specific plan. If this rule remains, it essentially strips the purpose of having health navigators in the first place.
  • §19.4014 (1) prohibits navigators from engaging in electioneering activities or finance or otherwise supporting the candidacy of an individual for government positions (including campaigning, persuading, promoting, advertising, or coordinating with any political party, committee, or candidate). I believe it is important for navigators to remain publicly impartial and objective in elections; however, I believe there should be clarifying language that exempts non-partisan voter education, outreach and turnout from this rule. In addition to high uninsured rates, many communities in Texas are also high in voter apathy and this is something that concerns me. Some individuals and entities that are involved in increasing enrollment in the health insurance exchanges may also be interested in increasing voter engagement. Voter engagement, I believe, is a civic responsibility. I request that TDI make this clarification in the rules.
  • §19.4009 outlines navigator education and examination requirements. My concern here is that the additional 40 hours of training required by TDI, on top of the 20-30 hours required by federal training, is excessive. This is far more training than other similar community-based enrollment assistant positions in Texas. The Community Partner Program (Texas Medicaid/CHIP navigator) only requires 4-5 hours of training; the Health Insurance Advocacy and Counseling Program (Medicare counselors) requires 25 hours of training and health insurance agents do not require any training.  A preliminary analysis by CPPP of the ACA navigator training requirements in other states appears to show that the proposed Texas rules would require many more hours than any other state. Other than Texas, Wisconsin has the highest requirement with 16  hours of state training on top of federal training.  Texas is proposing more than twice as many additional state training hours. Additional state-specific education may be necessary above what the federal government requires; however, I strongly suggest that TDI look at existing training requirements for similar community-based enrollment assistant positions and work with HHSC, other relevant state agencies, and the navigator entities to develop and implement appropriate training and testing that is not duplicative and excessive.
  • §19.4015 limits use of the term "navigator" unless registered with the department as a navigator entity or an individual navigator. This is a widely used term that has been in use for various programs even before it was used in the Affordable Care Act legislation. The rules should be amended to clarify that the prohibition only applies within the context of health insurance application assistance.
  • Furthermore, I am concerned that the navigator rules are overly broad and may be interpreted to require registration of anyone - family members, neighbors, co-workers, a clergyperson, even legislative staff - who is simply offering personal assistance to another. I ask that this be clarified.
  • The additional fees that will have to be paid by navigator individuals and navigator entities are a huge concern to me, and I would like to see these fees eliminated. Navigator entities have received set amounts of grant money from the federal government to help provide free assistance to the poor and uninsured. They are prohibited from charging these individuals any fees for the services they provide. The additional fees which will range from $320 to $980 are excessive and burdensome. By my calculation, the City of Houston with its 16 navigators will have to spend as much as $14,300 for registrations, fingerprinting and training. Where will the navigator entities get the additional funding in the next few months to implement the TDI requirements?  What I see is that these fees will divert money to TDI from federal grants that are meant to provide services to the poor. Furthermore, TDI was not authorized by SB 1795 to charge these fees.
  • I am pleased to see that the federal training modules include how to provide culturally and linguistically appropriate services; however, if possible, I would like to see TDI collaborate with HHS to improve the Spanish-language training modules which - I hear from advocates - are not fully functional. Additionally, I recommend that TDI allow a 50% extension of time on the state exam for those who speak English as a second language. This is an accommodation that HHS allows for the federal exam and I think it would be appropriate for the state exam, too.
  • I want to underscore the concern of many navigator entities that the evidence of financial responsibility may be excessive or unnecessary. For example, in the case of the City of Houston, and other government entities, which can self-insure, the requirements in the proposed rules are not necessary.
  • Lastly, the implementation date should be extended until after the enrollment period ends when navigators have time to begin the training and registration process. Under the proposed rules, navigators must comply with most of the requirements by March 1, 2014, which is the start of the last month of enrollment. These last three months are a critical time for enrollment activity and I believe the March 1 implementation date largely serves to slow down and undermine the process of enrolling individuals.

These are all my comments. Thank you for taking the time to have this additional hearing and to take public comments. I trust that you will carefully consider each and every one of our comments and work to strengthen the rules and truly adhere to the intent of the Affordable Care Act and SB 1795.  Our ultimate goal here should be to ensure that we allow navigators to do their job responsibly and eliminate our shamefully high uninsured rate in Texas. I ask for your cooperation in this.