NC encourages health care 'navigators' at county health sites

jmurawski@newsobserver.comSeptember 19, 2013 

— North Carolina health officials have cleared local social service agencies to help the public shop for subsidized insurance under the Affordable Care Act.

The local health departments are bracing for an influx of people seeking help and advice on Oct. 1, the beginning of a six-month enrollment period for mandatory insurance under the new health care law. The complex law includes federal subsidies to offset household insurance costs, as well as fines for those who don’t get insured.

As many as 1.5 million people in North Carolina will begin shopping for health insurance, the N.C. Department of Health and Human Services said in a letter this week to all county social service and public health directors.

Although North Carolina officials disavowed the Affordable Care Act earlier this year and won’t cooperate in promoting the law, they are open to social service agencies allowing trained “navigators” at their facilities to assist the public.

The navigators, funded by federal grants, are part of the new law’s outreach and enrollment program.

“We encourage all Social Services Agencies to allow navigators to work onsite if your facility can accommodate them,” DHHS wrote to the agencies on Wednesday.

“This will provide valuable assistance to those who are interested in purchasing a plan through the federal exchange.”

Earlier this year, North Carolina officials, in deciding not to cooperate with the Affordable Care Act, declined to extend Medicaid coverage to about a half-million people here.

As a result, many of those people will remain without coverage.

States that are actively promoting the Affordable Care Act received substantial federal grants for outreach and enrollment. North Carolina turned away about $27 million in federal assistance for promotional activities.

As a result, North Carolina’s outreach and enrollment are being handled by hospitals, nonprofits, volunteers and local agencies. Those efforts will receive about a quarter of the federal funding the state would have received if officials here had endorsed the program.

Still, North Carolina officials have not taken proactive steps to interfere with the health care law as have some other states. Florida and others have passed laws establishing licensing requirements for the “navigators” who will be trained to coach the public on the intricacies of the law.

Florida, which requires fingerprinting and background checks for navigators, also has banned navigators from promoting the health law at county health departments.

Ricky Diaz, spokesman for the state health department, said that allowing navigators at county offices is “the right thing to do.” The county public health and social service agencies are not bound by the state health department’s letter, however, and can turn away navigators or can help explain the law’s requirements to the public.

The lack of state involvement and uncertainty over which counties will participate in promoting the Affordable Care Act slow down the implementation of the health law and is also believed to discourage insurance companies from participating.

In North Carolina, only two insurers will sell subsidized policies: Blue Cross and Blue Shield, and Coventry Health Care of the Carolinas.

The Affordable Care Act primarily affects who are uninsured or those who buy individual policies. People who have coverage through their employers, Medicare or Medicaid are generally in compliance with the federal insurance mandate.

The Wednesday memo from the N.C. Department of Health and Human Services also encouraged local health agencies to sign up eligible children for Medicaid.

Small protest in Raleigh

Still, about 20 protesters rallied before the state agency Thursday morning to express frustration that state officials are doing little to promote the new health care law.

With less than two weeks to go before enrollment begins for subsidized insurance, polls show that a significant portion of the nation’s population is ignorant about or confused by the new law.

The Raleigh protest underscored the lingering anxiety here and elsewhere about chronic delays in implementing the complex health law. Without state government backing, outreach efforts in this state will likely be uneven across North Carolina’s 100 counties.

“People are coming to understand the benefits of Obamacare,” said Brenda Cleary, a Cary nurse who works as a health care consultant. “Some of them will have health insurance for the first time in their lives.”

Murawski: 919-829-8932

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