Help shape the future of the Connector program

Maryland Health Benefit Exchange logo

Here’s your chance to give us your thoughts and opinions on our Connector Program. Take this survey and let us know your preferences.

Purpose

The Maryland Health Benefit Exchange is distributing a Request for Information (RFI) to help determine how the current Connector program should change and improve for the future.   The Exchange seeks input from a wide range of stakeholders, including existing Connector Entities and certified staff.  We welcome detailed input into how the Exchange can best operationalize future Navigator functions and meet the requirements outlined in the ACA and State law.

This Request for Information is composed of an online survey with an option to submit written comments and additional materials through email.  Responses must be received by 5:00 PM Eastern time on Tuesday, September 8, 2015.  The information collected through the RFI will be used to develop the requirements for the future Connector program.

Background

The Patient Protection and Affordable Care Act (ACA) provided federal grant funding for States to establish a health benefit exchange to help connect consumers and employers to Qualified Health Plans (QHPs).  MHBE established the Connector Program in 2013, and it is currently in the third year of operation.

Section 1311(i) of the ACA requires Exchanges to establish a Connector Program to perform the following functions:

  • Conduct public education activities to raise awareness of the availability of Qualified Health Plans;
  • Distribute fair and impartial information concerning enrollment in Qualified Health Plans and the availability of premium tax credits and cost-sharing reductions in accordance with federal laws;
  • Facilitate enrollment in Qualified Health Plans;
  • Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman or any other appropriate state agency or agencies, of any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such a plan or coverage; and
  • Provide information in a manner that is culturally and linguistically appropriate to meet the needs of the population being served by the Exchange.

On May 2, 2012, Governor O’Malley signed into law the Maryland Health Benefit Exchange Act of 2012 (MHBE Act) that further established policies of Maryland’s Exchange to ensure compliance with the ACA by January 1, 2014. The MHBE Act defines the roles of Navigators within the Maryland market by separating SHOP and Individual Navigators, as well as separating Navigators from producers within the market. It requires the Individual Navigator Program to provide eligibility and enrollment support for Medicaid and the Maryland Children’s Health Program (MCHP) in addition to the qualified plans in the Exchange. The MHBE Act defines the certification, authorization and licensing requirements of each and requires the Exchange to develop a training program to support specific areas.

A brief summary of the MHBE Act is below and excerpts are provided for reference in the “Information Requested” Section. The complete MHBE Act can be found at: http://mlis.state.md.us/2012rs/chapters_noln/Ch_152_hb0443T.pdf.

 

Individual Exchange Connector Program
Overview of Program A Connector Entity is responsible for reaching out to and enrolling uninsured individuals and to provide seamless entry into all health plans and programs on the Individual Exchange.  Outreach is focused on individuals who do not have insurance. MHBE contracts with Individual Navigator Entities, including community based organizations and other entities familiar with vulnerable and hard-to-reach populations. The entities ensure that services are provided via Certified Navigators or Assisters, consistent with state and Federal law.
Connector Entity A Connector Entity enters into an agreement with the Exchange to provide the services required of the Individual Navigator Program, as well as other activities as directed by the Exchange.
Certified Navigator Individual Navigators assist consumers with choosing plans offered on the Individual Exchange. Certified Individual Navigators are able to discuss tax subsidies and support plan selection. The Individual Navigator certification limits the Navigator to provide information for plans offered on the Individual Exchange.  Must receive certification from Exchange.
Authorized MHC Producer Must receive authorization from the Exchange to assist consumers with choosing plans offered on the Individual Exchange. Authorized producers may offer plans outside of the Exchange under current MIA license.  Producers are paid directly by carriers.
Assister Not explicitly defined in statute. The law contemplates Navigator Entities hiring non-certified personnel to conduct certain activities. These non-Navigator personnel can: (1) perform outreach and education duties, (2) facilitate eligibility determinations and redeterminations for Medicaid and MCHP, and (3) provide ongoing support with the application and dis-enrollment processes for MAGI Medicaid. Assisters are not authorized to assist with Qualified Health Plan selection and/or participate in individual subsidy discussions.

 

Timeline and Submission Details

Again, the online survey may be accessed through the following link:

https://www.research.net/r/ConnectorStakeholderFeedback

Respondents may submit written comments and additional materials by email at: connector.mhbe@maryland.gov.  Please use “Stakeholder Feedback” as the subject.