'Navigator' set to help with ACA exchanges

Published on Thursday, 7 November 2013 23:28 - Written by

Lisa Williams is hitting the ground running as a navigator—a community worker hired by the state who is tasked with guiding people through the Affordable Care Act’s health insurance exchange application process.

She began her job last week, after about three weeks of training. Ms. Williams spoke Thursday during a town hall meeting at Tyler Junior College-West Campus, where she addressed the basics — and the caveats — of maneuvering through the insurance marketplace.

The Northeast Texas Disproportionality Advisory Board, a group that examines and works to reduce disparities in the community that affects vulnerable populations, hosted the town hall meeting.

The marketplace, or exchange, is one of the key parts of the ACA, which set out to get more people insured, regardless of pre-existing conditions. The exchange offers tax breaks to individuals and small businesses, depending on income.

Ms. Williams, who works for the Andrews Center, will be traveling across five counties to hold public forums or meet individuals one-on-one to assist with applying for health insurance. This includes Smith, Rains, Wood, Van Zandt and Henderson counties.

Earlier this year, Texas doled out $11 million to place navigators across the state. East Texas Behavioral Healthcare Network is one of eight entities designated for this role and is responsible for 75 counties in the project. Officials at ETBHN hired 24 navigators to cover these counties and two navigators are stationed in the Tyler area. Lauren Parlow, who works with the Andrews Center, is the other local navigator.

Ms. Williams admits there are several barriers that lie ahead for navigators. First, much of the community is still in the dark about the ACA, and how it will impact them.

With glitches and delays on the website set up to help the uninsured apply for insurance, it leaves room for more confusion.

“Right now with all the trouble they are having with the online application, the federal government is encouraging paper applications to be sent in,” Ms. Williams said.

Paper applications are available through navigators and at Texas Department of Health and Human Services offices. Private insurance companies may have them on hand as well.

There are five levels of plans: catastrophic, bronze, silver, gold and platinum. The higher the plan coverage, the higher the premium will be. Ms. Williams said tax credits are available only with the silver plan.

For insurance plans to be effective by January, people must enroll by Dec. 15. The deadline to obtain insurance before being assessed a penalty is March 31, 2014. Penalties will be assessed on most people who do not obtain insurance in 2014—$95 the first year — and will be applied to the 2015 tax season.

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Smith County has about 37,000 people who fall below the poverty line, and because Texas opted not to expand Medicaid, there still may be quite a few individuals without health insurance. These citizens will not be assessed a penalty. Ms. Williams, as well as some audience members, expressed concern about this gap.

“Medicaid has to expand for the numbers to work,” Ms. Williams said. “We’re defeating the whole purpose.”

Christina Fulsom, with East Texas Human Needs Network attended the meeting to learn more about the application process in order to inform other nonprofit agencies and its clients. She said the vulnerable population’s lack of access is an effect of the state’s decision not to expand Medicaid — not a defect of the ACA.

“Sure, they’ll be able to waive that $95 fee but they’ll still be without insurance which was supposed to be one of the solutions — to not have to go to the emergency room,” Mrs. Fulsom said. “Having a medical home is the most important piece. It’s heartbreaking to see that’s still happening and it’s happening in states like Texas where Medicaid was not expanded.”

In spite of the hurdles, Ms. Williams is optimistic that things will get better.

“It’s going to be a work in progress,” she said. “It’s not going to be a quick fix overnight. If we can get everyone to apply it’s going to work itself out and it’s going to be beneficial.”

Mrs. Fulsom’s message to her clients and other agencies charged with helping those who may be eligible for some kind of plan is to “be patient.”

“Everybody’s scared,” she said. “Everybody’s nervous. It’s more complicated than anyone hoped it would be and so people aren’t taking action because they’re so paralyze. They don’t know what steps to take.”

To get help with the health insurance marketplace, visit healthcare.gov then enter your city or zip code under “Finding local help.”

Health and Human Services offices will also have computers available for public use to get information and apply through the marketplace.