Minnesota is about to unleash one of the most unorthodox insurance sales forces in state history as it moves to the next phase of enrolling people for health coverage under the grand experiment known as Obamacare.
Even before last week’s launch of the MNsure online marketplace, state leaders had begun certifying thousands of Minnesotans who will get paid to help people sign up for health insurance. They come from groups as wide-ranging as the liberal Planned Parenthood family planning organization and the conservative Teen Challenge addiction program.
While the initiative might inspire a new round of insurance jokes — have you heard the one about insurance salesmen being premium lovers? — MNsure officials said these “navigators” will be essential to the law’s ultimate success because many of the nation’s uninsured won’t pursue coverage unless someone finds them and explains their options.
“The whole point is to take the service to the people,’’ said Rebecca Lozano, outreach program manager for Portico Healthnet, a St. Paul health access organization that will serve as a navigator.
While traditional salespeople such as insurance brokers will be in the mix, the state is enlisting nonprofits and businesses that already work with small segments of the state’s uninsured population. The goal is to take advantage of their existing relationships and insure as many of the estimated 490,000 uninsured Minnesotans as possible by Jan. 1. Open enrollment ends March 31, and those without coverage could face fines.
An estimated 60 percent of Minnesota’s uninsured are already eligible for subsidized coverage through Medical Assistance or MinnesotaCare — a sign that something more than the cost has kept people away.
Minnesota’s strategy is to blanket the state’s libraries, clinics, food shelves, fall festivals, hospitals and other locations with more than 5,000 people who have been certified to help consumers find plans on MNsure. They include insurance brokers, tax preparers, human resource staff and the navigators — an official term for individuals trained and funded by state and federal grants to provide unbiased advice on selecting plans.
“We do have a lot of interest and a lot of people who want to help, which is great,” said April Todd-Malmlov, MNsure executive director. By comparison, she said, California expects to have 7,000 such helpers.
Planned Parenthood’s Minnesota chapter became a navigator agency because about 75 percent of its clients — often young or pregnant women — are uninsured.
“They are the exact people we need to reach in order to make the Affordable Care Act work in our state,” said Planned Parenthood spokeswoman Jennifer Aulwes.
The Minnesota AIDS Project created a network of urban and rural navigators to make sure that coverage is offered to people who are HIV positive and to people who are gay, lesbian, bisexual or transgender. Health coverage could help prevent HIV infections and transmissions if it results in more people receiving regular medical care and advice.
“It’s a combined effort to reach a community that we know well,” said AIDS Project spokeswoman Melissa Conway.
Like the MNsure website, however, the navigator strategy has suffered glitches and delays. State officials planned to have navigators certified and ready to help by Day 1, but most of the participating agencies were still waiting late last week for the state to sign their contracts and provide the certification number their workers need before they can help anyone buy insurance. On Friday afternoon, the MNsure directory listed numerous brokers who were available to help, but only four navigator agencies.
Slow to get certified
Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness, said trying to get two staffers certified as in-person assisters has been frustrating. Sign-up information arrived at the last minute, and sending in their background checks via encrypted e-mail proved challenging.
“I couldn’t figure out how to do it, and there was no number to call,” she said. “We don’t have anyone certified yet, but we’re getting closer!”
Abderholden is eager to get her staffers connected with people because insurers for the first time are required to cover mental health and substance abuse treatment in every plan they sell on the exchanges.
The $15 million navigator program suffered an earlier embarrassment when well-known nonprofits working with uninsured populations — such as people with mental illness, immigrant communities and African Americans — weren’t among 30 selected to receive $4 million in federal grants to add staff and technology. Relative unknowns, such as retirement planner Bruce Lyon-Dugin, did receive awards. His grant came under fire when it was disclosed that he brandished a shotgun during a 2011 traffic stop in Wisconsin.
Lawmakers also questioned the decision to award funding to a start-up called Health Access MN, which was formed just days before the grant application deadline by Maureen O’Connell, a former top executive for the Minnesota Department of Human Services.
MNsure officials backpedaled after the furor over the grants, saying they were still vetting the applications. Todd-Malmlov said last week that the awards would be finalized “very soon.”
O’Connell said she didn’t work on any navigator activities while employed by the state, and that there were no conflicts of interest in her application. She said she was successful because she formed a partnership of charitable groups and advocates, such as the Minnesota Coalition for the Homeless, to promote MNsure.
Navigators paid per person
“Organizations that have the trusted relationships [with uninsured people] didn’t have the health care expertise and didn’t really want to” be navigators on their own, she said.
Navigators are paid $25 to $70 in state or federal grants when they help individuals use MNsure to sign up for a public or a private health plan. The per-person payments create the potential for competition among navigators for the same uninsured people. There are multiple groups, for example, whose focus is on insuring the homeless. But leaders of the various navigator groups believe there won’t be too much overlap.
O’Connell’s Health Access group is scheduling events at public libraries, because they are familiar and approachable locations for people without insurance. Navigators at these events will have laptops or handheld devices to enroll people on the spot.
Portico will be sending navigators to food shelves — where low-income families will be applying for food benefits anyway and will be able to sign up for health coverage in one stop.
The outreach is necessary because many uninsured people might finally believe they are eligible for coverage, but don’t know what to do, said Portico’s Lozano. “There’s this huge population of people, especially lower-income people, saying, ‘OK, maybe I am eligible. But where do I start? What do I do?’ ”