State-run exchanges are taking vastly different approaches to broker training, a result of the varied political and economic climates across the 16 states and the District of Columbia that have opted to create their own exchanges in compliance with the Affordable Care Act.
In Vermont, for example, the state plans to train navigators and brokers in basically the same way - a move that National Association of Health Underwriters' CEO Janet Trautwein "disagrees" with. Instead, she touts as "correct" the District of Columbia's plan to train brokers separately - a job that NAHU is contracted to do. "You can't say that someone who has no background in insurance needs the same kind of training as someone who may have been doing it for 20 years," Trautwein says.
EBA tracked broker and navigator training implementation across all of the state-run exchanges through interviews with state representatives. The findings reflect many different approaches because of demographics, costs, time, but one thing was true of almost all of the states: The organizers realize the unique role brokers play in communities and almost desperately want their assistance in the implementation of their respective exchanges. Most of the research and conversations took place during the last week of July and the first week of August and reflect the most up-to-date information before going to print.
Only Vermont, Minnesota and Idaho are using the same training for brokers and navigators. The reasons vary based on the state, but convenience is a common thread between the three.
Having the choice of how to set up broker training was unique in and of itself. The 34 remaining states, seven of which are state partnerships, will default to the federal government's plan for implementing training. A U.S. Centers for Medicare and Medicaid Services official says the federal broker training went live on Aug. 1, but could not confirm additional details like timing at press time. A CMS marketplace timeline provided to EBA in April stated that CMS had a goal of completing broker training by August. CMS officials did not respond to a request for comment on the apparent tardiness.
Vermont Health Access, the state's name for its exchange, is certifying brokers and navigators through essentially the same training process because, "if you think about them as doors into the website, both brokers and navigators are providing a similar service in terms of in-person assistance," says Mark Larson, commissioner, Department of Vermont Health Access. He says the biggest distinction between the training is that "brokers don't receive the outreach and education module" that navigators do. Larson says the online portion of the training is not yet ready, but is "on track" to get navigators and brokers ready by this month; this includes understanding the tech portion of the website. Vermont held the first in-person training for navigators and brokers in early July and had about 170 people in attendance. Larson explains that there will also be training post-Oct. 1 that will provide additional updates to brokers and navigators once they're doing assistance and may have questions. Vermont officials confirmed that there is no charge for training, and there will be a test at the end.
District of Columbia
NAHU's Trautwein says one reason for the separation of in-person assisters (D.C.'s Health Benefit Exchange Authority's term for navigators) and brokers on the D.C. exchange is partly due to the demographics at play in our nation's capital. In-person assisters' "primary focus is really on public programs," she says. "The biggest focus of their training is focused on Medicare, Medicaid. But it does touch on the private programs." Trautwein says that the broker training they're developing is "quite the opposite." It will focus mostly on the private insurance offerings on the public exchange, but will be peppered with some information about Medicaid and Medicare in case some of the people brokers work with qualify for those services. NAHU is planning to use the organization's extensive resources in broker education to support this training project that was announced on July 17. More than 2,500 brokers are expected to enroll on the exchange, D.C. officials say. Trautwein says there will be in-person trainings for brokers throughout August and September and also an online portion, mostly to learn the Web portal, in September once the IT component is finalized.
Maryland's state-run exchange is also separating broker and navigator training. "Whereas brokers and agents are already licensed by the state of Maryland, navigators, we believe, need a more robust training," says Tequila Terry, director of partner and plan management at the Maryland Health Benefit Exchange. "They will learn more on the basics of industry - health insurance 101 so-to-speak," she says of navigators. Terry says the group's plan for broker training is a three-phase process because "we want brokers to be very clear about how they can work with us." The first phase rolled out the first week of August and is an application for the broker to fill out to express interest and intent. The second is the actual training to understand the system, which ran through August, and the third is a notification by Maryland exchange officials that the broker has been certified. Terry confirms that navigator training is separate, and because it is more robust, is still in the process of being finalized. Testing will be a part of training for both groups.
In the Golden State, brokers and navigators will be trained separately. Michael Lujan, the director of sales and marketing for Covered California at the time of this interview [he has since left the organization], says brokers will have eight hours of in-person training, followed by four hours of online training, which includes an exam at the end. "The modules mirror navigators but are much more abbreviated because agents know about insurance," he says. "What isn't condensed is how to enroll folks who are eligible for subsidy ... how to use the IT platform, how to use the tools, including the SHOP and setting up a profile." Notably, California is one of three states that told EBA it is definitely charging brokers for some part of the training. Lujan says the $60 fee is required by the state's department of insurance and is in essence an endorsement fee once they've done the training. He says they're prepared for all of the 30,000 active individual and small-group agents to register for the training, but he realizes "some people may sit back and not do it immediately." Brokers began registering for training on Aug. 19. The navigator training is about two and half days in total, in comparison to the 13 hours for brokers, and Lujan thinks most of the session will be in-person. Covered California is anticipating about 2,500 assisters, as the state is referring to them. He adds that California, the most populous state, will have 30 venues for the in-person trainings.
"You have reached the epicenter of training development," says Jim Sugden, the small business marketplace manager of Connect for Health Colorado. This state has one of the longest required trainings for brokers - around 24 hours. It will be split into about eight hours of pre-training online (this could take as little as six hours depending on pace) and then conclude with a 16-hour in-person, instructor-led class. "As we developed this we realized we were really going to have to train our agents, and spend some time training administrative support, who will not be certified to sell but will be authorized with accountable log-in numbers," Sugden explains. He says the broker training will require quizzes and as of early August, the state had more than 1,000 agents and brokers signed up for the classes that began Aug. 19. The only cost to brokers is a $19.95 fee -the second state reporting a cost for brokers - for a background check because that line item wasn't included in the original grant request. "When we opened broker training we had 553 register for training in the first 24 hours," Sugden says. "We've had our share of questions and skepticism, but we've received outstanding support from the broker community." He adds that the reason broker training is so lengthy compared to other states has to do with more extensive security and consumer protection training and the fact that "our IT systems are more extensive." Navigators on the exchange will be dubbed health coverage guides and will be trained over the course of 48 hours, double the time for brokers. There will be approximately 500 such guides.
MNSure Executive Director April Todd-Malmlov says broker and navigator training will be mostly the same "because we're very consistent in content and streamlined in mode of delivery." The training is all online, the only state to report this format for both groups, and there will be testing at the end for both. She says the education will differ slightly in instructing navigators and in-person assisters about what they can and can't do in terms of giving advice and also training brokers on defined contribution. She says another reason the trainings will be streamlined is because "everyone needs to understand the basics and it makes more time and cost-effective sense to do this to get it out as soon as possible." Also, the tool operates in similar ways for both parties. Todd-Malmlov says there is no cost to either brokers or navigators.
Silver State Health Insurance Exchange, Nevada's marketplace name, is planning to rely heavily on brokers. "On the SHOP exchange we believe 95% [of business] will come in from brokers," says CJ Bawden, communications officer. Because of the state's confidence in its licensed brokers and agents, those who wish to register on the exchange will go through a simple four-hour in-person training course that will focus on how to use the Web portal and enroll people. "We realize that brokers and agents have a history in this so it doesn't surprise me that most states are taking different approaches to brokers and navigators," he says. Navigators in the state will have a 20-hour online course and they must pass a test in order to attend the same four-hour in-person training that brokers go through. Bawden says so far 175 brokers attended an onboarding meeting but they were hoping to recruit more for training that was to begin at the latest by September 1.
The New Mexico Health Insurance Exchange does not have the advantage of time. Because of a delay with the state legislature approving the exchange plan, the interim CEO Mike Nunez says the group did not begin work until April 29. As a result, they have had to defer the individual market in the state to the federal exchange for now, while still creating their own SHOP exchange. Brokers will have about 16 hours' worth of state training for the SHOP exchange, and if they choose to sell individual they will have to complete the federal training. Nunez says navigators will also have to complete the federal training, which, as of press time, CMS had not released details on yet, and may have a bit more robust training for the state in terms of the SHOP exchange. He says there are about 400 active brokers in the state, but expects less than that will train in the first year. There are about 250-275 in-person assisters and two navigator organizations. Projections show about 8,000 potential covered lives on the SHOP exchange and Nunez says, "We think the only way we'll get them is through brokers and agents."
Similar to New Mexico, Idaho's exchange was approved late in the state's legislative season. As a result, they are also using CMS as a crutch, in this case for their broker and agent application process. All brokers and agents will have to go through the 20-hour navigator training and also the federal broker training, mostly online. The navigator training will lean more toward in-person, with some online complimentary components. Jody Olson, the marketing coordinator for the Idaho exchange, says the number of brokers and navigators are still getting finalized, but the two groups have similar trainings except for the online versus in-person aspects. She says the exchange will be able to convert over to a fully state-run exchange by 2015. "It's a unique situation, it's a good situation because we have the opportunity to learn from the states that have gone ahead of us," Olson says. The brokers and navigators will be tested at the end of training.
According to Jeffrey Hammond, a spokesman for the New York State Department of Health, broker certification on the state's exchange is an eight-hour training course that counts for continuing education credits. There are two classes - one on the SHOP exchange and the other individual. Brokers must complete the SHOP course in order to do the individual course. The SHOP courses have begun but the individual are still being finalized. On the other hand, navigator training began the third week of August and consists of eight modules that will be administered over five days - the first two days are online and the last three are in-person in locations across the state. Hammond did not return requests for comment on the differences between broker and navigator trainings, as well as questions about cost, exams and the anticipated number of brokers and navigators.
Cover Oregon is the only exchange that reported a more lengthy training for brokers over navigators. Brokers will have an eight-hour class to get certified and that process is underway - it began in full force in July, according to exchange officials. Navigators, or community partners as the state has termed them, have a four-hour training program that has also begun. "We found that attending a half-day training is a little easier for community partners because they're stressed ... whereas agents are more focused on insurance," says Lisa Morawski, communications manager at Cover Oregon. The state is the third and final state that is charging brokers a fee - this one is $25 and covers the lunch at the full-day training. The state already has 1,600 agents signed up to participate and Morawski is expecting about 2,000. She says the goal is to have approximately 800-1,000 community partners trained. Just before print in mid-August, Cover Oregon announced that it would only open on Oct. 1 for brokers and community partners to enroll the uninsured on the exchange, and a few weeks later will allow anyone access. Morawski was confident, with training well underway, that both entities would be trained by September.
On the HealthSource RI exchange, brokers will only be selling on the SHOP. "It's state law, it has to do with the [state's] size," says Ian Lang, director of marketing and communications. "Rhode Island is a small state with only 15,000 directly insured individually. Another 45,000 aren't insured, so that's only 60,000." He says it makes sense for the brokers to focus on SHOP because, "Rhode Island is a small business economy; there's a need to help provide better insurance options for them." There are approximately 300,000 lives associated with the small businesses that don't currently provide insurance, so he says there's a real market there for brokers. "We're one of the only states where a lynchpin of our success is through small business," he continues. Lang was not able to comment at the time of this interview about the number of brokers and navigators expected to participate.
Brokers in the Evergreen State won't be able to sell on the SHOP exchange because there won't be one. Michael Marchand, director of communications, explains that's because of the nature of the state - more than 98% of the potential exchange customers in 2014 are individuals. Since brokers and agents are very focused on small businesses, Marchand acknowledges that exchange training might not be appealing to brokers. Nevertheless, 1,000-2,000 brokers have shown interest in the individual exchange so far and more than 200 community assistance organizations want to participate as navigators. Broker training has already begun online and there will be an in-person component in August and September. Navigator training will be in-person and has the same timeframe.
Phil Boyle , business-to-business outreach manager at Access Health CT, says the state is ahead of most others in broker training - the first session was July 16. The training overall consists of four hours of specifics on Connecticut's plan and then a systems training that will be held in September when the IT aspect is finalized. Boyle says so far 150 brokers are going through training "but we anticipate when all is said and done we'll have 250-300 brokers." Connecticut is also one of the few states to not require testing from brokers. "A lot of brokers are members of NAHU and NAIFA and have been inundated with information," he says, acknowledging that they're just too busy now, but says Access Health CT may reinstitute a test later, possibly by October. He says broker training should be complete by Sept. 15 and they will receive a confirmation. Josephine Sempere, training manager at Access Health CT, confirms that navigator training is much different and more robust than broker training. There are four phases, each with a 16-hour online component and an 8-hour, in-person component. That's about 96 hours of training. "It sounds a little grueling but we walk people through the steps and they understand they need to be prepared," Sempere says. Connecticut's navigator training is by far the most time of any state-run exchange that confirmed training length.
Rick Budar, chief marketing officer of Hawai'i Health Connector confirmed that broker and navigator/assister training in the state will be different because "we are primarily focused on using licensed agents and brokers to enroll individuals and small businesses on the connector." As such, he explains the training will focus on HIPAA and ACA regulations as well as cultural and systems/IT training. The state plans to use the market assisters, or navigators, to do education and outreach and thus their training will be adjusted as such. Budar says the state plans to recruit "hundreds" of brokers to participate but did not respond to EBA requests for more detail on timing of training and implementation, how many assisters will be on hand, whether there will be a charge or test with training and more.
Brokers in Kentucky don't have to worry about traveling for any in-person trainings. Bill Nold, deputy executive director of the Kentucky Health Benefit Exchange, says the broker training modules will take "between eight and 10 hours" and they're "in the process of setting up for brokers to receive CE credits." They're all online. An email went out to all licensed brokers in the state on July 31 and early predictions were that roughly 5,000 brokers might sign on. Nold says brokers were involved from the beginning and while initially skeptical, "we're at the point now where many have come around and are enthusiastically talking about the exchange." Connectors, as navigators and in-person assisters are termed, will have a different set of training modules and at least six and a half hours of in-person training.
As the only state with an existing exchange, thanks to the landmark legislation that passed in 2006, Massachusetts is another state with a unique situation. Dave Kerrigan, a health insurance exchange executive at Massachusetts Health Connector, says that for one thing, the state is 97% insured thanks to the seven-year-old law. Therefore, the navigator program is much less substantial than other states, and they will be used more as "member transition." There are about 10 navigator organizations and Kerrigan says about 55 people were at a training in August and are expected at a follow-up training in September. Brokers, on the other hand, were trained on the ACA in February and then at another session in April and May. He says about 200-300 brokers have been trained and they're working on summer outreach to train them on the actual new exchange technology that will be new to them. "We made sure to have a partnership with brokers in everything we do, we started an ad hoc advisory board," Kerrigan, a longtime employee benefit professional, says.
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