The counselors tasked with helping uninsured Texans navigate their way through the complicated process of buying health insurance will have to jump through a series of hoops to get licenses under new rules proposed by the Texas Department of Insurance.
The so-called navigators would have to prove their citizenship or employment eligibility, undergo a background check and show evidence of financial responsibility under the new rules, proposed Tuesday by Texas Insurance Commissioner Julia Rathgeber.
They would also have to receive 40 hours of education on Texas-specific Medicaid and privacy standards, then show proof that they have the proper training to guide consumers to the right health plans.
Navigators would be prohibited from charging for their services and from recommending specific health benefit plans to consumers. The proposed rules would also restrict navigators from providing advice on the substantive benefits or comparative benefits of different health plans, the department said.
"In Texas, we are being vigilant about safeguarding privacy and keeping personal information out of the wrong hands," Rathgeber said in a statement. "These proposed rules address insufficiencies in federal regulations and make the training and qualifications of navigators in our state more readily apparent to consumers and service providers."
The 64 pages of rules and restrictions come after the Texas legislature passed a new law this year requiring Rathgeber's office to come up with the rules if federal guidelines for navigators were deemed insufficient. Rathgeber's office said the federal rules don't address Texas-specific Medicaid programs and privacy standards.
The new rules will be published in Friday's edition of the Texas Register. The Insurance Department will hold a public hearing Dec. 20 and accept public comments until Jan. 6. The rules would go into effect soon after the public comment period ends.
There are about 200 federal navigators in Texas.
Supporters of the Affordable Care Act (ACA) said the rules, among the most restrictive in the country for navigators, will increase costs and could hinder consumers. The fact that navigators can't give explicit advice to consumers will slow down the enrollment process, those supporters say.
"This is an attempt to add cumbersome requirements to the navigator program and deter groups from working to enroll Americans in coverage in the Health Insurance Marketplace," said Joanne Peters, a spokeswoman for the federal Department of Health and Human Services. "The navigator program is similar to Medicare counselors, which have existed for years and never faced this kind of scrutiny from Texas. Despite the state's efforts, we are confident that navigators will continue to help Texans enroll in quality, affordable health coverage."
Navigators are already required to undergo training on specific health plans, privacy and security standards and eligibility requirements for the ACA's tax credits and subsidies.
Republicans have targeted the navigators as a way to slow down health-care reform. Both Gov. Rick Perry (R) and Attorney General Greg Abbott (R) have warned that consumer privacy could be at stake.
The Department of Health and Human Services said in August it would provide $67 million in grants to 105 organizations to provide navigator services.
At least 16 states, most with Republican-led legislatures, passed legislation or authored rules to require navigators to obtain licenses or certification from state agencies before helping consumers. Eight states - Georgia, Illinois, Missouri, Nebraska, New Mexico, Ohio, Texas and Virginia - passed regulations on the types of advice health-care regulators could offer, according to Stateline, a project of the Pew Charitable Trusts.