Exchanges: Coming to a store near you?

By National Underwriter

National Underwriter


By Allison Bell

The California Health Benefit Exchange board is hoping to get retail stores to provide in-store enrollment assistance for the state's Covered California individual health insurance exchange.

To participate in "Tier 1 retail partnerships" with the Covered California exchange, a store would have to get employees trained and certified as providers of in-person assistance, according to a written presentation prepared by Thien Lam, a deputy director at the board.

Members of the Covered California enrollment team believe that retail stores are good vehicles for reaching uninsured residents where they live, work and play, Lam said.

"Retail stores cater to a wide variety of consumers in various age groups, culturally diverse populations, and consumers with varying income levels," Lam said.

Covered California can use in-store market to give consumers the idea that they can use "one-stop shopping" to look at Covered California products as well as to buy groceries and pick up prescriptions, Lam said.

Stores not willing or able to get employees certified as in-person assisters could provide Tier 2 marketing support, by helping with marketing, education and referral activities, but not with actual enrollment services, and other stores could provide Tier 3 support, by putting up posters, distributing flyers and adding messages about Covered California to store bags and cash register receipts, Lam said.

The California exchange board was preparing to consider the proposal at a meeting last week.

Health Access Blog reported that the board had to postpone consideration of many items on the agenda. The board spent more time than it expected hearing comments from members of the public who crowded into the meeting to ask the board to translate its website into all of the 13 languages that the California Medicaid program now serves, not simply in English and Spanish.

The Patient Protection and Affordable Care Act of 2010 (PPACA) requires state and federal agencies to set up exchanges, or Web-based health insurance supermarkets, by Oct. 1, with the coverage sold through the exchanges to start taking effect by Jan. 1, 2014. Initially, the exchanges will be open to individuals and small groups.

States can set up their own exchanges or turn the job over to the U.S. Department of Health and Human Services. California intends to run its own exchange programs, and it hopes to enroll 1.4 million people into coverage through the exchange by the end of 2014.

HHS has proposed to have exchanges set up ombudsman programs, or "Navigator" programs, to ensure that low-income people, uninsured people, and other people who may be unfamiliar with health insurance get the kind of assistance that agents and brokers have traditionally provided for people who have health coverage.

The Navigators can include brokers, but they cannot get compensation from the insurers selling products through a state's PPACA exchange program, HHS officials have said.

A state cannot require all Navigators to have producer licenses, because the language in PPACA requires that a state offer consumers access to at least two different types of Navigators, but a state can require Navigators to meet certification requirements similar to the requirements that producers meet, as long as the Navigators don't have to be identified as agents, brokers or producers, HHS officials have said in an answer to frequently answered questions.

HHS officials also have recommended that states set up a corps of certified in-person assisters, to provide help for individuals who seek face-to-face assistance.

Originally published on LifeHealthPro.com