In a move one leading health law expert has described as “intimidation,” 15 Republican members of the House Energy and Commerce Committee are asking recipients of the $67 million in health law navigator grants to brief the panel on how they intend to spend the money.
The Aug. 29 letter directs the grantees to schedule a meeting no later than Sept. 13 and to provide additional documentation, including a written description of the work they intend to do, the number of employees and volunteers, their duties and how much they’ll be paid.
The committee members are also requesting information about how the navigators will be trained and monitored. “All documentation and communication” related to the grant, including application materials, are requested, including any communication between their organization and federal agencies involved in the health law, such as the Department of Health and Human Services and the Centers for Medicare and Medicaid Services, according to the letter.
In addition, the letter asks for documentation of any contact with Enroll America, a group with close ties to the Obama administration. The organization is trying to educate consumers about new insurance options and drive enrollment in the new marketplaces opening this fall for coverage that takes effect in January.
Navigators will provide assistance on the phone and in person to individuals signing up for coverage in the health law’s insurance marketplaces, as well as for public programs including Medicaid and the Children’s Health Insurance Program. They will receive 20 hours of online training and have to pass a test before they can start working. Their efforts could include help in evaluating health plans for sale on the marketplaces, also known as exchanges. They are not, however, allowed to expressly tell people which policy to choose.
Timothy Jost, a professor at Washington and Lee University School of Law, called the letter “an obvious attempt at intimidation of navigator programs, most of which are nonprofits that don’t have the resources to hire lawyers to fight this, nor the time to respond at this very busy time. … This attempt to bully these programs is shameful.”
HHS did not immediately respond to a request for comment, and the Energy and Commerce panel did not immediately return a call for additional information about the letter.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The navigator program has raised controversy among opponents of the health law. Critics see navigators as potential competitors to insurance brokers, and some want the navigators to receive more rigorous screening before they can work with consumers. Some lawmakers and state attorneys general have expressed concerns that there are not enough safety guidelines in place to ensure that navigators do not misuse individuals’ personal information.
Hospitals, universities, Indian tribes, patient advocacy groups and local food banks were among organizations awarded $67 million in federal grants to more than 100 groups earlier this month to help people sign up for coverage in new online health insurance marketplaces that open for enrollment Oct. 1.
According to a Commonwealth Fund assessment in July, 14 states, including Florida, Georgia, Ohio, Texas, Virginia and Wisconsin, have passed laws setting requirements for navigators and five others are considering such action.
Navigators will be required to adhere to strict security and privacy standards, including how to safeguard a consumer’s personal information, according to HHS. All types of enrollment assisters – including navigators – are subject to federal criminal penalties for violations of privacy or fraud statutes, in addition to any relevant state penalties.
Phil Galewitz contributed to this article.
