In the Minnesota Eligibility Technology System (METS), pending and approved both mean that pre-eligibility verifications are required to confirm a consumer’s eligibility. An active status means no verifications are required or the consumer has submitted any pre-eligibility verifications. MNsure will only issue a per-enrollee payment for cases that have an active eligibility determination.
Yes. If you are associated with the case at the time the status changes to active in METS, your organization is eligible for a per-enrollee payment. If another navigator was associated with the application at the time it was submitted, but you are associated with the case at the time it becomes active, your organization will receive the per-enrollee payment.
For your organization to receive a payment, you would need to be associated with the consumer through the assister portal at the time the case becomes active in METS, or you will need to submit the Navigator Case Association Form and select the reason, “Assisted a consumer who submitted an application and the navigator and consumer were not associated at the time the application was submitted.”
No. MNsure will only issue a per-enrollee payment for a case that has an active eligibility determination. Active means the consumer has submitted any required pre-eligibility verifications.
Yes. MNsure will issue a per-enrollee payment for cases that have an active status. MNsure does not verify whether the consumer has made a premium payment.
MNsure will only issue one payment for a case – the oldest active determination.
Yes. MNsure will issue a per-enrollee payment if you help a consumer submit an application that results in a QHP determination with an active eligibility determination, even if the consumer does not select a plan or does not pay their first premium.
No. MNsure will only issue one payment for a case. If you assist the same consumer with both the application and QHP enrollment, your organization is only eligible for a single payment for both steps.
No, your organization is not eligible for a per-enrollee payment if you assist a consumer with reporting a life event that results in a change in their eligibility.
However, if the consumer’s eligibility changes from MA to QHP or from MinnesotaCare to QHP, your organization is eligible for a payment if you assist a consumer with enrolling a QHP. In this situation, for your organization to receive a payment, you will need to be associated with the consumer through the assister portal at the time of plan selection, or you will need to submit the Navigator Case Association Form and select the reason, “Assisted a consumer with selecting a QHP for a special enrollment period (no assister portal association).”
Yes, if you are adding a new household member to the application or changing a non-applicant to an applicant, you are helping a consumer get new coverage. Your organization is eligible for a per-enrollee payment for that consumer, unless that consumer was already active on another case.
Examples of situations when your organization would be eligible for a payment:
To be associated with the case for payment purposes, you will need to submit the online Navigator Case Association Form and select the reason, “Assisted with reporting a life event that resulted in active Medical Assistance (MA), MinnesotaCare or qualified health plan (QHP) coverage for a new household member or a household member who was previously a non-applicant.”
An example where your organization wouldn’t be eligible for payment is if a couple gets married, but both individuals already have an active case in METS. The couple must report the change to move the individuals into the same household; however, the organization would not be eligible for a payment since both individuals already had coverage.
Yes, if that application results in a determination with an “active” eligibility determination.
If you are submitting the DHS-6696, in order to be associated with the case for payment purposes, you must complete the portion of Appendix C labeled: "For certified application counselors, navigators, in-person assisters, agents, and brokers only." The county will enter the information from Appendix C as case evidence. There is no need to submit a Navigator Case Association Form if you have completed Appendix C.
If you are submitting the DHS-3876, to be associated with the case for payment purposes, you must submit a Navigator Case Association Form.
Navigator organizations are eligible for a flat amount of $25 for each individual with an MA determination with an active eligibility determination. If all 10 members of the household are determined eligible for MA, your organization would receive 10 x $25 (or $250) for that single application.
MNsure’s authorization to make navigator per-enrollee payments comes from the Minnesota Administrative Rule 7700.0090, which states that "consumer assistance partners may receive payment for each successful enrollment through MNsure." MNsure interprets successful enrollment as the submission of an application or renewal that results in eligibility for a QHP through MNsure or eligibility for a public health care program, or the selection of a QHP through MNsure, including properly using the appropriate system tools, resources, and data to perform this function.
Other activities performed by navigators are appropriate duties for navigators as defined by the Affordable Care Act and contribute to a consumer accessing or maintaining coverage. However, navigator per-enrollee payments compensate an organization for the successful measurable outcome of those activities – getting a consumer access to health insurance coverage.
MNsure uses the Navigator Outreach and Enrollment Grant program to provide additional funding to navigator organizations selected through a competitive RFP process.
No. Your organization is not eligible for a per-enrollee payment if you assist a consumer who has an Auto Renewed status.
Your organization is eligible for a per-enrollee payment if you assist a consumer in a Need to Renew status. The payment is based on the program the consumer was originally enrolled in
To be associated with the case for payment purposes, you will need to submit the online Navigator Case Association Form and select the reason, "Assisted with submitting a pre-populated Renewal Form for a consumer in a 'Need to Renew' status in METS."
A passive renewal means a consumer will have their QHP plan automatically renewed for the next plan year with updated eligibility without the consumer needing to take any action.
An active renewal means the consumer either is required to, or chooses to, select a different QHP for the next plan year during the renewal process.
It is MNsure's policy that your organization is eligible for a per-enrollee payment if you assist a consumer with selecting a different QHP for the new plan year during the renewal process.
MNsure strongly discourages consumers from actively selecting the same plan online if the consumer is not changing plans for the new plan year. This unnecessary action requires both MNsure and the health insurance company to devote staff resources to identify and remove duplicate records.
Yes, an organization may receive a $25 payment for assisting a consumer with the DHS-7310 that results in eligibility and for a $70 payment for assisting the same consumer with an (online or paper) application that qualifies for a per enrollee payment.