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Navigator Payment Policy

Scope

This policy applies to navigators.

Terms and Definitions

Insurance Affordability Program (IAP): Insurance Affordability Programs (IAPs) include Medical Assistance, MinnesotaCare and Advanced Premium Tax Credit (APTC).

Auto Renew: This term applies to those enrolled in an IAP where there was sufficient information available to automatically renew coverage

Need to Renew: This term applies to those enrolled in an IAP where there was not sufficient information to automatically renew coverage. The individual must complete and sign a pre-populated renewal form within 30 days to avoid loss of coverage.

Passive renewal: This term applies to a consumer who is enrolled in a qualified health plan (QHP) through MNsure for the current plan year and MNsure can automatically renew the consumer into the same QHP for the next plan year.

Paper application: Unless otherwise specified, paper application refers to the Application for Health Coverage and Help Paying Costs (DHS-6696) and the Application for Health Coverage (DHS-6741).

Policy Details

MNsure will pay navigator organizations for each individual successfully enrolled in an Insurance Affordability Program (IAP) or qualified health plan (QHP) resulting from the submission of an application through MNsure by a certified navigators.

Effective October 1, 2013, the payment rate is:

  • Seventy and 00/100 dollars ($70.00) per successful enrollment in a QHP.

  • Twenty Five and 00/100 dollars ($25.00) per successful enrollment in Medical Assistance (MA).

  • Seventy and 00/100 dollars ($70.00) per successful enrollment in MinnesotaCare.

Payment rates are set by the MNsure board and any changes to the rate must be published in the State Register. Payments are based on the availability of funding.

Navigator organizations are eligible for payments for:

  • An application (online or paper) that results in a QHP determination (with or without assistance).

  • An enrollment in a QHP during a special enrollment period. 

  • An application (online or paper) that results in a determination of eligibility for MA, including Emergency Medical Assistance.

  • An application (online or paper) that results in a determination of eligibility for MinnesotaCare.

  • A paper Application for Certain Populations (DHS-3876) that results in a MA enrollment.

  • Assisting with the following renewal actions:

    • MA member in a Need to Renew status that results in a successful renewal in METS.

    • MinnesotaCare member in a Need to Renew status that results in a successful renewal.

    • QHP enrollee who actively selects a plan for the new plan year.

Navigator organizations are not eligible for payment for assisting with:

  • MinnesotaCare member that is auto renewed.

  • MA member that is auto renewed or renewed in MAXIS.

  • QHP enrollee that passively renews into the same plan for the new plan year.

  • Reporting life event changes, unless the change results in adding new IAP coverage for a household member.

Procedures

To be eligible for payment, a navigator with an active certification must use one of the approved methods for association:

Assisting a consumer with submitting an online application through MNsure:

  • Navigator's Assister ID and organization entered on the signature page of the online application, or

  • Active association with the navigator through the assister portal at the time the application is submitted. The application can be submitted using either the consumer’s account or the assister portal.

Assisting a consumer with actively selecting a qualified health planthrough MNsure (navigator did not assist with submitting the application, the consumer is renewing, or the consumer is enrolling during a special enrollment period):

  • Active association with the navigator through the assister portal at the time the consumer enrolls in a QHP. The application can be submitted using either the consumer’s account or the assister portal, or

  • Submit the online or paper Navigator Case Association Form within 30 days of the application submission date.

Assisting a consumer with submitting a paper Application for Health Coverage (DHS-6696 or DHS-6741), including an application for Emergency Medical Assistance (EMA): 

  • Complete assister portion of Appendix C.

Assisting a consumer with submitting a paper Application for Certain Populations (DHS-3876):

Assisting a consumer in a “Need to Renew” status within METS with submitting a renewal form (MAXIS renewals are not eligible for payment):

  • Submit the online or paper Navigator Case Association Form within 30 days of the application submission date.

Assisting a consumer with reporting a life event that results in adding new IAP coverage for a household member (this does not include a life event that results in a change of coverage to a different IAP):

Assisting a consumer with a Deferred Action for Childhood Arrivals (DACA) application, health care application for an inmate, or an application for Medicare Savings Program:

Refer to the Assister Case Association policy and Navigator Case Association Form policy for procedures on how to associate with a consumer.

References and Related Documents

Assister Case Association policy

MNsure Grant Services Contract Navigator/In-Person Assister Attachment A (PDF)

MNsure Joint Powers Agreement Navigator/In-Person Assister Attachment A (PDF)

MNsure Grant Services Contract with Tribal Nation Navigator/In-Person Assister Attachment A (PDF)

Navigator Case Association Form

Navigator Case Association Form Policy

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