Navigator Payment Policy

Policy Details

In accordance with Minnesota Administrative Rule 7700.0090, MNsure will issue payments to contracted organizations for navigator assistance with the application, enrollment and renewal process. A navigator must be actively certified and associated with an eligible case through approved methods for the organization to receive a payment.

MNsure will pay navigator organizations based on a state-run report. Effective January 1, 2023, MNsure is changing from a quarterly to a monthly reporting period. Payments are issued within 60 days following the end of the reporting period.

Effective July 1, 2023, the payment rate is:

$70.00 per successful determination of eligibility for or enrollment in a QHP (with or without financial assistance).
$100.00 per successful determination of eligibility for Medical Assistance (MA).
$100.00 per successful determination of eligibility for MinnesotaCare.

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

A navigator organization is eligible for a per-enrollee payment when a certified navigator performs the following actions:

Qualified Health Plans

Navigator Action	Method(s) of Associating for Payment
Assist a consumer with submitting an online application that results in a QHP determination (with or without financial assistance).	Assister portal Signature page of online application (Using BOTH methods is recommended)
Assist a consumer with submitting a paper application (DHS-6696 or DHS-6741) that results in a QHP determination (with or without financial assistance).	Appendix C of the paper application
Assist a new consumer with enrolling in a QHP during open enrollment (if the consumer submitted an application prior to working with the navigator).	Assister portal (preferred method), OR Navigator Case Association Form
During open enrollment, assist a renewing consumer with selecting a different QHP for the new plan year.	Assister portal (preferred method), OR Navigator Case Association Form
Assist a consumer with enrolling in a QHP during a special enrollment period.	Assister portal (preferred method), OR Navigator Case Association Form
Assist a consumer with adding a new member to the household who is applying for coverage, which results in a QHP determination (with or without financial assistance).	Navigator Case Association Form
Assist a consumer with changing a non-applicant to an applicant, which results in a QHP determination (with or without financial assistance).	Navigator Case Association Form

MinnesotaCare

Navigator Action	Method(s) of Associating for Payment
Assist a consumer with submitting an online application that results in a MinnesotaCare determination.	Assister portal Signature page of online application (Using BOTH methods is recommended)
Assist a consumer with submitting a paper application (DHS-6696) that results in a MinnesotaCare determination.	Appendix C of the paper application
Assist a consumer with submitting a DHS-6696 paper application for a Deferred Action for Childhood Arrivals (DACA) individual.	Navigator Case Association Form
Assist a MinnesotaCare member in a Need to Renew status that results in a successful renewal. Payment rate will be the MinnesotaCare rate regardless of eligibility once the renewal is processed.	Navigator Case Association Form
Assist a consumer with adding a household member who is applying for coverage, which results in a MinnesotaCare determination.	Navigator Case Association Form
Assist a consumer with changing a non-applicant to an applicant, which results in a MinnesotaCare determination.	Navigator Case Association Form

Navigators are prohibited from providing choice counseling or enrollment services as defined in 42 C.F.R. §438.810 to individuals who have been determined eligible for MinnesotaCare.

Medical Assistance

Navigator Action	Method(s) of Associating for Payment
Assist a consumer with submitting an online application that results in a Medical Assistance (MA) determination with an "active" eligibility determination.	Assister portal Signature page of online application (Using BOTH methods is recommended)
Assist a consumer with submitting a paper application (DHS-6696) that results in an MA determination with an "active" eligibility determination.	Appendix C of the paper application
Assist a consumer with submitting a paper application (DHS-3876) that results in an "active" eligibility determination for MA or Medicare Savings programs.	Navigator Case Association Form
Assist a consumer with submitting an Emergency Medical Assistance (EMA) application.	Navigator Case Association Form
Assist an individual being released from prison within the next 45 days with submitting a paper application (DHS-6696 or DHS-3876) AND the Individual Discharge Information Sheet (DHS-3443) that results in an "active" eligibility determination.	Navigator Case Association Form
Assist an MA member in a Need to Renew status that results in a successful renewal. Payment rate will be the MA rate regardless of eligibility once the renewal is processed.	Navigator Case Association Form
Assist a consumer with adding a household member who is applying for coverage, which results in MA eligibility with an "active" eligibility determination.	Navigator Case Association Form
Assist a consumer with changing a non-applicant to an applicant, which results in MA eligibility with an "active" eligibility determination.	Navigator Case Association Form

Navigators are prohibited from providing choice counseling or enrollment services as defined in 42 C.F.R. §438.810 to individuals who have been determined eligible for MA.

Activities Not Eligible for Payment

Assisting a consumer with an Auto-Renewal status, even if they need to report a change
Assisting a consumer with reporting a life event (except as noted above)
Assisting a renewing QHP consumer who passively renews into the same plan for the new plan year
Assisting with any renewal that is processed in MAXIS (non-MAGI populations)
Checking a consumer's application or enrollment status
Explaining notices
Filing an appeal
Online or manual account creation
Providing education to consumers about their coverage
Resetting a password
Submitting a MinnesotaCare or QHP premium payment
Terminating QHP coverage

Procedures

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

Frequently Asked Questions

See FAQ about navigator payments.

Terms and Definitions

Auto renewal: Those enrolled in Medical Assistance (MA), MinnesotaCare or a qualified health plan (QHP) where sufficient electronic information was received or available to confirm continued eligibility.
Enrollment: 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.
Insurance Affordability Program (IAP): These programs include Medical Assistance, MinnesotaCare and Advanced Premium Tax Credit (APTC).
MAXIS: System that processes information to determine eligibility for public assistance programs not processed through METS.
METS: The acronym for the Minnesota Eligibility Technology System. System that processes information to determine eligibility for insurance affordability programs.
Need to renew: Those enrolled in MA, MinnesotaCare or a QHP 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: 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.