Health Insurance Navigators in Missouri to Need Licenses

July 18, 2013

A new Missouri law will require insurance counselors to get state licenses before they can help people search for health plans on an online marketplace.

The legislation, Senate Bill 262, signed recently by Gov. Jay Nixon imposes state requirements on so-called navigators, who can be paid through federal grants to guide consumers through the coverage options on a health insurance exchange.

Open enrollment is to begin Oct. 1 through the exchanges, which were created under the federal 2010 Affordable Care Act signed by President Barack Obama. Missouri’s Republican-led Legislature opted against setting up a state-run exchange, meaning the federal government will create one for Missouri consumers.

The St. Louis Post Dispatch reported that some advocates for the uninsured fear the new state law will make it harder to implement a health insurance exchange in Missouri.

The exchange is intended to be a one-stop shopping site for people who lack affordable, job-based health insurance. Navigators are to help consumers sort through the options and figure out whether they are eligible for premium tax credits or free or low-cost coverage through Medicaid.

The counselors must be trained by Oct. 1, but the state has no regulatory framework to license the insurance navigators. Even if it can quickly create a licensing structure, the law bars insurance navigators from recommending specific plans.

Critics question the need for state licensure, because navigators must take a 30-hour federally required training course and pass an exam.

“We believe the intention was to make it harder for people to access new insurance options,” said Jen Bersdale, executive director of Missouri Health Care for All, a St. Louis-based coalition that supports the Affordable Care Act.

The licensing law was sought by insurance agents and brokers. They said it will keep out unscrupulous counselors and prevent fraud. In determining eligibility for federal subsidies, the navigators will have access to consumers’ tax records.

“To me, it’s just common-sense consumer protection,” said Larry Case, executive vice president of the Missouri Association of Insurance Agents.

Missouri is one of at least 14 states that passed legislation regulating the navigators, according to an update this month by a health law blog at the Georgetown University Health Policy Institute.

The National Conference of Insurance Legislators drafted the navigator provisions and distributed them to states as model legislation, said state Sen. Scott Rupp, R-Wentzville.

“The state has to have some authority over who are the navigators,” Rupp said. “We have to be able to root out any bad apples.”

But others contend the licensing bill grew, at least in part, out of a turf battle.

“Agents and brokers are pushing this very hard because they’re concerned about losing market share,” said Tim Jost, a health law expert and professor at the Washington and Lee University School of Law in Virginia.

Topics Agencies Legislation Missouri

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