Texas Department of Insurance Proposes Background Checks for Healthcare Navigators

Texas Insurance Commissioner Julia Rathgeber
Texas Insurance Commissioner Julia Rathgeber

The Texas Department of Insurance has proposed rules to add extra protections for consumers who seek assistance from federal health exchange navigators, the department announced this week. Proposed are criminal background checks, privacy training, proof of identity, and evidence of financial responsibility for individuals providing the navigator assistance.

“In Texas, we are being vigilant about safeguarding privacy and keeping personal information out of the wrong hands,” Commissioner of Insurance Julia Rathgeber said in a statement. “These proposed rules address insufficiencies in federal regulations and make the training and qualifications of navigators in our state more readily apparent to consumers and service providers.”

Navigators are already required to undergo training on specific health plans, privacy standards, and eligibility requirements for the ACA’s tax credits and subsidies.

The Insurance department will hold a public hearing Dec. 20 and accept public comments until Jan. 6. The rules would go into effect soon after the public comment period ends. There are about 200 federal navigators across the state.

Lt. Governor David Dewhurst echoed Rathgeber, with more political fervor.

“When it comes to the Obama Administration’s encroachments on the individual liberties of Texans, the hits just keep on coming,” he said in a statement. “As they attempt to recruit enrollment in Obamacare, this cadre of ‘navigators’ cannot get unregulated access to people’s personal information the way they might in other states. Considering the litany of failures and excuses that accompanied the launch of the healthcare.gov website, we must be on guard against the continuing missteps of the Obama Administration. I applaud the Texas Department of Insurance for taking the initiative to regulate the Obamacare navigators as a way to protect our citizens.”

Critics aren’t buying the department’s “consumer protection” platform.

“This is an attempt to add cumbersome requirements to the navigator program and deter groups from working to enroll Americans in coverage in the Health Insurance Marketplace,” Joanne Peters, a spokeswoman for the federal Department of Health and Human Services, told the Washington Post. “The navigator program is similar to Medicare counselors, which have existed for years and never faced this kind of scrutiny from Texas. Despite the state’s efforts, we are confident that navigators will continue to help Texans enroll in quality, affordable health coverage.”

Senate Bill 1795—passed by the Texas Legislature—requires the Commissioner of Insurance to set standards ensuring that navigators can perform their required duties if federal standards are determined to be insufficient, Rathgeber said. The department posted an outline of concerns with federal regulation of navigators on Nov. 15, following an informal stakeholder meeting conducted on Sept. 30.

In addition to the background checks, navigators would be prohibited from:

- Charging consumers for providing information about health coverage
- Selling, soliciting, or negotiating health insurance coverage
- Recommending a specific health benefit plan
- Providing advice regarding substantive benefits or comparative benefits of different health plans
- Engaging in electioneering activities or financing or otherwise supporting the candidacy of an individual for government positions

The news comes on the heels of last month’s revelation that Dallas-based navigators had urged consumers to lie in order to get lower Obamacare insurance rates. A video—produced by conservative activist James O’Keefe—shows the four employees during explanatory meetings with potential health insurance enrollees. The three navigators advise a man posing as a college student, telling him not to report the outside income on his health insurance application, and not to divulge that he occasionally smokes.

Following the release of the video, the Urban League of Greater Dallas suspended three employees and fired a fourth.

And in September, Woodlands-based Cardon Outreach returned more than $800,000 in navigator grant money, claiming that those opposed to the healthcare law were making it difficult for the programs to launch. Cardon’s funds were to be used to hire people in four states to help explain the ins and outs of the health insurance exchanges to millions of the uninsured.

“The emerging state and federal regulatory scrutiny surrounding the Navigator program requires us to allocate resources which we cannot spare and will distract us from fulfilling our obligations to our clients,” Cardon officials said in an email to the federal government.

At least 16 states have passed legislation or written rules to require navigators to obtain licenses or certification before helping consumers. Seven other states—Georgia, Illinois, Missouri, Nebraska, New Mexico, Ohio, and Virginia—passed regulations on the types of advice navigators could offer, according to Stateline.

Read the entire proposed regulation below:

Texas Navigator Rules Proposal by Bradford Pearson

One comment on “Texas Department of Insurance Proposes Background Checks for Healthcare Navigators

  1. Bradford,

    This legislation is a great idea. In my state we have no such regulation. I have no evidence but right after I applied for health insurance my identify was stolen. That was the only new place I gave my information too. It is better to be safe than sorry. Don’t you think?


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