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Health care 'navigators' chart course to coverage

December 06, 2014

From left, Mohamed Raheb, Karen Puco-Pinho and William O'Connell Jr. assist people in signing up for health insurance at Family Health Center of Worcester. (T&G Staff/CHRISTINE PETERSON)

WORCESTER — When patients arrive at the Family Health Center of Worcester in search of help signing up for health insurance, many have already given up trying to understand the state's insurance exchange on their own.

Some do not even have email accounts, so a small crew of "navigators" who work with them set up the mail accounts, click through online insurance forms and jot down all the passwords and security information the newly insured patients will need.

"I know it can be overwhelming for our patients," said Karen Puca-Pinho, a Portuguese speaker, interpreter and cultural case manager at the busy facility off Queen Street, who is preparing to be certified as a navigator.

Walking patients through the intricacies of co-payments, subsidized plans and new email accounts is all part of the job for navigators at Family Health Center and other centers across the state, as open enrollment for publicly backed health insurance moves into its fourth week in Massachusetts.

The state expects 175,000 to 225,000 people will need to apply for subsidized coverage during open enrollment, which began Nov. 15 and continues to Feb. 15.

Navigators could help many of them.

Navigators were conceived as a crucial part of the nation's Affordable Care Act, which requires most individuals to get health insurance. The idea was to create a corps of knowledgeable helpers close to their communities who could dispense information in a fair, impartial way. Some are bilingual or multi-lingual.

Although navigators became a point of controversy in some states where officials opposed the Affordable Care Act, that never troubled Massachusetts, according to Amy Whitcomb Slemmer, executive director of the advocacy group Health Care for All.

"We have been living with health reform since 2006," she said, referring to the Massachusetts insurance law that was a model for national legislation. "For us it's a way of life. The priority is to maintain coverage, make sure everybody gets coverage, and we know one of the effective tools for increasing our coverage rates, and certainly the success rates for applications, is by supporting this navigator program."

There are about 80 certified navigators at 15 centers across Massachusetts, their work this year supported by nearly $1.6 million in state grants. The Family Health Center in Worcester was the only Central Massachusetts site to win a grant, receiving $142,102.

One of the navigators' critical tasks involves knowing their way around the state's health insurance exchange, also known as the Massachusetts Health Connector.

The Connector's website launched last year, the first season of insurance enrollment under the Affordable Care Act, only to crash and fail.

Unable to apply for health insurance online or even determine if they might be eligible for subsidies, Massachusetts residents were forced to file paper applications. The state, unable to rapidly verify eligibility, simply extended MassHealth to thousands of people.

Fixing the website cost $80 million and brought the expense of setting up an online exchange in Massachusetts to $254 million, according to state reports.

Navigators and others who work with patients at Family Health Center said last year's technical difficulties no longer exist.

"There's nothing to compare it," said navigator Mohamed Fouzi Raheb. "Day and night."

As of Thursday, the Connector website had determined nearly 54,000 people were eligible for MassHealth, the Medicaid health program for the poor that is funded by the state and federal governments. The site had also determined nearly 30,000 people were eligible for subsidized health insurance.

Family Health Center provides medical, dental and behavioral care, plus social services, to poor and underserved residents in the Worcester area, many of them immigrants. The center has employed workers since 1999 to help patients with insurance questions, according to William C. O'Connell, the center's grants manager. The center calls them "health benefits advisers."

"I think we realized that many people, many of our patients, were having difficulty accessing health insurance, or they had questions about health insurance or how to utilize their health insurance," Mr. O'Connell said.

Now five of those advisers are certified as navigators, and three more are undergoing certification. In addition to working at the center, they are spending time at the Family Health Center office in Southbridge and at community events, such as a senior citizen event at the DCU Center.

It's not clear yet how many people the Family Health Center navigators have assisted with insurance through the Connector so far, but the center is a bustling facility. Last year Family Health Center served more than 33,000 patients.

Mr. Raheb said his first question to people seeking insurance is whether they have a family. Follow-up questions can become more delicate: Is the person a U.S. citizen? A permanent resident? Someone without documents?

Navigators ask patients to bring in documents such as Social Security cards and federal tax returns to supply information for the application. Sometimes, Mr. Raheb and Mrs. Puca-Pinho said, they still must resort to paper applications if the system could not identify a person.

"Our main goal is to get them coverage, with the treatment and with the care they need," Mr. Raheb said.

Lisa Eckelbecker

Worcester Telegram & Gazette

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