Health Care Navigators and Counselors Prepared to Help

Jeanne Rabel is a Certified Application Counselor (CAC) under the Affordable Care Act (ACA). Since she took training in October to become a CAC, she’s volunteered almost 20 hours a week at the Community Clinic of Door County, helping people understand insurance and health care.

She worries about the issues with, about people stuck with high-deductible plans and about those who are still left out by the ACA, but there’s one concern that weighs most on Rabel.

How will she find the people who need her most?

Mary Rose Perez works with a client at the Sturgeon Bay library. Photo by Len Villano.

“I think there are a lot of people who have no idea this is happening, and what happens when they go to file their income tax in 2015?” Rabel said. “I don’t know how that’s going to play out.”

Under the Affordable Care Act, people who don’t purchase insurance or file for an exemption by March 31, 2014, will be fined. Rabel thinks many people aren’t aware of that new policy, and won’t be until they get fined.

Rabel is one of a handful of CACs in Door County. CACs, along with one navigator who splits her time between Kewaunee and Door County, are charged with helping residents sign up for insurance plans, file exemptions and teach the public about changes to health care. Click here for their contact information>>

It’s a big task. There are 800 people in Door County no longer eligible for BadgerCare who will have to purchase insurance, and that still leaves those dropped from private plans and those currently uninsured.

“I am more worried about the people who have no idea what’s happening,” she said. “I don’t know how to reach them. I don’t know how we’re going to find those people.”

Getting in touch is only the first step in helping people enroll. The second is actually giving the help, and that step hinges on communication.

That’s why the navigators in Northeast Wisconsin are bilingual. Door and Kewaunee County’s navigator, Mary Rose Perez, speaks Spanish and English and two of her co-workers speak Hmong.

“[Non-English speakers] just in general are underserved populations for any type of services,” Perez said. “I know that at the same time those are populations that may have concerns about getting help, knowing if they can get help in their language. We want to make sure that everybody is able to be helped in some way.”

Navigators and counselors both attend training sessions to learn about health care exchanges, but navigators undergo background checks and take extra training to learn to help small businesses. Both are available to help people understand insurance but neither can give actual advice on purchasing one plan over another.

Perez and the CACs are charged with understanding more than just signing up for plans. They have to understand insurance and be able to explain the basics of premiums, networks and deductibles to enrollees.

“I have some people who don’t even know what eligibility is, some people who don’t know if they make enough money or if they make too much money [for subsidies],” Perez said. “Some people don’t understand insurance at all.”

Brian Stephens, revenue cycle director for Ministry Door County Medical Center, said the county’s counselors and navigators are stretched thin.

“So many people are going to need assistance and so far the people we’ve sat down and talked to it’s taken an hour or more,” he said. “Two people [at MDCMC] aren’t going to be able to do it and five people in the county aren’t going to be able to do it so we’ll have to use other people as extensions of those who are certified.”

Even when the bulk of people are signed up for insurance plans or filed for exemptions, there will still be need for access to free or low-cost health care.

“Some people are not going to be able to afford insurance,” Rabel said. “Hopefully they can get a hardship exemption, but if they get a hardship exemption the bottom line is they still don’t have insurance. What do they do when they need to have doctors’ care? What do they do if they need to go into the hospital, if they need prescription drugs? The Community Clinic does a lot of things but we can’t meet every single need of every single person – we don’t have the resources to do that.”