Most of the enrollment advisors who will be available to help Florida's uninsured enroll in a health plan through the federal Marketplace will apparently not be covered by Florida's licensure law.
That's because they fall into a different category, "Certified Application Counselors," or CACs. This job classification -- calling for some training, but not as much as navigators -- emerged from the Centers for Medicare and Medicaid Services as a rule in July.
Hospitals, health centers and social-service agencies have applied for and received federal approval to certify the counselors once they pass an online course. There could soon be thousands of CACs across the state, compared to only about 150 licensed "navigators."
The state law covering the Affordable Care Act requires that navigators who help the uninsured enroll in the Marketplace obtain licenses from the Division of Financial Services. DFS issues a navigator license only after it receives documentation that the applicant has passed the federal test and the state background check, including fingerprinting.
But the law doesn't mention Certified Application Counselors because it was passed in April and signed by the governor May 31 -- well before the federal rule on CACs came out. So do they have to have a license?
"There is nothing in Florida law that states they do," said DFS spokesman Chris Cate.
"I've actually asked that question to some of our legislative leaders. We don't have an answer yet," said Andrew Behrman, president and CEO of the Florida Association of Community Health Centers. The organization is made up of about 50 non-profits that operate hundreds of clinics throughout the state.
Members of the health-center association should have a total of around 440 CACs by the time training and certification are done, counting the hundreds who were already on staff when 41 clinics received $8.1 million in federal grants in July to hire more.
The health centers -- like hospitals and many other health-care organizations -- had eligibility workers on staff to help uninsured patients enroll in Medicaid, KidCare, or some other program. When CMS created the job classification for "Certified Application Counselors" in July, the health centers wanted eligibility workers to have those skills and certification, too.
Federal documents say that as soon as an organization has received designation as a CAC employer, its staff and volunteers may begin the online training program at the Marketplace (also called the "Exchange.") When the trainees complete the program, their employer can certify them as application counselors.
"This certification process provides assurance to consumers that they are receiving assistance from persons trained by the Exchange who are overseen by organizations that are required to protect personally identifiable information," says the July 12 "guidance" document from CMS Deputy Administrator Gary Cohen, director of the Center for Consumer Information and Insurance Oversight.
Several Florida officials, including Gov. Rick Scott and Attorney General Pam Bondi, have raised concerns in recent weeks about how well the Marketplace and navigators will guard patients' privacy. Health organizations say they have proved trustworthy in enrollment for Medicaid and KidCare, so they can also be trusted with the Marketplace sign-up.
Health-care or social service organizations that want to certify their staff or volunteers as CACs can find information at this site.
Florida is one of 36 states that chose to let the federal government operate its Marketplace rather than create one itself. The Department of Health and Human Services announced Wednesday that in Florida, enrollees will have a choice of more than 100 health plans, on average -- less in some counties, more in others. On Tuesday, the plans and prices will be searchable by zipcode at www.healthcare.gov.
The Affordable Care Act provides for premium subsidies through the Marketplace for uninsured people whose family income is between 100 percent and 400 percent of the federal poverty level. It also offers financial help at the lower end of that income range to help with out-of-pocket expenses.
In Florida, there will be no program to offer those under 100 percent of the poverty level. About half the states expanded Medicaid, using federal funds to pay most of the cost. Florida stood to receive an estimated $51 billion over 10 years, but the Florida House said no.
That decision can be revisited, and groups from the League of Women Voters to the Chamber of Commerce have recently called for that. However, there has been no sign from leaders in the House that they are willing to do so.