Oops! Health Dept. on Navigator List

Oct 3, 2013

The Hillsborough County Health Department showed up Tuesday on the list of  "navigators" to help uninsured people enroll in the federal online Marketplace. That was a real surprise since the state Department of Health made national headlines last month when it ordered local health department directors not to allow navigators on their premises.

After noticing the HCHD name on the navigators list at Healthcare.gov, Health News Florida asked the state DOH press office whether the agency had rescinded its controversial policy. The question apparently set off a scramble.

DOH spokesman Nathan Dunn responded in an e-mail: "That information for Hillsborough (County Health Department) is not accurate and the Department has requested that it be removed."

As of Wednesday afternoon, the listing was still there. HCHD spokesman Steve Huard said, "We're trying to get it removed," but said that had proved somewhat difficult. The federal Marketplace officials who would be the ones to take it down are the same people who are frantically trying to iron out the bugs in the online exchange that are annoying millions of Americans who are trying to use it.

The listing was an "honest mistake" that occurred when some staff members at HCHD wanted to volunteer to help uninsured people who needed help with enrollment, he said. They had not realized that cooperation with the Affordable Care Act online shopping project was a no-no. 

Health News Florida reported on Sept. 11 that C. Meade Grigg, DOH deputy secretary for statewide services, had sent a memo to 60 county health unit directors, telling them that they could provide informational materials and directions to where navigators could be found.

“However, Navigators will not conduct activities on the grounds of the health departments,” Grigg wrote.

The memo appeared to be triggered by politics, since Gov. Rick Scott and other Republican officials had been issuing warnings that the federally funded navigators might breach patient privacy. A spokeswoman for Gov. Scott later confirmed that he knew about the policy memo.

The order led to friction between counties and the state, starting with Pinellas County. There, after the department director pointed out that the counties owned the buildings the state clinics were in, a compromise was achieved that allows navigators in the buildings but outside the DOH offices.

By that time, national news outlets including Huffington Post, Reuters and Forbes were covering the story, not to mention late-night TV comedians. The New York Times and other newspapers began describing Florida as a state that was trying to block information on health-plan enrollment to the uninsured.

At that point, DOH sent out news releases and a  fact sheet that said the agency was simply enforcing a long-standing policy. The fact sheet mentioned that most uninsured people who seek primary care through the local health departments would not qualify for navigator services.

The reason, as  Health News Florida then reported, is that health department clinics typically attract uninsured people who have family incomes under 100 percent of the federal poverty level. That group will gain coverage through expanded Medicaid under the Affordable Care Act in many states, but not Florida.

The state Senate voted to accept $51 billion in federal funds to expand health coverage to poor adults, but the House voted it down. The adults not covered are those with household income of about $11,500 for a single person and $23,500 for a family of four.

About two weeks after the memo was published on the no-navigator policy, the Broward County Commission voted to defy it. Commissioners said that since the county owned the clinic buildings, it had the right to insist that navigators be allowed in.

On Tuesday, the Miami-Dade County Commission unanimously approved a proposal to allow navigators on county-owned facilities. Commissioners also formally asked the state DOH to repeal its ban and instructed the mayor to review the county's health-department leases with the state, The Miami Herald reported (paywall alert).