Scope
This policy applies to brokers, navigators and certified application counselors (CACs)
Policy Details
Information about assister roles and responsibilities for Minnesota Health Care Programs (MHCP) applicants and enrollees.
Data Privacy and Information Sharing
DHS is prohibited from sharing an applicant or enrollee’s private information with a third party unless the applicant or enrollee has provided their authorization.
- If an assister is associated with a case, as documented in Navigator/Assistor Broker evidence in METS, DHS staff will only share information with that specific assister unless a separate release of information is on file.
- DHS will accept a completed General Consent/Authorization for Release of Information (DHS-3549) form from an assister organization seeking to have information released to any staff members at the organization besides the specific assister associated with a health care case.
- If a properly completed DHS-3549 on file includes the company or agency name under “This information will be released to,” the authorization provided by the DHS-3549 extends to the entire organization instead of just the specific assister listed on the form.
This data privacy direction is for Minnesota Department of Human Services (DHS) staff only. County and tribal agencies should follow their internal policies and procedures regarding data privacy practices and information sharing.
Assister Roles and Responsibilities for MHCP Applicants and Enrollees
The lists below assume all necessary authorization has been obtained.
Navigators and certified application counselors provide applicants and enrollees with information about:
- The roles and responsibilities of an assister
- Health insurance options and the value of coverage
- Application and renewal processes
- Required documentation, mandated requirements, and any exemption criteria
- Program eligibility rules
- What health program a person may be eligible for/if they may be eligible for financial assistance after conducting a screening
- Referrals to appropriate support services or programs for further assistance
- Non-medical referrals
- Benefits specified by the Affordable Care Act for American Indians and Alaskan Natives
Navigators and certified application counselors are able to, on behalf of the applicant or enrollee:
- Start, resume and/or submit an application on the applicant’s behalf using the assister portal if an assister is meeting in-person, talking over the phone or following up after an appointment
- Submit a manual account request form, which must be signed the applicant
- Obtain eligibility and enrollment status
- Check the status of an application
- Submit verifications, if provided to the assister by the applicant or enrollee
- Request case information necessary to do their job in assisting the applicant or enrollee
Navigators and certified application counselors are able to, with the presence of the applicant or enrollee:
Assisters help people by meeting with them in-person, over the phone or by video. When they help people remotely, they may obtain electronic signatures when an applicant or enrollee’s signature is required.
- Help create an online account through MNsure.org
- Request the applicant or enrollee’s username and reset an account password
- Help complete and submit an online application through MNsure.org, unless there is an assister portal authorization
- Help complete and submit a paper application
- Help correct a mistake or report a change to information on an application
- Help submit a request to enroll in or change managed care plan selection
- Help report changes in circumstances
- Help complete the renewal form
- Help request a notice reprint
- Help request a new medical ID card
- Help enrollees who no longer qualify for MHCP apply for private coverage with financial assistance
- Help respond to a request for information
- Help applicants and enrollees gather and submit verifications
- Help respond to a periodic data matching discrepancy notice
- Help applicants and enrollees submit an appeal, and be appointed as a representative for the appeal on the DHS-0033 Appeal to State Agency form
Navigators and certified application counselors are not able to:
- Be an authorized representative (AREP) for a person on their caseload
- Independently take any action that requires the presence of the applicant or enrollee
- Provide choice counseling or enrollment services to enrollees who have been determined eligible for Medical Assistance or MinnesotaCare. For example, assisters may not persuade enrollees on which managed care plan to select.
- Help an enrollee understand covered services and benefits. A navigator or Certified Application Counselor can explain general concepts and help refer the enrollee to the appropriate agency to address their questions.
For state, county and tribal servicing agencies only:
- To raise a concern or report a complaint about a MNsure-certified assister, or to file a report of fraud involving MNsure or MNsure.org, send a message to mnsurecompliancehotline@mnsure.org or call the MNsure anonymous complaints telephone line at 1-844-466-7873.
- The MNsure Compliance Team investigates every complaint. A team member may need to ask follow-up questions in order to comprehensively investigate your compliant. Unless you wish to report anonymously, please either send your complaint by email or provide contact information for this purpose.
- See Protect Against Fraud for more information.
Definitions
- Assister: An individual who has certified with MNsure as a navigator, certified application counselor (CAC) or broker. Assisters do not have METS caseworker access and do not process applications or manage health care cases.
- Navigator: MNsure-certified navigators are trained experts at local, trusted community organizations. They can help a person complete an application, enroll in coverage, complete a renewal, report changes, and provide enrollment follow-up. They can assist but cannot advise on private plan selection or enrollment. Navigators specialize in MHCP application and enrollment and may need to refer an applicant to a broker for more complex private insurance plan enrollment situations. Services from MNsure-certified navigators are always free.
- Certified Application Counselor or Agency (CAC): MNsure-certified CACs are trained to help people with MNsure questions. They do this as part of their jobs with organizations such as hospitals, clinics, associations, or other groups, and are not obligated to help any applicant or enrollee that contacts them for assistance. They can assist but cannot advise on private plan selection or enrollment. CACs specialize in MHCP application and enrollment and may need to refer an applicant to a broker for more complex private insurance plan enrollment situations. Organizations that serve as CACs agree to provide free assistance.
- Broker: MNsure-certified brokers are insurance professionals licensed by the state of Minnesota and certified by MNsure who provide enrollment help and can recommend private plans. Brokers usually get commissions from health insurance companies for enrolling people into private insurance plans. Some brokers may only be able to sell plans from specific health insurance companies. Services from most MNsure-certified brokers are free. Brokers must disclose in advance if they will charge a fee, and how much. Brokers specialize in private insurance plans and their experience assisting Minnesota Health Care Programs (MHCP) applicants and enrollees may be more limited.
- Assister Resource Center (ARC): A contact center team dedicated to supporting navigators and CACs. Navigators and CACs typically use ARC as a first point of contact before reaching out to a specific servicing agency. While ARC does have METS caseworker access, they do not process applications or manage health care cases. ARC has read-only access to the eligibility systems MAXIS and MMIS. ARC staff are DHS employees that are supervised within MNsure’s contact center. ARC does not assist brokers, as brokers have a separate resource team.
