For insurance exchanges, states need ‘navigators’ — and hiring them is a huge task

“I don’t know that any corporation would set goals that high, even if they were going into it with the kind of money they have for marketing Coke or Pepsi,” Reisberg said afterward.

Compounding the difficulty, de Percin said, is that many of the uninsured struggle with English or don’t have easy access to the Internet. Others aren’t familiar with concepts like co-payments and deductibles, let alone the subsidies that will be provided for lower-income people or the new eligibility rules for Medicaid.

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“If you’ve never shopped for insurance before, it’s just not a simple task. It’s going to be a lot of new information for people,” she said.

A funding Catch-22

Adela Flores-Brennan, head of the navigator program for Colorado’s exchange, said she expects to train “thousands” of navigators and other in-person helpers. But it’s unclear how much of that effort the exchange will be able to pay for.

In a kind of Catch-22, the money must come from an exchange’s operating funds, which will rely on fees from insurers. But those won’t be available until at least Jan. 1, well after navigators must be in position.

States can pitch in during the meantime. But that’s an unlikely option in Colorado, which has stringent rules governing its budget.

So Flores-Brennan is seeking grants from a third source: private foundations.She said she will also try to tap a related funding stream that the Obama administration recently offered to help states get around the federal funding catch. Essentially, Obama officials created another category of helpers — called “in-person assisters” — who will fill the same role as navigators but who can be financed through certain federal grants for exchanges.

Maryland plans to apply for some of this money to pay for as many as 250 assisters, who will supplement about 150 navigators the governor has proposed paying for with $9.8 million out of the state’s general fund.

In California, where lawmakers have adopted a law barring the use of state dollars for the exchange, practically the entire system for providing in-person help will be handled by such assisters. The state’s exchange plans to deploy about 21,000 of them to serve about 700,000 people with about $40 million in federal money already obtained for the purpose through the end of 2014.

Arkansas has adopted the same strategy to hire about 535 in-person assisters, whom officials plan to train by midsummer — albeit for a different reason.

The state is one of 32 that has chosen to let the federal government run its exchange. In these cases, the Obama administration is in charge of setting up the state’s navigator program. But Cynthia Crone, Arkansas’s director of planning for the exchange, said state officials worried that the administration wasn’t moving quickly enough.

“Our population has a lot of uninsured, not a lot of Internet use, and is very rural and very diverse,” Crone said. “We felt like we couldn’t wait.”

States consider strict rules

Lawmakers in Virginia, Ohio and Utah, meanwhile, are considering imposing strict standards on navigators. These include proposals to explicitly prohibit them from giving advice, require them to get a state license and mandate that they post surety bonds to cover any liability in case they provide someone with faulty guidance.