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Massachusetts Navigator Program
Notice of Grant Opportunity
Commonwealth Health Insurance Connector Authority
100 City Hall Plaza
Boston, Massachusetts 02108
Notice of Grant Opportunity
Navigator Program
May 18, 2015
Massachusetts Navigator Program
Notice of Grant Opportunity
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TABLE OF CONTENTS
SECTION 1: GENERAL INFORMATION ............................................................................................................ 3
SECTION 2: PROGRAM DESCRIPTION.................................................................................................. ............ 9
SECTION 3: APPLICATION REQUIREMENTS.................................................................................................. 18
SECTION 4: GENERAL APPROACH OF GRANT PERIOD………………....................................................... 21
SECTION 5: APPLICATION SELECTION AND EVALUATION PROCESS……............................................ 22
SECTION 6: TIMELINE AND GENERAL INFORMATION...................…………............................................ 23
APPENDIX A: GLOSSARY............................................................................ ....................................................... 26
APPENDIX B: OUTREACH AND ENROLLMENT WORKPLAN TEMPLATE................................................ 29
APPENDIX C: BUDGET WORKSHEETS ……………………………………………………………..……... 32
APPENDIX D: APPLICATION CHECKLIST ……………………………………………………………..…… 36
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1.0 General Information
1.1 Introduction
The Navigator program is an outreach, education and enrollment assistance program required by
the federal Patient Protection and Affordable Care Act (“ACA”) for every Health Insurance
Marketplace. The Commonwealth Health Insurance Connector Authority (the “Health
Connector”), the designated Marketplace for Massachusetts, is issuing this Notice of Grant
Opportunity to obtain applications from eligible organizations (see Section 2.2.1.) to become
Navigators for Massachusetts residents.
In Massachusetts, more than 96% of the population has health insurance, but more needs to be
done to reach the remaining uninsured. In 2014-2015, the primary objective of the Navigator
program was to assist members in transitioning from their existing coverage to new ACA-
compliant coverage. This required all affected populations to re-apply for benefits in a new
system governed by new rules. Overall, the Navigator program and the Commonwealth’s
member transition efforts more broadly were a tremendous success. Nevertheless, there are still
people in Massachusetts who have yet to complete the transition, and there are still more people
who remain uninsured.
As such, for the 2015-2016 Navigator program, the primary objectives for Navigators are (1)
outreach the remaining uninsured and those that did not successfully transition last year and
enroll all of them into new ACA coverage; (2) assist those in coverage through the Health
Connector with updating their applications and renewing their coverage for 2016; and (3)
generate awareness of the Health Connector and access to coverage through the Commonwealth
in the hardest-to-reach communities. Special attention should be paid to those communities,
cultures, and languages that disproportionately represent the populations that did not transition to
ACA coverage or are chronically uninsured.
Specifically, for 2015-2016, Navigators must:
1) Target the Uninsured
Outreach and assist those consumers who are known to the Navigator organizations,
who have not started an application, or were determined but did not yet enroll
Conduct targeted outreach to those consumers within their communities who remain
uninsured due to cultural, linguistic or other barriers
2) Mitigate Gaps in Coverage
Assist those currently enrolled in a Health Connector Qualified Health Plan (“QHP”)
with their renewal leading up to and during Open Enrollment (“OE”; this year from
November 1, 2015 to January 31, 2016)
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Support shopping for members who would like to make changes to plans or who are
eligible for new programs in 2016
Assist those consumers who experience any life changes with reporting that
information to the Commonwealth
3) Increase Awareness
Using culturally and linguistically appropriate methods, continue to generate
awareness about the available health insurance programs and options through
MAhealthconnector.org
1.1.1. The Health Connector
The Health Connector was established by the landmark Massachusetts health reform law of 2006
(Chapter 58 of the Acts of 2006, or “Chapter 58”). The mission of the Health Connector is to
connect Massachusetts residents and small businesses with affordable health insurance.
The Health Connector is an independent public authority governed by an eleven-member board,
comprising government officials and members of the public. The Health Connector board
represents a range of interests and expertise, including organized labor, employee health benefits,
consumers, small business, health insurance brokers, actuarial science, and health economics.
The Health Connector currently serves as a Marketplace, facilitating enrollment in health
insurance plans for Massachusetts individuals and small businesses. The Health Connector offers
individuals subsidized and unsubsidized health insurance options, and facilitates federal tax
credits and Wellness Track rebates to small businesses.
The Health Connector’s subsidized program, known as ConnectorCare, offers subsidized health
insurance to eligible adults with incomes up to 300% of the Federal Poverty Level (“FPL”) who
are not eligible for MassHealth and generally do not have access to Employer-Sponsored
Insurance (“ESI”). ConnectorCare enrollees include Aliens with Special Status who are lawfully-
present immigrants not eligible for federally-funded coverage through MassHealth. In addition
to ConnectorCare, eligible individuals with incomes up to 400% of the FPL meeting similar
eligibility requirements as outlined above may be eligible for Advance Premium Tax Credits
(APTC) to help them pay for a portion of the costs of an otherwise unsubsidized commercial
health plan.
The Health Connector’s unsubsidized program serves as a Marketplace for eligible individuals
and small employers to shop for unsubsidized commercial health plans. Initially launched on
July 1, 2007, for individuals, the program expanded in February 2009 to offer coverage for small
employers with up to 50 benefits-eligible employees. The Health Connector’s unsubsidized
program offers a broad range of plans for purchase by individuals, families and small businesses,
subject to geographic availability and Open Enrollment Period rules.
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In addition to administering these subsidized and unsubsidized programs, the Health Connector
is charged under Chapter 58 with several policy and regulatory functions. These include, but are
not limited to, the implementation and administration of the Commonwealth’s adult health care
coverage mandate, development of regulations defining what constitutes Minimum Creditable
Coverage, and adoption of an Annual Affordability Schedule defining who is subject to the
Commonwealth’s adult health coverage mandate. The Health Connector is also responsible for
policy development associated with the administration of Certificates of Exemption and appeals
of the Commonwealth’s individual mandate for those tax filers who have chosen to appeal
potential tax liabilities for not having coverage.
1.1.2. MassHealth
MassHealth is the Massachusetts Medicaid program administered by the Executive Office of
Health and Human Services (“EOHHS”). Medicaid is a means-tested entitlement program,
jointly funded by state and federal governments, that pays for health care for eligible
Massachusetts residents. MassHealth provides or supplements health care coverage for nearly
one of every four residents of Massachusetts. Its members include low-income children and
families, parents and caretakers, pregnant women, adults, women with breast or cervical cancer,
people with HIV/AIDS, seniors, and people with disabilities. Eligibility for coverage is different
for each of these categories and determined based upon a variety of factors, including income
relative to the FPL, age, immigrant status and, for some categories of eligibility, assets.
1.1.3. Moving Beyond The Health Connector’s ACA Transition Planning
The Health Connector has been designated, in accordance with Chapter 96, §7 of the Acts of
2012, to serve as the ACA-compliant Marketplace for the Commonwealth. The Health
Connector has implemented significant programmatic and operational changes to align with
ACA-required rules, which include, but are not limited to, eligibility determinations for
Marketplace participation and insurance affordability programs, certification of Qualified Health
Plans (“QHPs”), and enrollment of Marketplace populations in QHPs.
In addition to implementing market and product reforms, the Health Connector continues to
augment its operational and technological infrastructure to better serve individuals and small
employers purchasing coverage through the Marketplace.
A key required function of an ACA-compliant Marketplace is real-time eligibility determination
that facilitates enrollment in the Marketplace as well as other subsidized coverage options.
Specifically, the Marketplace must have the capability to assess individuals’ Modified Adjusted
Gross Income (“MAGI”), as required by the ACA, which will be used to determine eligibility for
APTCs and Cost-Sharing Reductions (“CSRs”) afforded by federal law. In Massachusetts, the
Health Connector is able to support these determinations as well as determinations of eligibility
for MassHealth, and as such, serves as the single front-door from an online perspective for
application, eligibility determination and enrollment into MassHealth and Health Connector
programs.
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Individuals with income up to 400% FPL may be eligible to obtain federal APTCs when they
purchase QHPs through the Marketplace. Eligible individuals with income up to 250% FPL are
also able to access federal CSRs. To further enhance coverage affordability, the Health
Connector provides additional subsidies in the form of a state wrap, (also known as
ConnectorCare plans) which includes both a premium component and a cost-sharing component,
to eligible individuals with income up to 300% FPL through the Marketplace.
The 2015-2016 Open Enrollment period will run from November 1, 2015 through January 31,
2016. This year, users can expect new system functionality to better support consumers in
application and shopping and new communications and notices related to eligibility
redetermination and plan renewals. In late summer/early fall, Health Connector members will
begin to receive communications regarding their 2016 coverage and Open Enrollment
information. The Open Enrollment period will be a critical time for those consumers who are
already enrolled in coverage to take a closer look at their health insurance options to ensure that
they are enrolled in the plan that best meets their needs. Open Enrollment is also an opportunity
for those consumers who were unable to enroll this past year or for consumers looking for health
or dental coverage anew. More details about this process will be shared during the summer
months through the Health Connector’s Board of Directors meetings and in other venues.
1.1.4. The Role of the Massachusetts Navigator
The approved grantee(s) will assist individuals, families and small businesses across the
Commonwealth in a fair and impartial manner with finding or maintaining ACA-compliant
health and dental insurance programs offered through the Health Connector and will provide
ACA-related education and outreach on topics that will facilitate such enrollment in a culturally
and linguistically appropriate manner.
1.2 Defined Terms
Capitalized terms not defined herein shall have the meanings assigned in the Glossary attached
as Appendix A hereto unless the context clearly indicates otherwise.
1.3 Issuing Officer
The Health Connector is issuing this Notice of Grant Opportunity. The Issuing Officer for this
Notice of Grant Opportunity is:
Paul Landesman
Commonwealth Health Insurance Connector Authority
100 City Hall Plaza
Boston, MA 02108
617-933-3148
Email: paul.s.landesman@state.ma.us
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Interested parties may submit questions only in accordance with Section 6.3 below. No other
contact with a Health Connector employee and/or Board member with respect to this Notice of
Grant Opportunity is permitted from the date of release of this Notice of Grant Opportunity until
a final agreement is executed, unless otherwise directed by the Issuing Officer.
1.4 Terms of this Notice of Grant Opportunity
The required services are set forth in Section 2.0 below. Any organization that submits an
Application (“Grant Applicant”) must be ready to provide services in accordance with those
requirements.
This Notice of Grant Opportunity is not an offer or promise to award a grant to a particular
applicant or applicants. The Health Connector may select none, one, or more than one grantee.
Grants may be awarded in full, awarded in part, or not awarded at all. The Health Connector will
decide how many grants to award, and the amount of each grant based on a number of factors,
including the availability of grant funding, the number, scope and quality of the grant
applications, and the need to use grant funding to serve diverse populations across the
Commonwealth.
Successful Grant Applicants will be awarded grant funding subject to terms and conditions,
including the requirements set forth in Section 2 of this Notice of Grant Opportunity, which the
grantee must agree to. Grantees will be required to complete the training necessary and pass a
certification exam to become certified navigators in order to receive grant funds. Grantees will
be required to obtain criminal offender record information (CORI) checks on all staff/volunteers
in accordance with the Health Connector’s Navigator Criminal Offender Record Information
Policy for Navigators Designated by the Massachusetts Health Connector.
The Health Connector reserves the right to modify the terms of this Notice of Grant Opportunity
at any time prior to the issuance of final awards. Any such modifications will be posted on
COMMBUYS and interested parties are encouraged to check COMMBUYS regularly for
information regarding this Grant Opportunity.
1.5 Term of Grants
The grants awarded under this Notice of Grant Opportunity shall be for the period commencing
on August 1, 2015, and ending on July 31, 2016, with the grant monies being disbursed on a
monthly basis. The first payment will be released in mid-September 2015 after successful
completion of training including achieving a passing score on the certification exam. Subsequent
installments will be released upon successfully submitting the required monthly report which is
due to the Health Connector by the second Friday of every month. Each report must be
accompanied by a monthly budget. More detail on this can be found in Sections 2.5 and 2.6. The
Health Connector reserves the right to withhold funds from Navigator organizations that do not
meet expectations as defined in the Outreach and Enrollment Workplan.
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1.6 Funding
The award of any grants for the Navigator program is subject to sufficient state appropriation.
2.0 Program Description
2.1 General Scope
The Massachusetts Navigator program shall fulfill federally-specified standards and comply with
all federally-mandated regulations under the ACA, including the minimum qualifications as
outlined in 45 C.F.R. §155.210 as well as state law and other requirements outlined below. The
Navigator program is designed to support the Health Connector’s mission of facilitating access
to affordable, quality coverage options using culturally and linguistically appropriate methods for
eligible individuals and small businesses in Massachusetts.
The Navigator program is designed to maintain and improve upon the current near-universal
health insurance coverage in Massachusetts by actively targeting identified geographic and
demographic communities of need through outreach activities. The Health Connector envisions
that Navigators will develop their own multifaceted campaigns that include a mix of
complementary activities that will be used to meet the objectives of the program. Navigators
should develop strategies that focus on assisting those individuals, families and small businesses
that may need assistance with their redeterminations plan renewals or who are applying for
insurance for the first time.
The Navigator program is a component of the Health Connector’s broader outreach and
education efforts to maintain and expand coverage and minimize unnecessary gaps. The
objectives of the Navigator Program for 2015-2016, as described in Section 1, focus on three
areas: Targeting the Uninsured, Mitigating Gaps in Coverage, and Increasing Awareness.
Navigators must also provide general outreach and education to individuals, families and small
businesses that are eligible for health insurance offered through the Health Connector. They
should support the Health Connector and MassHealth by providing information related to health
insurance options and facilitating application and enrollment for individuals, families and small
businesses.
When responding to the grant application, applicants should review the findings from two (2)
sources as the information and data analysis contained in these reports can inform applicants as
they prepare their outreach and enrollment workplans for the Navigator grant application:
1. The recent Blue Cross Blue Shield of Massachusetts Foundation resource, The
Geography of Uninsurance in Massachusetts, 2009-2013
(http://bluecrossfoundation.org/publication/geography-uninsurance-massachusetts-2009-
2013), This brief and set of detailed tables, prepared by the Urban Institute, provide
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estimates of the number and rate of uninsurance in Massachusetts by various geographic
units ranging from congressional districts to counties to neighborhoods. The resource is
based on the 2009 to 2013 five-year file of the American Community Survey (ACS),
which included a sample of 140,001 people in Massachusetts.
2. The Findings From The 2014 Massachusetts Health Insurance Survey from the
Massachusetts Center for Health Information and Analysis (CHIA,
http://chiamass.gov/assets/docs/r/pubs/15/MHIS-Report.pdf) This survey provides
information on health insurance coverage and health care access and use by
Massachusetts residents, and provides information on the remaining uninsured in
Massachusetts. Furthermore, it is a tool that is used to track and monitor the experiences
of Massachusetts residents in obtaining timely and affordable health care.
The Health Connector is looking for Navigators that are uniquely situated to target these
populations as they disproportionately comprise the remaining uninsured and former members of
the Health Connector that did not complete re-enrollment activities last year. In their response,
applicants should outline how they are uniquely capable of reaching some or all of the
populations outlined below and in the referenced reports, along with their unique and innovative
strategies for reaching these hard-to-reach populations.
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Areas of High Need for Outreach in Massachusetts
City Languages of Interest
Dorchester English
Vietnamese
Spanish
Cape Verdean Creole
Worcester English
Spanish
Vietnamese
Albanian
Lawrence Spanish
English
Brockton English
Cape Verdean Creole
Haitian Creole
Lowell English
Cambodian
Spanish
Lynn Spanish
English
Springfield English
Spanish
New Bedford English
Portuguese
Spanish
Fall River English
Portuguese
Quincy Chinese
English
Vietnamese
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2.2 Minimum Qualifications
In order to be considered for a Navigator grant, an applicant must meet the minimum
qualifications set forth in this Section 2.2.
2.2.1. Eligible Organizations
The ACA defines eligible organizations in 45 C.F.R. § 155.210(c) as any of the following:
Zip Code Languages of Interest
01841 - Lawrence • Spanish
• English
02301 – Brockton • English
• Cape Verdean
• Haitian Creole
02128 – East Boston • English
• Spanish
• Arabic
02148 – Malden • English
• Chinese
• Haitian Creole
02124 – Dorchester • English
• Vietnamese
• Spanish
02150 – Chelsea • Spanish
• English
01902 - Lynn • Spanish
• English
02151 – Revere • English
• Spanish
02124 – Everett • English
• Spanish
• Haitian Creole
• Portuguese
02125 - Dorchester • English
• Vietnamese
• Spanish
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A community or consumer-focused non-profit;
Trade, industry, or professional association;
Commercial fishing industry, ranching or farming organization;
Chamber of commerce;
Union;
Resource partners of the Small Business Administration;
Licensed agents and brokers; and
Other public or private entities or individuals that meet Navigator requirements,
including, but not limited to, Indian tribes, tribal organizations, urban Indian
organizations and state or local human service agencies.
2.2.2. Ineligible Organizations
As prohibited by the ACA in 45 C.F.R. §155.210(d), a Massachusetts Navigator must not:
Be a health insurance issuer or stop loss insurance issuer;
Be a subsidiary of a health insurance or stop loss insurance issuer;
Be an association that includes members of, or lobbies on behalf of, the insurance or stop
loss insurance industry; or
Receive any consideration directly or indirectly from any health insurance or stop loss
insurance issuer in connection with the enrollment of any individuals or employees in a
QHP or a non-QHP.
2.3 Navigator Program
The purpose of this Notice of Grant Opportunity is to solicit applications from qualified and
interested organizations to participate in the Massachusetts Navigator program.
This year, the Health Connector will be seeking applicants to target specific geographic and
demographic communities that data suggests additional outreach and enrollment assistance is
needed. In addition, we are seeking Navigators that will also be able to support existing
populations that may need to update their application or shop for a new plan during the
upcoming Open Enrollment. The Health Connector’s organizational focus for the upcoming
grant year centers around the 2016 Open Enrollment period. This year the Health Connector will
be focused on redetermining eligibility of its existing members, and renewing those members
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into their 2015 plans (or similar plans, as needed), which will be a new experience for both
subsidized and unsubsidized QHP members who enrolled through hCentive in the last year. As
such, for this year, we are re-focusing the Navigator program’s overall activities to provide more
targeted, culturally appropriate outreach and education activities to attract the remaining
uninsured while still maintaining staff to provide application and enrollment assistance for both
new and renewing members. To that end, for this year’s grant period, Navigators, among other
requirements, must:
Develop their own multifaceted outreach campaign, which includes a mix of
complementary activities that will be used to meet the objectives of the program
(attracting the remaining uninsured, assisting renewing members, and generating broad
awareness of health care reform and the Health Connector)
Create, organize and run their own community events
Be available to support ad hoc outreach and/or enrollment events that may be conducted
by the Health Connector and MassHealth during weekdays, evenings and weekends
Hold at least one larger enrollment event with other community partners such as Certified
Application Counselors (CACs) from local hospitals and health centers during the Open
Enrollment period at which Health Connector and MassHealth staff may offer needed
back-office support (but not direct application assistance)
2.4 Navigator Program Requirements
As a Navigator grant recipient and in accordance with 45 C.F.R. § 155.210(e), an organization
will be required during the grant year to:
Maintain expertise in eligibility, enrollment, redetermination and renewals, and program
specifications for Health Connector programs as well as MassHealth
Provide information and services in a fair, accurate and impartial manner, acknowledging
other health programs as appropriate or connecting consumers with other assisters or
brokers, as needed
Generate knowledge of and interest in the Health Connector programs, particularly
through public education activities
Facilitate the selection of QHPs
Provide referrals to any applicable federal or Massachusetts agency for any enrollee with
a grievance, complaint, or question regarding their health plan, coverage, or a
determination under such plan or coverage
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Provide information in a manner that is culturally and linguistically appropriate to the
needs of the population being served by the Health Connector, including individuals with
limited English proficiency
Ensure accessibility and usability of Navigator tools and functions for individuals with
disabilities in accordance with the Americans with Disabilities Act and Rehabilitation
Act
Ensure that applicants are informed of the functions and responsibilities of Navigators
Require applicants to provide authorization prior to the Navigator obtaining access to an
applicant’s personally identifiable information in a form prescribed by the Health
Connector and maintain records of these forms
Maintain a physical presence in the Commonwealth of Massachusetts so that face-to-face
assistance can be provided to applicants and enrollees
2.5 Specific Deliverables
During the grant period, Navigator Organization(s) will be required to:
Achieve the projected outreach activity goal per phase as expressed in the Outreach and
Enrollment Work Plan in Appendix B
Achieve the projected consumer outreach goal per phase as expressed in the Outreach
and Enrollment Work Plan in Appendix B
Achieve the completed application goal per phase as expressed in the Outreach and
Enrollment Work Plan in Appendix B
Achieve the enrollment goal per phase as expressed in the Outreach and Enrollment
Work Plan in Appendix B
Achieve the projected consumer redetermination assistance goal per phase as expressed
in the Outreach and Enrollment Work Plan in Appendix B
Achieve the projected consumer renewals assistance goal as expressed in the Outreach
and Enrollment Work Plan in Appendix B
2.6 Performance Management
Navigator organizations will be required to report on performance metrics on a regular basis, to
be defined in the terms of the agreement. Performance metrics have been established and are
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designed to measure the progress towards achievement of Specific Deliverables as outlined in
Section 2.5.
The Health Connector will establish an electronic performance management report to collect
regular updates on performance metrics. Navigator organizations may suggest additional metrics
that they will collect and report. The Health Connector reserves the right to modify reporting
metrics and frequency during the course of the grant award. Navigators will be given sufficient
notice prior to the collection of new measures.
The following measures are examples of what may be collected and submitted to the Health
Connector on a regular basis (e.g. monthly or even daily during open enrollment):
Age/demographic/income data of applicants assisted, and status of applicants at the time
of application (uninsured vs. active or recent insurance coverage)
Number and type of interactions (e.g., community events, one-on-one assistance, etc.)
Total hours dedicated to Navigator activities
Changes to monthly budget report
As part of the regular evaluation of each Navigator organization, grantees will be required to
participate in scheduled on-site visits.
2.7 Additional Obligations
Navigator organizations must meet all certification or other standards prescribed by the ACA, the
Commonwealth of Massachusetts or the Health Connector, if applicable. These certification
standards could include, but are not limited to the following:
Complete training and pass the certification exam to be a Certified Navigator as well as
any other additional training during the grant period
Obtain criminal offender record information (CORI) checks of any and all staff or
volunteers in accordance with the Health Connector’s Navigator Criminal Offender
Record Information Policy for Navigators Designated by the Massachusetts Health
Connector
Participate in follow-up and on-going evaluation on a periodic basis as described in
Section 2.6
Adhere to policies and procedures of the Health Connector during the grant period (e.g.
policies and procedures related to eligibility, enrollment, payment policies, etc.)
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Comply with privacy and security standards as required by applicable federal regulations
(See 45 C.F.R. §155.260), state laws, and any security requirements and administrative
safeguards that are established for access to any related state systems that Grantees may
gain access to during the grant period; comply with conflict of interest standards as
required by applicable federal regulations (See 45 C.F.R. §155.210) and set forth in any
subsequent agreement entered into between the selected grantee(s) and the Health
Connector
Participate in regular feedback sessions with Health Connector Navigator program staff
Attend four quarterly (one per quarter) Massachusetts Health Care Training Forum
(MTF) meetings during the grant period to receive policy and operational updates
2.8 Training
As noted above, entities seeking certification as Navigators must complete initial certification
training and pass the certification exam to become a Certified Navigator and must complete
additional training throughout the Grant Period, as needed. The goal of the training will be to
educate Navigators on the Health Connector’s eligibility application, shopping and enrollment
processes. In addition, Navigators must be thoroughly trained on other consumer-assistance
channels, such as those identified in Section 2.1, to know when and how to refer consumers to
other resources available in the market.
The Health Connector will develop the training modules and certification exam to be used to
certify Navigators in collaboration with other partners and based upon feedback received from
various stakeholders, including, but not limited to, other state agencies, the Health Connector
Board of Directors, Massachusetts health insurance carriers, providers and consumer advocacy
groups. Training topics will include, but may not be limited to:
• Navigator Policies and Procedures
• Legal Requirements
• Conflict of Interest
• Privacy and Security Standards
• Ethics
• Program administration, including reporting,
evaluations, and reviews
• Consumers
• Individuals and Families
• Employers, Employees
• Shopping Experience
• Web capabilities for Eligibility, Application
and Enrollment
• Decision-support tools
• Access to Medicaid and/or QHPs, including
mixed households
• Eligibility and Enrollment
• Eligibility criteria
• MAGI calculations
• Open enrollment period and restrictions
• Renewals and Redeterminations
• Member Costs
• Premium rates
• Advanced Premium Tax Credits (inc. Tax
reconciliation)
• Cost-sharing reductions
• Additional state subsidies
• Small Business federal tax credits
• Wellness Track rebate
• Individual Mandate
• MCC Requirements
• Individual and Small Business penalties
• Additional Consumer Support
• Brokers
• Customer Service
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• Products
• Qualified Health Plans (metallic tiers)
• Dental plans (inc. pediatric)
• Catastrophic plans
• Options for Small Business (SHOP)
Training courses will use a blended learning approach, inclusive of online modules, in-person
sessions and printed materials, and will be followed by a final certification exam. Initial training
must be completed in advance of the Open Enrollment Period, commencing November 1, 2015,
in order to obtain final certification as a Navigator.
3.0 Application Requirements
3.1 Applicant Letter of Intent (Limited to one page)
Each applicant must submit a letter of intent by Friday, May 29, 2015, stating the entity’s intent
to submit an application. The Letter of Intent can be submitted electronically in PDF format to
paul.s.landesman@state.ma.us. The purpose of the Letter of Intent is to estimate the number of
applications. The Letter of Intent is non-binding on the submitter.
3.2 Application Submission Process and Deadline
Two original, unbound applications (signed in ink) and eight (8) copies must reach the Health
Connector offices no later than 5:00 p.m. EDT on Friday, June 5, 2015 at the address below:
Commonwealth Health Insurance Connector Authority
100 City Hall Plaza, 6th floor
Boston, Massachusetts 02108
Attn: Paul Landesman
An electronic submission is also requested by the above date and time. Electronic submissions in
a commonly acceptable format may be delivered to paul.s.landesman@state.ma.us.
Applications should be prepared in as concise a manner as possible, delineating the capabilities
of the Grant Applicant to satisfy the requirements of this Notice of Grant Opportunity.
Applications should include each of the components outlined in the Application Check-List
(Appendix D). Total length of the application, excluding sample deliverables, resumes and
audited financial statements, must not exceed 30 pages.
3.3 Transmittal Letter (Limited to one page)
A signed transmittal letter, no longer than one page, shall accompany each application. The
transmittal letter shall be executed by an individual authorized to bind the Grant Applicant
contractually. The transmittal letter shall, at a minimum:
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Confirm the Grant Applicant’s willingness to be bound by, and ability to perform fully in
accordance with, the requirements set forth in Section 2.0 of this Notice of Grant
Opportunity
State that the Grant Applicant has not colluded with anyone in the preparation of the
application
Outline your organization’s eligibility to be a Navigator as specified in Section 2.2
Include the federal tax identification number and legal name of the Grant Applicant. The
application should provide the name, title, and contact information for the individual
responsible for the application, who will be available to respond to Health Connector
requests for additional information, if necessary
Disclose any potential or potentially perceived conflicts of interest as described in
Section 2.2.2
3.4 Project Abstract (limited to one page)
A project abstract shall accompany each application and include the following information:
Describe the population and geographic region that the applicant currently serves
Include a brief description of the target market(s) or population(s) that will be served,
including the extensiveness of geographic reach and its relation to the geographic areas
outlined in Section 2.1
Provide a brief description of the proposed approach to meet the goals of the 2015-2016
Navigator Program
The outreach, application and enrollment goals for the entire grant period
A brief description of the proposed approach to meet the projected outreach and
application, enrollment, redetermination and renewal goals
Indicate amount of funding requested
3.5 Qualifications and Program Proposal
In a brief narrative, Applicants must also address the following:
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Knowledge of the implementation of the Affordable Care Act in Massachusetts and the
role of the Health Connector
How the applicant researched, investigated and analyzed the remaining uninsured and
what conclusions the applicant has drawn about how the applicant is uniquely qualified to
outreach and assist those consumers
Experience in managing a program of this scope, both programmatically and financially
Experience in assisting individuals and families with applying for and/or enrolling in
health coverage
Competencies with health insurance, usability, accessibility and ADA compliance
Experience working with state or federal government agencies
Ability to identify and eliminate barriers in order to achieve the projected outreach and
application and enrollment goals
Existing relationships or strategies to create such relationships with employers,
employees, consumers (including uninsured and underinsured consumers), or self-
employed individuals likely to be eligible for health and dental coverage through the
Health Connector
How the applicant arrived at the projected outreach and application and enrollment goals
identified in the Project Abstract
Staffing capacity (and the hiring plan for additional staff, if necessary) including cultural
and linguistic capabilities required to perform the activities necessary to meet the
projected outreach and application and enrollment goals and the needs of targeted
communities
Plans and strategies for local and regional outreach and enrollment events
Strategy for actively assisting the Health Connector and MassHealth with outreach and
enrollment events in targeted areas of need
How the applicant will structure the Navigators’ time to focus on group enrollment
activities and outreach in hard to reach communities
Unique outreach and enrollment approach using grant monies in order to execute
successful multifaceted campaigns. This should include a mix of complementary
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activities such as: local and ethnic media, mailings, brochures, flyers, space rental, and
door knocking or other activities that are appropriate for the community being
outreached.
3.6 Outreach and Enrollment Work Plan
Each applicant must submit a detailed Outreach and Enrollment Work Plan that addresses how
they will achieve the projected outreach, application, enrollment, redetermination and renewal
goals – using their own multifaceted campaigns that include a mix of complementary activities.
See Sections2.3 for details.
When developing their workplan, applicants should reference Section 2.1 and also consider the
following:
The three grant phases: Pre-Open Enrollment, Open Enrollment, Post-Open Enrollment
and the efforts and communications that the Health Connector and MassHealth will be
implementing during that time
Other Assister organizations near them that they may be able to partner with for activities
and events during the three grant phases
Continue to work optimally when assisting the hard to reach communities
An Outreach and Enrollment Work Plan Template with additional instructions is located in
Appendix B.
3.7 Budget Narrative and Proposal
Each applicant must provide a budget narrative that describes how each line item will support the
execution of proposed objectives and achievement of projected outreach, application and
enrollment, redetermination and renewal goals. Each applicant should prepare a proposed
budget that includes only those costs that are integral to carrying out Navigator program
activities which will facilitate the achievement of the outreach and application/enrollment goals.
A Budget Worksheet with additional instructions is located in Appendix C. Note that Full-Time
Equivalent (“FTE”) hours devoted to Navigator activities have a set grant award rate, as further
detailed in Appendix C.
3.8 Approach to Program Oversight
As part of the grant application, applicants are required to include the following information:
Strategy for monitoring its progress toward achieving the outreach and
application/enrollment goals and meeting the needs of the targeted market(s) and
population(s)
Approach to addressing challenges or barriers once identified
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Policies and procedures for ensuring the privacy and security of any personally
identifiable information and other secure data
3.9 References
Applicants should provide three (3) current references. The references should be previous
clients/members for whom the Grant Applicant served for engagements which have provided the
experience requested under Section 3.6. Please provide telephone numbers and the names of
contact persons.
4.0 General Approach of Grant Period
The selected grantee(s) will be responsible for meeting the requirements and producing the
specific deliverables outlined in Section 3.6 during the term of the grant period. The grantee(s) is
expected to work closely with the Health Connector throughout the grant period, with frequent
communication on progress.
The approved grantee(s) would take part in at least the following activities by the specified
timeframes:
Certified Navigator training and certification exam
(individuals from selected grantee organizations)
August/September 2015
Navigator certification Upon successful completion of
training and certification exam
Conduct Navigator outreach, education and enrollment
activities to individuals, families and small businesses to
facilitate eligibility and enrollment
August 1, 2015 – July 31, 2016
Submit regular reports on quantitative and qualitative data
and monthly Navigator staff numbers
Monthly
End of Grant Period Report (final report due 30 days after
the end date of the Grant Period)
September 1, 2016
The Health Connector must review and approve any change in scope, deliverables or due dates.
5.0 Application Selection and Evaluation Process
Once a Grant Applicant has been deemed compliant with the application submission instructions
stated in this Notice of Grant Opportunity and to have met the minimum qualifications set forth
in Section 2.2 above, the Grant Applicant will be evaluated based on its written application,
reference checks, and any other information available to or known by the Health Connector.
The Health Connector will convene a Grant Awarding Committee (“GAC”) comprised of staff
members from the Health Connector and MassHealth to evaluate submissions.
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5.1 Navigator Grant Application Selection Criteria
The Health Connector will review applications for their reasonableness and value. Additionally,
the Health Connector will determine the size of a grant award based on the availability of funds,
the need to serve diverse populations across the state or in targeted areas of need, the number and
quality of grant applications, and the cost-effectiveness of a particular application. The Health
Connector is not required to select an applicant, nor required to select the lowest priced
applicant. In addition, the Health Connector may, in its discretion, decide not to issue any
Navigator grants.
The Health Connector will thoroughly review responses from applicants giving significant
consideration to the following:
Applicant’s alignment with Navigator program requirements
Applicant’s strategy to maximize outreach and enrollments and achieve projected
outreach, application, enrollment, and redetermination and renewal outcomes
Strength of the applicant’s proposed staffing plan that demonstrates the applicant’s ability
to meet the projected outreach, application and enrollment outcomes
Degree of innovation in outreach and enrollment work plan
Distinction from the applicant’s other funded activities
The GAC will recommend awards to Grant Applicant(s) whose applications provide the best
value to the Commonwealth.
6.0 Timeline and General Information
6.1 Relevant Deadlines
It is the Health Connector’s intent to select grantee(s) on or before Friday, July 3, 2015, with the
requirement that the accepted Grantee(s) be prepared to execute an agreement by August 1,
2015. The Health Connector reserves the right to modify such dates in its discretion.
The following estimated timetable, although subject to change, indicates the Health Connector’s
intentions regarding the Notice of Grant Opportunity:
Deadline Date
Notice of Grant Opportunity Issued Monday, May 18, 2015
Grant Applicant Questions Due Wednesday, May 20, 2015
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CCA Responses to Applicant Questions Due Friday, May 22, 2015
Applicant Letter of Intent Due Friday, May 29, 2015
Grant Application Due Friday, June 5, 2015
Oral Presentations from Finalists (if necessary) Week of June 29, 2015
Notice of Award (NoA) Friday, July 3, 2015
Navigators Return Signed NoA and Agreement to CCA Wednesday, July 8, 2015
Commencement of Work Saturday, August 1, 2015
6.2 Additional Information
It may be necessary for the Health Connector to request additional information from one or more
Grant Applicants and the Health Connector reserves the right to do so. The Health Connector
may ask certain Grant Applicants to make oral presentations. The Health Connector, in its sole
discretion, will determine which Grant Applicants will do so.
The Health Connector reserves the right, in its sole discretion, to request, at any time following
submission of applications and prior to the final selection of Grant Applicants that all or some
Grant Applicants clarify any given aspect of their application.
6.3 Questions
Questions regarding this solicitation or requests for additional information should be directed to
paul.s.landesman@state.ma.us. All requests for additional general information should be
received by 5:00 p.m. EDT on May 20, 2015. Written responses to such questions will be
provided to all eligible Grant Applicants by 5:00 p.m. EDT on May 22, 2015. The Health
Connector will not respond to any requests for information from potential Grant Applicants
about this Notice of Grant Opportunity other than those submitted in writing in accordance with
this section. Potential Grant Applicants are expected not to contact Health Connector employees
or board members for information about this Notice of Grant Opportunity other than as set forth
in this section.
6.4 Reimbursement
The Health Connector will not reimburse Grant Applicants for any costs associated with the
preparation or submission of any Grant Application or for any travel and/or per diem expenses
incurred in any presentations of such Grant Application.
6.5 Health Connector Rights
The Health Connector reserves the right to reject any and all applications, to waive any minor
irregularities in an application, to request clarification of information from any Grant Applicant,
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and to effect any agreement deemed by it to be in its best interest with any of the Grant
Applicants.
Issuance of this Notice of Grant Opportunity is not a guarantee that a grant will be awarded. The
Health Connector may at any time prior to the issuance of a final notice of award and acceptance
thereof by the successful applicant notify Grant Applicants of the cancellation of this grant
opportunity, for any reason and without penalty.
6.6 Applicable Laws
The Grant Applicant shall be responsible for compliance with provisions of federal, state and
local laws applicable to the development and submission of any application received in response
hereto. By submitting an application, the Grant Applicant agrees that Commonwealth laws shall
govern any and all claims and disputes that may arise between parties.
6.7 Public Records
All applications and related documents submitted or presented to the Health Connector as part of
this Notice of Grant Opportunity shall become its property. They may be subject to disclosure
upon request under M.G.L. c. 66, § 10, and c. 4, § 7, cl. 26. The Health Connector is under no
obligation to return any applications or materials submitted by a Grant Applicant in response to
this Notice of Grant Opportunity, including Grant Applicant “trade secrets” and financial
information (which are not exemptions in the public records laws). The foregoing applies even if
the Grant Applicant has submitted a non-disclosure or other statement asking the Health
Connector to retain the security or confidentiality of the trade secret and/or financial information.
6.8 Ownership of Materials and Data
All material and data produced for the Authority under an Agreement resulting from this Notice
of Grant Opportunity are the exclusive property of the Authority. Any information provided by
the Authority cannot be used for any purpose other than the functions described in an Agreement
without the express written consent of the Authority.
6.9 Health Connector Liability
The Health Connector shall have no liability whatsoever to any Grant Applicant for any financial
losses or expenses incurred by such entity or entities in response to this Notice of Grant
Opportunity or in connection with a contract or the services of such thereunder except as
expressly set forth in a contract.
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APPENDIX A
GLOSSARY
For the purpose of this grant the following terms are defined as:
Advance Premium Tax Credit (“APTC”): The Affordable Care Act provides a tax
credit to help consumers with income up to 400% FPL afford health coverage purchased
through the Marketplace.
Affordable Care Act (“ACA”): The federal law that enacts comprehensive reforms for
health insurance and requires the establishment of Marketplaces.
Business Express: An offering within the Small Group segment in which small
employers select a single QHP for all their benefits-eligible employees.
Commonwealth Health Insurance Connector Authority (“Health Connector”):
Established pursuant to M.G.L. c. 176Q, §2, the Health Connector is the state’s
designated Marketplace whose primary responsibility is to facilitate access to affordable
health insurance coverage for eligible individuals and small employers. The Health
Connector is charged with fulfilling additional policy and regulatory responsibilities
under Chapter 58 of the Acts of 2006.
ConnectorCare Plan: A Massachusetts program that will supplement federal subsidies
with state-funded premium and cost-sharing assistance to further strengthen affordability
of coverage for individuals and families with incomes at or below 300% FPL. The State
Premium Wrap and State Cost-Sharing Wrap are offered under the State Wrap.
Cost-Sharing Reduction (“CSR”): A discount that lowers the amount paid out-of-
pocket for deductibles, coinsurance, and copayments for an Enrollee with a household
income at or below a specified percent of the FPL.
Eligibility Determination: An assessment to determine if someone meets requirements
and qualifies for a federal or state benefit.
Employer Sponsored Insurance (“ESI”): Health insurance offered by an employer to
an employee that is subsidized or paid for in part by the employer.
Enrollee: Eligible individuals, eligible employees and eligible dependents enrolled in a
QHP and entitled to coverage thereunder.
Essential Health Benefits (“EHB”): A set of health care service categories that must be
covered by plans offered in the Marketplace.
Federal Poverty Level (“FPL”): A measure of income level issued annually by the
Department of Health and Human Services. Federal poverty levels are used to determine
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your eligibility for certain programs and benefits.
Grant Applicant: An organization that meets the minimum requirements set forth in
Section 2.0 of this Notice of Grant Opportunity that chooses to submit an Application in
response to this Notice of Grant Opportunity.
Marketplace (“Exchange”): A resource where individuals, families, and small
businesses can: learn about their health coverage options; compare health insurance plans
based on costs, benefits, and other important features; choose a plan; and enroll in
coverage. The Marketplace also provides information on programs that help people with
low to moderate income and resources pay for coverage. The Marketplace in
Massachusetts is the Health Connector.
MassHealth Program or MassHealth: The medical assistance and benefit programs
administered by the Commonwealth’s Executive Office of Health and Human Services
(“EOHHS”). MassHealth is the state-administered Medicaid health insurance program
for low-income families and children, pregnant women, the elderly, and people with
disabilities.
Minimum Creditable Coverage (MCC): A particular level of value or standard of
health insurance benefits that a resident of the Commonwealth must have in order to
satisfy the state’s individual mandate requirement. The Health Connector Board of
Directors is responsible for defining what constitutes MCC for the majority of people that
are covered by commercial insurance.
Minimum Essential Coverage (MEC): The type of coverage an individual needs to
have to meet the individual responsibility requirement under the Affordable Care Act.
This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP,
TRICARE and certain other coverage.
Modified Adjusted Gross Income (MAGI): The figure used to determine eligibility for
APTCs and CSRs in the Marketplace and for Medicaid and CHIP. Generally, modified
adjusted gross income is a consumer’s adjusted gross income plus any tax-exempt Social
Security, interest, or foreign income.
Non-Group: Individual health insurance.
Open Enrollment Period: The period during which an eligible individual may enroll in
health benefit coverage through the Health Connector. For the 2016 benefit year, the
Open Enrollment Period is November 1, 2015 – January 31, 2016.
Post-Open Enrollment Period: The period of time between the end of the Open
Enrollment period, February 16, 2016 and the end of the Navigator grant program, July
31, 2016.
Pre-Open Enrollment Period: The period of time between the start of the Navigator
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grant program, August 1, 2015 and before November 1, 2015 when the Open Enrollment
period begins.
Premium: A monthly payment made by, or on behalf of, a covered person to purchase
and maintain a health benefit plan, regardless of whether the covered person uses health
care services or not.
Qualified Dental Plan (“QDP”): A dental plan that is certified by the Health Connector
as meeting certain standards regarding quality, value, and coverage and is offered
through the Marketplace.
Qualified Health Plan (“QHP”): A health plan that is certified by the Health Connector
as meeting certain standards regarding quality, value, and coverage and is offered
through the Marketplace.
Small Employee Health Options Program (“SHOP”): The Small Business Health
Options Program operated by a Marketplace through which a qualified small employer
can provide its benefits-eligible employees and their dependents with access to one or
more QHPs. The Health Connector will offer QHPs for purchase by small employers in
accordance with applicable SHOP rules.
Small Group: Group health and/or dental insurance coverage offered by eligible
employers in accordance with 45 C.F.R. §155.710 and 211 CMR 66.00.
Special Enrollment Period: A period during which a qualified individual or enrollee
who experiences certain triggering events may enroll in, or change enrollment in, a QHP
through the Health Connector outside of the Open Enrollment Period.
Target Market: A market segment that is based on factors such as, uninsured, culturally
diverse populations, certain employment sectors, populations with Limited English
Proficiency and individuals and families with incomes less than 400% of the FPL.
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APPENDIX B
OUTREACH AND ENROLLMENT WORKPLAN TEMPLATE Required Format: Microsoft Word
Grant Period: 8/01/2015 to 7/31/2016
Applicant Organization Name: _______________________________
Instructions
In Sections I – III, using the information provided in Sections 2.1, 2.3, and 3.6, describe the
applicant’s Outreach and Enrollment strategy for each phase of this grant: Pre-Open Enrollment,
Open Enrollment and Post-Open Enrollment. These and other metrics will be used when
evaluating the strength of the application.
Applicants should include a mix of complementary activities that will be used to meet the
objectives of the Navigator program (attracting the remaining uninsured, assisting renewing
members, and generating broad awareness of health care reform and the Health Connector).
Consider the following types of Outreach Activity categories when developing your multifaceted
strategy:
Media
Enrollment Events
Equipment/IT
Mailing
Collateral
Other (Please describe in detail)
Please note, when identifying application and enrollment goals, an application is considered
complete only when all relevant application materials have been submitted on behalf of a
consumer either online or through the appropriate processing center. With respect to identifying
an enrollment goal, an enrollment is deemed complete only when the consumer has selected a
plan and has submitted their first premium payment.
In Section IV, indicate the applicant’s projected outcomes (numbers) per category for the
duration of the Navigator grant award. These and other metrics will be used when evaluating the
ongoing performance of the selected Navigator organization(s).
I. Pre-Open Enrollment: August 1, 2015 - October 31, 2015
During the Pre-Open Enrollment weeks, the Health Connector will be sending
consumers various communications such as: redetermination notices, final eligibility
notices, and renewal or discontinuance notices. Keeping this in mind, please describe
what plan of action the applicant would take to also support the Health Connector’s
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pre-Open Enrollment activities, including the types of activities that the applicant
plans to hold.
Given this framework, indicate the projected outcomes for the Pre-Open Enrollment
timeframe:
1. Total # of Outreach Activities Planned
2. Total # of Consumers Reached
3. Total # of Applications Submitted
4. Total # of Enrollments Completed
5. Total # of Consumers assisted with Redeterminations
Describe the outreach and education approach and strategy for the Pre-Open Enrollment
phase and explain why this approach is most effective toward reaching the applicant’s
projected outcomes.
II. Open Enrollment: November 1, 2015 - January 31, 2016
During Open Enrollment, the Health Connector will be focused on ensuring that those
consumers who need to renew their health care coverage or go through the program
redetermination process complete their objectives. The Health Connector will also be
working with Assisters on their enrollment events on weekdays, nights and weekends
by providing back office support.
Given this framework, indicate the projected outcomes for the Open Enrollment
timeframe:
1. Total # of Outreach Activities Planned
2. Total # of Consumers Reached
3. Total # of Applications Submitted
4. Total # of Enrollments Completed
5. Total # of Consumers assisted with Redeterminations
6. Total # of Consumers assisted with Renewals
Describe the outreach and education approach and strategy for the Open Enrollment
phase and explain why this approach is most effective toward reaching the applicant’s
projected outcomes.
III. Post Open Enrollment: February 1, 2016 – July 31, 2016
During post-Open Enrollment, the Health Connector will continue to work with
Assisters on group enrollment and outreach activities in an effort to assist the hard to
reach communities and redeterminations.
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Given this framework, indicate the projected outcomes for Post Open Enrollment
timeframe:
1. Total # of Outreach Activities Planned
2. Total # of Consumers Reached
3. Total # of Applications Submitted
4. Total # of Enrollments Completed
5. Total # of Consumers assisted with Redeterminations
6. Total # of Consumers assisted with Renewals
Describe the outreach and education approach and strategy for the Post-Open
Enrollment phase and explain why this approach is most effective toward reaching
the applicant’s projected outcomes.
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IV. Total Projected Outcomes for the Grant Period
In this section, indicate the applicant’s projected outcomes (numbers) per category for the
duration of the Navigator grant award. These and other metrics will be used when evaluating the
ongoing performance of the selected Navigator organization(s).
Outcome Category Total Projected Outcome
Outreach Activities Planned
Consumers Reached Through Grant
Activities
Applications Completed
Enrollments
Redeterminations
Renewals
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APPENDIX C - BUDGET WORKSHEET
Required Format: Microsoft Excel Worksheet
Applicant Organization Name: _______________________________
Instructions
Complete each section of the budget worksheet as described below. Insert additional rows as
needed. Please do not modify content or structure of worksheet.
Applicants should not allocate grant funds to cover expenses they would have funded in the
absence of grant funding.
I. Navigator Applicant Budget
Required Format: Microsoft Excel Worksheet (DO NOT PDF the spreadsheet upon
submission)
a. Personnel Costs: The budget requested for Personnel Costs must not exceed $15.00 per hour of
Navigator activities conducted. Organizations who are applying for the grant
should calculate the requested amount based on an annual basis. Holidays and
vacation time should not be included in the requested amount.
If a Navigator Organization is applying with a subcontracted organization, the
personnel expense should be calculated in the same way.
Using the excel spreadsheet provided, include detailed personnel information
below each section as indicated for current, proposed new hires and in-kind
personnel support.
b. Direct Costs: Organizations should use their discretion when requesting an amount for
Direct Costs. Grantees should categorize their requests for Direct Costs into
one of the following categories:
Media
Enrollment Events
Equipment/IT
Mailing
Collateral
Other
Examples of direct costs include but are not limited to Advertising in local
Newspaper, ethnic media, event space rental, rented equipment such as
laptops, printers and fax machine, letters, envelopes and postage, brochures,
postcards, flyers.
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c. Indirect Costs: The amount requested for Indirect Costs must not exceed 5% of total budget.
Indirect costs, or overhead, are those costs that are not exclusively part of the
grant project but are necessary to conduct the grant (e.g., rent).
II. Navigator Applicant Budget Narrative
Required Format: Microsoft Word
Prepare a budget narrative that describes how each line item will contribute to the
execution of the Outreach and Enrollment Work Plan and the achievement of the
projected outreach, application and enrollment goals.
Sample Budget Worksheet
a) Personnel
Costs
Lead
organization
staff
Position Title Staff Name
Number of
hours the
Navigator
will commit
during the
grant year
Total Dollar Amount
Lead Navigator First Name,
Last Name 2000 $30,000
Navigator First Name,
Last Name 1000 $15,000
Navigator First Name,
Last Name 1000 $15,000
Navigator First Name,
Last Name 500 $7,500
Navigator First Name,
Last Name 500 $7,500
Navigator First Name,
Last Name 500 $7,500
In-kind staff
Navigator (IN KIND) First Name,
Last Name 500
Navigator (IN KIND) First Name,
Last Name 500
Subtotal 6500 $82,500
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Subcontracted
organizations -
if applicable
Name of Organization Location
Number of
hours the
Navigator
will commit
during the
grant year
Total Dollar Amount
NA NA $0
$0
$0
$0
Subtotal
(Subcontracted) 0 $0
Subtotal (Lead
+
Subcontracted)
6500 $82,500
b) Outreach &
Enrollment
Activities
Describe Costs $ Amount Requested
Media
advertising in local newspapers $2,500
advertising in local radio stations $2,000
advertising on television $2,500
Enrollment
Events
space rental Senior Center each Saturday during Open
Enrollment $10,000
Equipment/IT
2 laptops for outreach events $1,800
1 portable printer for outreach events $500
Mailing Letters, envelopes and postage $5,000
Collateral Spanish brochure and Haitian Creole brochure $5,000
Other Flyering campaign 2 PT staff (20 hrs.) per week for 26
weeks $5,200
Subtotal Total Grant Funded Outreach and Enrollment
Activities Requested $34,500
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c) Indirect
Costs (limited
to 5% of overall
request)
Describe Costs $ Amount Requested
Detail 5% of indirect program support costs $6,413
Subtotal $6,413
Personnel Total $82,500
Total Request $123,413
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APPENDIX D - NOTICE OF GRANT OPPORTUNITY APPLICATION CHECKLIST
Required Format: Microsoft Word
Applicant Organization Name: _______________________________
A complete application to be considered for review consists of the following materials in two
original, unbound applications and eight (8) copies organized in the sequence below. Please
ensure that the materials are page-numbered. The sequence is:
� Applicant Letter of Intent
(Required by May 29, 2015)
� Transmittal Letter
� Project Abstract
(Limited to one page)
� Qualifications and Program Proposal
� Outreach and Enrollment Work Plan
(Appendix B)
� Budget Worksheet, Narrative and Proposal
(Appendix C)
� Approach to Program Oversight
� References