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Compromise Allows Navigators Near Health Dept.


Pinellas County officials say the state Department of Health has agreed that Affordable Care Act enrollment advisors can operate within the same buildings as the local health department staff.

And DOH staff can refer uninsured patients to the advisors, called Navigators, for help in enrolling in a health plan on the Marketplace when it opens Oct. 1. 

"What the state said was that we could not hire Navigators, but that we could refer people to county offices within our buildings," said DOH/Pinellas spokeswoman Maggie Hall. She said it amounts to a "compromise."

The county and state agency were able to reach it because Pinellas County owns the buildings that the state DOH rents for its local operations. The Navigators cannot operate within the same offices as DOH staff, under the dictates from Tallahassee, which still stand. But they can be stationed nearby, providing one-stop-shopping to those who seek treatment at the health department.

It is not clear how many counties in the state are in the same situation, having DOH staff in county-owned buildings or next door to a county office.

The compromise may reduce tension between Affordable Care Act opponents, including Gov. Rick Scott and other high-ranking state officials, and those who strongly believe the state should enroll as many of Florida’s uninsured in a health  plan as possible, especially since there are federal subsidies for most who qualify.

The dispute began late Monday when DOH Deputy Secretary for Statewide Services C. Meade Grigg sent a note to 60 local health directors saying Navigators "will not conduct activities on the grounds of the health departments.”

That sent Pinellas County officials into a tizzy, since the county and local health department were partners on a project that won a $600,000 Navigator grant from the Department of Health and Human Services. Altogether HHS provided $7.8 million in such grants to Florida organizations.

On Wednesday, when Health News Florida published the article Navigators Not Welcome at Health Dept.,  Pinellas County Commission Chairman Ken Welch gave an interview broadcast on WUSF calling the decision "sad and disappointing." He called on state officials to "stop politicizing health care."

By Thursday, when the state's major newspapers picked up the story, Democrats in the Legislature began to protest. Congresswoman Kathy Castor sent Scott and Surgeon General John Armstrong -- who functions as DOH Secretary -- a letter calling the Navigator pronouncement "absurd."

Castor said Grigg's order was "in direct conflict with the State of Florida Health Improvement Plan," was "poor public policy and could result in harm to Florida Families."

But there was movement behind the scenes. Early Thursday morning, local health department director Dr. Claude Dharamraj had sent an e-mail to Grigg asking for "clarification" of the order, given that "all our  buildings are county property" or rental space in buildings that house other public agencies.

"I believe I am not in the position to dictate to them what kind of staff they put in their office," Dharamraj wrote. "So there  may be navigators in 'our' properties..."

It is not clear exactly what happened after that, but just before 3 p.m. Dharamraj sent a note to county administrators and commissioners that proclaimed "Good news. The county  navigators are allowed to be stationed in offices in county health departments. Health Department staff will refer patients to them for enrollment."

Commission Chairman Welch quickly tweeted the news. But when Health News Florida double-checked with DOH in Tallahassee, Communications Director Nathan Dunn denied that there was any change in agency policy.

"Consistent with normal departmental practice, we do not allow outside organizations to access Department of Health office space and information technology systems to conduct activities. We are treating the request for Navigators' space as any other organization that has sought to establish a physical presence in a county health department."

He added, "Protecting personal health information is a high priority for the Florida Department of Health."

Scott and other members of the Florida Cabinet have raised concerns about whether Navigators and the Marketplace could place patient privacy at risk. HHS officials say the concerns are unwarranted, given the design of the technology and the security checks in place.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.After serving two years as a Peace Corps volunteer in Colombia, Gentry worked for a number of newspapers including The Wall Street Journal, St. Petersburg Times (now Tampa Bay Times), the Tampa Tribune and Orlando Sentinel. She was a Kaiser Foundation Media Fellow in 1994-95 and earned an Master's in Public Administration at Harvard’s Kennedy School of Government in 1996. She directed a journalism fellowship program at the Centers for Disease Control and Prevention for four years.Gentry created Health News Florida, an independent non-profit health journalism publication, in 2006, and served as editor until September, 2014, when she became a special correspondent. She and Health News Florida joined WUSF in 2012.
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