Applications are now being accepted for the New Jersey State Navigator Grant Program.
Donor Name: New Jersey Department of Banking and Insurance
State: New Jersey
County: All Counties
Type of Grant: Grant
Deadline: 09/04/2025
Size of the Grant: More than $1 million
Grant Duration: 1 Year
Details:
Navigator grants support the work of organizations that offer assistance to consumers to shop for and enroll in coverage on the Marketplace and help them apply for financial help. To be eligible for funding through this grant program, organizations must demonstrate that they comply with the minimum regulatory requirements outlined by the U.S. Centers for Medicare and Medicaid Services (CMS) and the Department’s minimum requirements outlined in this RFA. The funding made available through the New Jersey State Navigator Grant is for a performance period of one year. Grant contracts awarded under this RFA may be renewed, upon approval by the Department, for up to a one-year extension.
Section 1311(i)(3) of the Affordable Care Act requires the New Jersey Health Insurance Exchange (Marketplace) to establish a Navigator program. At a minimum, under 45 CFR 155.210(e), Navigators must:
- Maintain expertise in eligibility, enrollment, and program specifications and conduct public education activities to raise awareness about the Marketplace;
- Provide information and services in a fair, accurate, and impartial manner, which includes: providing information that assists consumers with submitting the eligibility application; clarifying the distinctions among health coverage options, including Marketplace qualified health plans (QHPs); and helping consumers make informed decisions during the health coverage selection process. Such information must acknowledge other health programs;
- Facilitate selection of a Marketplace QHP;
- Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under section 2793 of the PHS Act, or any other appropriate State agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage;
- Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Marketplace, including individuals with limited English proficiency and with a low literacy level, and ensure accessibility and usability of Navigator tools and functions for individuals with disabilities in accordance with the Americans with Disabilities Act and section 504 of the Rehabilitation Act;
- Ensure that applicants:
- Are informed, prior to receiving assistance, of the functions and responsibilities of Navigators, including that Navigators are not acting as tax advisers or attorneys when providing assistance as Navigators and cannot provide tax or legal advice within their capacity as Navigators.
- Provide authorization on a form that explains the Navigator’s responsibilities prior to a Navigator’s obtaining access to an applicant’s personally identifiable information (PII), that the Navigator maintains a record of for six years and can produce upon request; and
- May revoke at any time the above-referenced authorization provided to the Navigator related to PII access.
- Provide targeted assistance to serve underserved or vulnerable populations, as identified by the Department; this may include offering Department-approved translations of educational materials into other languages.
- The Department is authorizing and may require Navigators to provide information and assistance with any of the following topics:
- Reach out to consumers who were auto-renewed to ensure attestations are updated, income estimates are as accurate as possible, and consumers understand premiums, and reconciliation and repayment requirements;
- Understanding the process of filing Marketplace eligibility appeals;
- Understanding and applying for exemptions from the individual shared responsibility payment;
- The Marketplace-related components of the premium tax credit reconciliation process, and understanding the availability of IRS resources on this process;
- Understanding basic concepts and rights related to health coverage and how to use it; and
- Referrals to licensed tax advisers, tax preparers, or other resources for assistance with tax preparation and tax advice related to consumer questions about the Marketplace application and enrollment process, exemptions from the requirement to maintain minimum essential coverage and from the individual shared responsibility payment, and premium tax credit reconciliation.
Funding Information
The Department is making available $5 million through this Request for Applications.
Project Period
The grant period for this Request for Applications (RFA) is for the 2026 coverage year which begins October 1, 2025 and ends September 30, 2026.
Eligibility Criteria
Organizations that meet all the criteria outlined in this RFA are eligible to be considered for a Navigator Grant from the Department. In addition, all applicants must meet the following eligibility criteria as described below, which include requirements under 45 CFR § 155.210(c)(1). A Grantee must:
- Demonstrate that the entity has existing relationships, or could readily establish relationships, with local communities, consumers (including uninsured and underinsured consumers), or selfemployed individuals likely to be eligible for enrollment in a Marketplace QHP – particularly those in job types or income ranges without access to employer-sponsored coverage;
- Demonstrate willingness to meet, and prior to operation meet, the standards prescribed by the Marketplace;
- Show that the Grantee has, or will have prior to the commencement of Navigator operations, employees or associated volunteers who have a GetCoveredNJ Assister Training 2026 Certificate of Completion issued by the Department. If the Navigator and/or Grantee ceases to have certified individuals on staff, all Navigator and/or Grantee operations and funding must cease;
- The Grantee and each Navigator shall not have a conflict of interest during their term as a Grantee and/or Navigator, and each shall notify the Department immediately if a conflict of interest occurs (including receipt of payment or other consideration from a health insurance issuer/carrier in connection with enrollment of individuals or groups), and may be required to pay back Grant funds to the Department;
- Comply with all privacy and security standards required by federal regulation, the GetCoveredNJ Rules of Behavior and this RFA.
- In addition, Navigators must:
- Be located in New Jersey and include the use of ongoing permanent physical locations where eligible consumers can receive eligibility and enrollment assistance in-person. Having the ability to provide in-person and virtual assistance Monday through Friday is required yearround. Having the ability to provide assistance outside of normal business hours is preferred year-round and is required during the Open Enrollment Period. Have available hours of operation during key dates, including, November 1, December 15, December 30 and 31, and January 30 and 31.
- Be able to demonstrate how current organizational activities or prior experience are applicable to identifying, reaching, and supporting communities with relatively high uninsured rates compared to the rest of the state, recently unemployed and/or uninsured residents, and consumers with jobs or income levels that would indicate likelihood of eligibility for Marketplace coverage. Be able to provide support to populations with non-English language preferences and a variety of cultural preferences, especially racial/ethnic minorities.
- Demonstrate that the entity has established credibility and experience in the areas of health or social services, specifically in supporting consumers with income-based applications for government programs, navigating the complexities of the health care system, health insurance education and enrollment support, consumer or patient advocacy, or other activities where the entity has advocated on behalf of or directly assisted and educated consumers seeking support in getting access to coverage or health care services.
For more information, visit NJDOBI.
