Nine states have passed navigator laws and declined to expand Medicaid: Florida, Georgia, Indiana, Maine, Missouri, Montana, Tennessee, Texas and Wisconsin. Nineteen states have passed navigator laws. State officials said the laws were meant to keep personal information private and make sure the navigators were fully trained. “In Texas, we are being vigilant about safeguarding privacy and keeping personal information out of the wrong hands,” Insurance Commissioner Julia Rathgeber said in a statement in December. “These proposed rules address insufficiencies in federal regulations and make the training and qualifications of navigators in our state more readily apparent to consumers and service providers.” STORY: Most insurance enrollees older than 45, records show The George Washington University survey included 247 health centers in states with Medicaid expansion and 136 states that didn’t. Findings included: States that did not expand Medicaid are less likely to notify patients of potential eligibility. Only 65% of the clinics in restricted states notified patients, while 81% of health clinics in states with expanded Medicaid did so. Clinics in restricted states are much less likely to help people gather documents they need to apply for the federal exchange, with 56% able to do so, compared with 77% of full-implementation states. Health clinic workers are less likely to help fill out paper enrollment forms, with 78% doing so vs. 86% in full-implementation states. Restricted state clinics are much less likely to have enrollment forms and assistance in other languages, as 60% of those states have that information available in clinics while 76% those in full-implementation states do. Clinics in restricted states are less likely to help select a health plan; only 29% of clinics in restricted states did that compared to 51% in states with full implementation of the law. “What shocked me was how significant some of the findings were,” Rosenbaum said. “This was not a case of some of this was a close call; they’re huge differences.” She said it was remarkable that even for existing state-based programs, such as Medicaid, the center workers had access to fewer resources. About 1,250 health centers are required by the law to help enroll medically underserved people, and the Health Resources and Services Administration gave out $150 million in grants to those clinics to assist people.