Senior Policy Analyst
The Department of Health and Human Services (HHS) used faulty measures to distribute funds last year among navigator groups, which provide outreach and enrollment assistance to people buying marketplace health coverage, a new Government Accountability Office (GAO) report found. In addition, HHS’ decision not to set numeric targets for total marketplace enrollment hampered its ability to monitor its performance during the open enrollment season and to decide how best to use its resources, GAO found.
Under the Affordable Care Act (ACA), each marketplace must have a navigator program that raises awareness about marketplace coverage, provides fair and impartial information about health plan options and subsidies to make coverage more affordable, and helps people enroll in coverage. HHS is responsible for ensuring that navigator programs perform these functions in the 34 states using the federal marketplace.
Two months before the November 1, 2017 start of open enrollment for 2018 coverage, HHS announced it would slash navigator funding by 42 percent from the previous year. HHS also announced that it would allocate the funding based solely on each group’s enrollment goal; HHS previously considered a variety of factors, including public outreach events and how many consumers received any form of assistance.
HHS’ new metric was “problematic for multiple reasons,” GAO concluded. Not only did it fail to account for the other duties that navigators must perform, but HHS got the enrollment data from a source that it itself acknowledged was “unreliable.” Moreover, HHS’ instructions to groups about their performance goals were unclear, so navigators varied in how they set their goals. GAO recommended that HHS provide navigator groups with clear guidance about their goals and other information they must give HHS that will affect future funding.
GAO also recommended that HHS set targets for marketplace enrollment, as it had in past years. These targets, which had enabled HHS to monitor progress during open enrollment and focus resources on consumers that HHS believed were highly likely to enroll, “could help the agency meet its program objectives of stabilizing the market and of increasing the mix of younger and healthier consumers purchasing plans.”
On top of its other harmful changes, HHS has dramatically cut the navigator funding it will award this year to just $10 million — more than 80 percent below the 2016 level. HHS officials suggest that agents and brokers reimbursed by health insurers can replace navigators, but navigators are different from agents and brokers. They’re required to provide fair and impartial information about health plan options, not promote particular options. They also provide services that agents and brokers generally don’t, such as making referrals for people to get help if they have a grievance related to their coverage, helping eligible people enroll in Medicaid or the Children’s Health Insurance Program, helping people resolve inconsistencies when their applications don’t match federal data records, and helping underserved groups such as people with limited English proficiency and people in rural areas.