Senior Policy Analyst
Trump Administration actions will leave far fewer Americans with access to trained enrollment assisters, or “navigators,” during the six-week open enrollment period for health insurance marketplace coverage that begins November 1. Navigators help people select plans that meet their needs, apply for subsidies to lower their premiums, and deal with other issues. As a result, fewer people will likely enroll in coverage for 2018 and get needed medical care.
The Centers for Medicare & Medicaid Services (CMS) announced on August 31 that it will slash navigator groups’ funding for the open enrollment period by about 40 percent below last year’s level. Also, each group’s funding will be based on how well it met its enrollment target last year — a group that met 70 percent of its goal would receive 70 percent of last year’s funding, for example.
That’s a flawed metric. It doesn’t account for the many other duties that navigators perform under the Affordable Care Act, such as raising awareness about health plan options and subsidies and referring consumers to appropriate assistance if they have a coverage-related grievance.
Moreover, the actual cuts don’t seem to be based on performance, as CMS claims. Some navigator groups report receiving far larger cuts than they should have under this method. Funding for one New Jersey group, for example, plummeted from $805,000 to $291,000 even though the group exceeded its enrollment target. Some states were hit especially hard: overall awards fell by at least 56 percent in 15 states and by over 70 percent in five of them (Indiana, Nebraska, Louisiana, Michigan, and Ohio).
Moreover, CMS is administering the cuts in a way that harms all navigator programs, not just those facing funding cuts:
Under this timeline, navigator groups will likely receive final approval of their funding just days before open enrollment’s November 1 start.
The Ohio Association of Foodbanks, whose funding was cut by 71 percent, closed its program in response to the cut and uncertainty about funding. The loss of this program will leave a significant gap for Ohioans who need help enrolling in the marketplace. Without this group, only one navigator group remains in the state and people in about 73 of Ohio’s 88 counties won’t have access to navigators.
In addition to cutting financial support for navigators, CMS has taken other actions that will pose additional challenges for navigators and other groups promoting marketplace enrollment this year:
Navigators, community health centers, advocates, outreach groups, and others are preparing for what promises to be a challenging open enrollment period. A new non-profit organization, Get America Covered, launched today to raise awareness about the availability of marketplace coverage. But experts fear that many eligible uninsured people will miss out on the opportunity to sign up for coverage due to the Administration’s retreat from activities to promote enrollment.