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Trump Administration Undermining Community Efforts to Help Marketplace Consumers

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:

  • Its August 31 announcement came just days before groups would run out of their previous year’s funding.
  • CMS then took more than two weeks to give groups new maximum funding amounts and required groups to submit updated proposals by September 27 that reflected the new funding levels. Many groups facing large cuts had to redesign their programs to cope with smaller budgets.
  • CMS told groups it would take up to 30 days to review and approve their revised proposals and budgets, and funding wouldn’t be guaranteed until final approval.

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:

  • CMS cut the outreach budget by 90 percent over last year.
  • CMS ended contracts with two private firms to provide in-person assistance in states using for marketplace enrollment. Since the first open enrollment period in 2013, Cognosante LLC and CSRA Inc. have provided one-on-one assistance for people enrolling in marketplace plans and applying for subsidies.
  • CMS will shut down for system maintenance every Sunday morning during open enrollment except one. Sunday mornings are popular times for assistance groups to help people enroll at community events, including at faith-based gatherings.
  • The Department of Health and Human Services (HHS) will no longer allow regional office staff to participate in marketplace education and enrollment events. This change came to light after a regional office staffer cancelled her participation in a series of events scheduled by the Mississippi Health Advocacy Program, forcing the events’ cancellation.
  • HHS, though legally responsible for implementing the ACA, continues to describe the law as a failure that has harmed consumers, which could discourage some consumers from seeking marketplace coverage.

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.