Groups acting as Affordable Care Act navigators are struggling after Health and Human Services officials informed them that their funding for services this year will be reduced by as much as 92 percent. Some, however, anticipated the Trump administration's move and have already secured alternative funding to advertise and help people sign up for exchange plans during open enrollment this fall.
The Centers for Medicare & Medicaid Services on Aug. 31 announced that it plans to spend $10 million on promotional activities in order to meet the needs of new or returning ACA enrollees, a figure that the agency says is consistent with promotional spending on Medicare Advantage and Medicare Part D. CMS itself will advertise and conduct outreach to educate consumers on the new dates of the open enrollment period, which starts Nov. 1, through digital media, email, and text messages.
"These outreach methodologies have proven the most effective in reaching existing and new enrollees," the agency writes. "During the most recent open enrollment period, CMS spent more than $100 million on promotional activities — nearly double what was spent in 2015 — but saw first-time enrollment decline by 42 percent and effectuated enrollment decline by approximately 500,000 individuals."
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During the most recent open enrollment period, Navigators received over $62.5 million in federal grants while enrolling 81,426 individuals, according to CMS. Seventeen Navigators enrolled less than 100 people each at an average cost of $5,000 per enrollee, and 78 percent of Navigators failed to achieve their enrollment goal.
"For the upcoming enrollment period, Navigator grantees will receive funding based on their ability to meet their enrollment goals during the previous year," the agency writes. "These performance-based adjustments will ensure accountability within the Navigator program and avoid rewarding grantees that have failed to meet their performance measures."
Advocates of the navigator program, including congressional Democrats and some Republicans from rural states, tell the Washington Post that the substantive cuts will undermine work to help consumers get insurance coverage once open enrollment begins. And the depth of some funding reductions, which were made official late Wednesday, raised questions about those state programs' viability and the fairness of the administration's method for deciding how much money each group gets.
"There is no way you can run what we had on $328,000," Insure Georgia's Sarah Sessoms tells the Washington Post. The group last year received $2.2 million, but was informed of the substantial cut by an HHS email notice that arrived at 11:53 p.m. Wednesday.
Enroll Michigan executive director Dizzy Warren tells the publication that the group may shut down within a matter of months now that its $1.2 million grant was cut to $129,899.
"As you can imagine, this decimates our entire organization," he wrote in an email. The collective effort there enrolled 16,290 Michiganders in health plans last year.
Navigators do more than just sign people up on the exchanges during open enrollment, according to the groups' representatives. Throughout the year, they also conduct general outreach to communities about how to obtain coverage under the law, and they help individuals learn which health plans are offered on state and federal insurance exchanges.
Moreover,navigators typically advise consumers on how to provide proof of health coverage when filing their taxes; how to find a primary doctor; and how to address issues related to premium payments and insurance billing. They also work with employers on fulfilling their obligations under the ACA.
But some conservatives tell the Washington Post that they support the administration's action.
"The administration clearly has done a cost-benefit analysis in determining if the money that had been spent on the navigator program produced the needed results," Grace-Marie Turner, president of the Galen Institute, writes in an email. "Programs were significantly under performing in their cost per enrollee."
Meanwhile, some groups are currently figuring out how to make up the gap, and certain organizations were already planning to boost their ad spending after the Trump administration cut ACA ad funding by $5 million at the tail end of the 2017 open enrollment, according to the Washington Examiner.
California's state-run ACA exchange, one of 12 in the country, boosted its marketing and outreach budget by $5 million to a total of $111 million.
"The additional funding will be used to increase the number of television and radio ads around key dates throughout the upcoming open enrollment period, which will run from Nov. 1 through Jan. 31 in California," Covered California spokesman James Scullary tells the Washington Examiner. The federal open enrollment also starts on Nov. 1, but ends on Dec. 15.
"Covered California plans on submitting a report this week on how investing in marketing and outreach can boost enrollment," the report says.
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Katie Kuehner-Hebert
Katie Kuehner-Hebert is a freelance writer based in Running Springs, Calif. She has more than three decades of journalism experience, with particular expertise in employee benefits and other human resource topics.
