On Thursday, September 14, the Trump Administration dealt many Navigator programs across the country a lethal blow by sending funding announcements, many with substantial cuts, to the organizations that provide in-person assistance to consumers in federally facilitated marketplaces (FFMs). This comes two weeks after the Department of Health and Human Services (HHS) announced its plans to significantly reduce funding for Navigator programs, as well as funding for open enrollment marketing and promotion. This latest announcement comes just one and half months before the start of open enrollment (November 1 – December 15), and now these organizations facing cuts of 20 percent to 92 percent must work at break-neck speed to re-submit their budgets for approval from HHS within two weeks.

Since implementation of the Affordable Care Act began, the country has seen a tremendous drop in our uninsured rate in nearly every state. The the current administration’s actions will directly undermine those efforts and will result in more people uninsured and in need of assistance. To work towards filling the gap created by the reduced funding, increased outreach and enrollment support from foundations, hospitals, state and local government and consumer health advocates will be crucial. Along with in-person assister organizations, stakeholders must coordinate efforts and pool resources to maximize outreach and enrollment in light of the large reduction in support from the administration.

The recent Navigator awards reduce overall Navigator funding down to $36 million, compared to $63 million awarded last year. This is more than a 40 percent decrease in funding, and will lead to a decrease in the number of Navigators available to assist consumers in enrollment for the upcoming open enrollment period. This map shows the widespread effects of this decision, with the South and Midwest bearing the brunt of the harm. In Georgia, the statewide Navigator group Insure GA suffered a 85 percent cut going from 2.2 million to a little over $300,000 for the year. In Louisiana, a state that has seen a tremendous boost in enrollment after successfully implementing Medicaid expansion in 2016, the Southwest Louisiana Health Education Center, the statewide navigator group, is looking at a 72 percent cut which will take the number of statewide navigators from approximately 20 to a mere four or five.  In Ohio, the Ohio Association of Foodbanks’ funding was cut by 71 percent, going from $1,679,029.00 to a $485,967.00 award. Navigator groups across the country are left in shock and still trying to determine how many staff they can afford to let go for the coming enrollment period and still assist consumers in the way they need.

Enrollment assisters are an essential link between consumers and access to coverage. Research shows that consumers are about twice as likely to successfully enroll in coverage with in-person assistance than those who attempt to enroll on their own. This is particularly true for hard-to-reach populations and for families with complex situations. For example, African Americans and Latinos are 43 percent more likely to seek in-person assistance than their white counterparts. In addition, many who seek out in-person assistance lack the confidence to complete the application on their own. Thirty-one percent of respondents to a 2016 survey by the Kaiser Family Foundation of assister programs said that most or nearly all of their consumers sought help due to lack of internet at home. Nearly 80 percent reported that consumers needed help understanding their plan options.

Beyond enrollment, assisters provide additional help to consumers to ensure that they use and retain their coverage. This includes educating consumers about how to use their health insurance and explaining complicated health insurance terms like in-network providers or deductible. Enrollment assisters also provide post-enrollment follow up to make sure that consumers have received their insurance cards, paid their premiums and found an in-network provider. Outside of open enrollment, assisters continue to do enrollment outreach and promote the value of health coverage. They also enroll consumers through Special Enrollment Periods or Medicaid and assist consumers with premium tax credit reconciliation. They provide year-round help to consumers with a wide range of coverage-related issues to help ensure that obtaining coverage leads to receiving needed care.

Regardless of past involvement with outreach and enrollment, state consumer health advocates need to get involved now to support in-person assistance and help fill the gap left by the funding cut. Ideas for involvement include:

  • Collect and share stories from Navigators and consumers about the benefit of in-person application assistance.

  • Talk to your Congressional delegation about the benefit of in-person assistance.

  • Encourage local and state government, foundations, philanthropies, and hospitals to support in-person assistance.

  • Promote open enrollment dates: November 1 to December 15.

  • Partner with in-person assister organizations to learn how you help through advertising, performing outreach, providing policy analysis and updates, etc.

It is important to note that this funding change will only affect states that use the Federally-Facilitated Marketplaces. State-Based Marketplaces (SBM) fund their own marketing campaigns and Navigator programs. In addition, the Navigator funding cut will not impact Certified Application Counselors or other types of in-person assisters who have different funding streams. Three-quarters of states use the Federally-Facilitated Marketplace and have federally-funded Navigator programs that provide vital enrollment assistance.

As you work to provide support for outreach and enrollment, remember that Community Catalyst is available as a resource to you. Community Catalyst will continue to keep you informed about outreach and enrollment changes.