More on Patient Engagement

CMS awards grants for the Federally-Facilitated Exchange Navigator Program

Agency says navigators are required to give consumers information on association and short-term insurance, as well as ACA qualified health plans.

Susan Morse, Managing Editor

The Centers for Medicare and Medicaid Services has awarded $10 million in Navigator grants to 39 organizations in federally- facilitated exchange states to help consumers select plans for Affordable Care Act coverage.

Open enrollment for 2019 starts November 1.

Last year, CMS awarded $36 million, in funding, a 42 percent cut from 2017, according to a Government Accountability Office report. Some Navigator organizations last year reported cuts of 75 percent or more.

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The Government Accountability Office, in a July report, took issue with the way CMS calculated Navigator funding, saying the agency used "problematic data."

CMS set new requirements for Navigator funding this year. 

The money would be based on performance from previous years. 

Navigators would also be required to give consumers information on association and short-term limited-duration insurance, as well as ACA qualified health plans.

Under the Trump Administration, the duration of short-term plans has increased from three months to a year.

On Wednesday, CMS said Navigator applicants were encouraged to work with other organizations to target consumers who were "left behind," defined as those who are disproportionately without access to health insurance coverage and who could be unaware of the full range of options.

Navigator applicants were encouraged to leverage volunteers and to partner with public and private organizations to coordinate activities such as with local Medicaid/CHIP outreach, or to provide more virtual or mobile assistance to consumers.

"The grants announced today mark a new direction for the Navigator program aimed at providing a more cost-effective approach that takes better advantage of volunteers and other community partners," CMS Administrator Seema Verma said Wednesday. 

The grants awarded will have a period of performance of one year from September 12 to September 11, 2019. 

The Government Accountability Office report found that 8.7 million consumers in 39 states enrolled in ACA coverage, a number that was 5 percent less than the 9.2 million who enrolled in 2017 and the 9.6 million who enrolled in 2016.

Several factors accounted for the decline, the GAO said.

Plan affordability likely played a major role in enrollment, the report said. Also, consumers were confused over the status of the ACA given legislative efforts to repeal and replace the law.

In 2018, HHS spent 90 percent less on advertising for the ACA, from $100,000 in 2017 to $10,000 in 2018.

Stakeholders were divided whether the shortened, six-week enrollment period had an effect, the report said.

Twitter: @SusanJMorse
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