Navigator organizations that help consumers enroll in exchange plans through the Affordable Care Act have received federal funding cuts of up to 75 percent, according to one director interviewed.
Some areas have seen cuts of up to 92 percent, according to The Washington Post.
Insure Georgia is getting $328,000 this year, compared to $2.2 million last year and Enroll Michigan is contemplating shutting down due to its $1.2 million grant being slashed to $129,899, The Washington Post said.
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In comparison, Florida Covering Kids & Families based out of the University of South Florida, and Get Covered Tennessee, are both getting reductions of 15 percent.
The Florida navigator is getting $4.9 million from the Department of Health and Human Services this year, according to Jodi Ray, program director of Florida Covering Kids & Families, who works with 12 partner organizations.
The 15 percent cut, though smaller than in other areas, will still be felt, according to Sandy Dimick, program director for Get Covered Tennessee.
"People seek out assistance for a reason, it's difficult for them to do it on their own," Dimick said. "We thought by year three they would enroll on their own. It just doesn't happen that way."
The navigator budget for the Arizona Alliance for Community Health Centers was cut by $300,000, or 35 percent, according to Allen Gjersvig, director for Navigator and Enrollment Services.
"This is compared to some who got 75 and 50 percent less," Gjersvig said. "We all have to revise the scope of work and our budget and submit it for approval. We're not at a point to say what's going to happen in a reduction of people and staff."
Gjersvig said the Arizona Alliance may contemplate reducing services after open enrollment.
"We are obligated to provide post-enrollment assistance," he said.
After open enrollment season, navigators field calls from consumers who say they never got insurance card, or who ask for information on finding a doctor or wanting to know which drugs are covered, he said.
Gjersvig said he had a chance to compare funding levels last week during a conference in Washington, D.C., that included directors of the navigator programs.
One frustration is no one can figure out the formula used by HHS to release the funds, Gjersvig said.
Seema Verma, administrator for the Centers for Medicare and Medicaid Services, said in late August that the navigator budget going into the new open enrollment period would be based on performance in enrollment numbers last year.
But Gjersvig said navigators didn't know whether this would include only numbers for Affordable Care Act open enrollment or also for Medicaid expansion. Navigators enroll beneficiaries in both, he said, because the consumers don't always know for which program they're eligible.
Also, as is the third year of three-year grant cycle, no one knows if there will be another grant cycle, Gjersvig said.
As navigators gear up for a new open enrollment period on November 1, Republican Sens. Lindsey Graham and Bill Cassidy have put forward a last-chance effort to repeal and replace the Affordable Care Act. The Graham-Cassidy bill is going forward in time for the September 30 deadline for it to pass through budget reconciliation.
While the bill awaits a Congressional Budget Office score, preliminary reports estimate millions would lose insurance coverage.
Another bipartisan effort headed by Republican Senator Lamar Alexander and Democratic Senator Patty Murray, aims to stabilize the market in part by a continuation of the cost-sharing reduction payments to insurers.
Insurers have said the CSRs are necessary to remain in the market without hiking premium rates by about 20 percent. Payer must set their final premiums by Sept. 27.
However in Michigan, the Health Alliance Plan, which had decided to sell plans on the exchange in 2018, withdrew the same day that navigator Enroll Michigan announced a 90-percent funding cut, according to the St. Louis Post-Dispatch.
Gjersvig and others navigators are pushing for certified application counselors, who help enroll consumers and who are not funded through navigator funds, to help make up for the loss of staffing in areas where cuts are forcing directors to eliminate positions.
The Arizona Alliance has about 85 staffers trained as navigators, but of those, 30 to 35 are funded by the federal grant, he said.
Hospitals can be a part of the solution by applying to become a certified application counselor organization, or they could train large numbers of certified application counselors, he said. The CACs could be voluntary auxiliary members during open enrollment, he said.
Ray in Florida also said word needs to get out for a successful open enrollment. As it is, open enrollment is shortened this year to six weeks, from Nov. 1 to Dec. 15.
"Because of the decreased resources for outreach and marketing, we will need more help from the communities and from the media to make sure the open enrollment window and deadlines are shared and widely publicized," Ray said.
The current federal navigator contract expired on September 1. Navigators would usually get a new contract by Sept. 2, but this year it came through late last week. The money is not retroactive to Sept. 2.
At the end of August, CMS said navigator funding would be reduced by over 40 percent.
Navigator money does not come from tax dollars, but from insurers, Gjersvig said, who has questioned the decision by HHS not to spend all of those funds and where the rest of the money is going.
The Centers for Medicare and Medicaid Services has also slashed promotion of Affordable Care Act open enrollment by 90 percent over last year's budget. It is investing $10 million, as opposed to the $100 million spent to promote enrollment for 2017.
The Bi-State Primary Care Association navigator funding was not cut, according to Stephanie Pagliuca, director of the Bi-State Recruitment Center.
Bi-State received the $354,512 it requested for New Hampshire, with funding for Vermont coming from another source.
"We consider ourselves very lucky," Pagliuca said.