More on Policy and Legislation

Navigator organizations wait in limbo for reduced funding to enroll consumers in the ACA exchanges

Department of Health and Human Services is expected this week to release letters announcing funding based on enrollment performance.

Susan Morse, Senior Editor

Navigator organizations that help consumers enroll in exchange plans through the Affordable Care Act are waiting in limbo for a new contract they expect will include less funding than last year.

The current federal navigator contract expired on September 1. Navigators would usually get a new contract by September 2, but so far, they have yet to get one, according to Allen Gjersvig, director of Navigator and Enrollment Services for the Arizona Alliance for Community Health Centers.

Navigator organizations interviewed have slashed staffing hours as they await word.

All through the summer Gjersvig said he was receiving federal assurances that there were no bumps in the road or rumors that things would go wrong.

And then at the end of August came the announcement from Centers for Medicare and Medicaid Services Administrator Seema Verma that navigator funding would be reduced by over 40 percent and that organizations would receive funds based on enrollment performance for the 2017 open enrollment.

"We were shocked and almost simultaneously disappointed at how it would impact low income people," Gjersvig said.

Enrollment generally went down last year due to uncertainty in the ACA market after the election of President Donald Trump and his promise to repeal and replace the ACA, he said.

[Also: Trump administration, HHS stepping away from Affordable Care Act promotion, bundled payments]

Gjersvig and other navigators said they have learned that when the federal funds are released, the money will not be retroactive to September 2..

"Consequently every navigator organization has zero dollars at this time," he said. "We immediately informed our 15 sub-grantees. … You can apply for new funds for that gap period."

But there's no guarantee, he said.

"We're on a shortened work week," he said. "As of Monday, our hours are further reduced. Once we hear our amount we'll have to do a complete revision of the scope of our work and budget."

Gjersvig said he has no idea what the amount will be, but that 70 percent of navigator grantees missed their target for enrollment for 2017.

The money does not come from tax dollars, but from insurers, he said, questioning the decision by HHS not to spend all of those funds and where the rest of the money is going.

Jodi Ray, program director of Florida Covering Kids and Families is also spending the week in limbo, both due to Hurricane Irma, which closed the University of South Florida in Tampa where she works, and the navigator uncertainty.

Last year her program received $5.8 million in grant funding and subcontracted  a lot of the work.

"Most of them have suspended a lot of that work," Ray said.

How it will affect her navigator program is difficult to say until she knows the level of funding, she said.

There are certified application counselors who answer enrollment questions and whose positions are not affected by navigator funding, but it's the navigators that do the heavy lifting, according to Ray.

Sandy Dimick, program director for Family and Children's Service in Tennessee, said HHS is using only enrollment numbers for qualifying health plans in the marketplace, and they fell short on that number last year.

"We're expecting a 15 to 20 percent cut," Dimick said.

The notice from CMS affected them immediately, Dimick said.

"One subcontractor had to drop out," she said. "We had three subcontractors in the state."

The subcontractor dropped out because it was too small an agency to wait for reimbursement, she said.

"The other two are trying to determine what they'll do," she said. "We feel like we can at least move forward with our staff for a period of time. If there are cuts to be made, we'll have a budget in place."

But after open enrollment, positions or hours could be cut.

There are about three times the number of certified application counselors in Tennessee as navigators.

Families First of the Greater Seacoast in Portsmouth, New Hampshire, has four certified enrollment counselors who are  funded by grants not associated with navigator funding, according to spokeswoman Margie Wachtel.

"We're preparing to go ahead," said Elaine Beauchesne, an enrollment coordinator for Families First.

Open enrollment starts November 1.

The Department of Health and Human Services said only that it expected to make available to navigators the notices of award and corresponding terms and conditions this week. 

[Also: CMS awards $63 million in 'Navigator Awards' to groups that help consumers find coverage on marketplace]

The U.S. Department of Health and Human Services cut funding by  43 percent for 2018 navigator organizations that provide help for ACA enrollment.

The Centers for Medicare and Medicaid Services also slashed promotion of the 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.

[Also: CMS to invest $10M to promote Affordable Care Act open enrollment]

Yet in late August, CMS Administrator Seema Verma said those working in the navigator program established by the ACA would be assisting consumers this enrollment period with plan selections, especially in areas where there are fewer insurers than last year.

Twitter: @SusanJMorse

Crazy Explosive Boost 2017 PK