Funding Cuts for Navigator Programs Will Reduce Outreach, Services During ACA Enrollment

The Center for Biosimilars Staff

Navigator programs, which provide outreach, education, and enrollment assistance to consumers eligible for health coverage through the Affordable Care Act marketplace and Medicaid, learned on August 31, 2017, about a 40% CMS spending cut on the program, with a wide disparity in funding cuts per state.

The Kaiser Family Foundation has released results from an online survey of Navigator programs, outlining changes that the programs expect to make in light of CMS’ recently announced cuts to funding.

Navigator programs, which provide outreach, education, and enrollment assistance to consumers eligible for health coverage through the Affordable Care Act marketplace and Medicaid, learned on August 31, 2017, about a 40% CMS spending cut on the program, with a wide disparity in funding cuts per state—reductions in funding ranged from 0% (Delaware, Kansas, and West Virginia) to 80% or more (Louisiana, Indiana, and Nebraska).

All Navigator programs were contacted about the survey, conducted between September 22, 2017, and October 4, 2017, and 51% of programs responded. The survey found that rationales for cuts to Navigator budgets were neither well explained nor aligned with performance:

  • 49% of respondents said that CMS did not provide a rationale concerning their funding levels, while another 40% said that the rationale provided was not clear.
  • Performance in terms of assisting consumers with selecting qualified health plans did not seem to have a strong relationship to funding; only 15% of programs that exceeded or met 95% of their goals saw their funding levels maintained, while 7.5% of programs that did not meet their goals saw their funding reduced by the same or similar percentage as those that succeeded in meeting their goals.
  • Funding does not appear to align with other performance metrics; 83% of programs met goals for the number of consumers who were provided with one-on-one assistance, 71% met their goals in providing help for consumers eligible for Medicaid or CHIP, and 75% met their outreach and public education benchmarks.

The survey also found the following with respect to likely outcomes of the budget cuts:

  • 55% of statewide and 72% of regional programs expect to limit the services that they provide to rural consumers
  • 45% of statewide and 67% of regional programs expect to reduce the geographic areas that they serve
  • 89% of programs expect to lay off staff
  • 81% expect to reduce outreach activities
  • 57% expect to reduce the time staff will devote to assisting consumers who have complex cases
  • 54% expect to reduce services to those consumers who have limited English language proficiency
  • 43% expect to limit the assistance that they provide to Medicaid- and CHIP-eligible individuals

The report’s authors highlight the fact that the administration’s decision to reduce funding to Navigators comes at the same time as insurers are exiting the ACA marketplace, as well as at a moment of uncertainty as to whether the federal government will continue to fund cost-sharing reduction payments. “This confusion, coupled with a shortened open enrollment period, increases demand for the consumer education and in-person enrollment assistance Navigators provide,” the authors state. “At a time when more help may be needed, the funding reductions are likely to reduce the level of in-person help available to consumers during this fall’s open enrollment and throughout the 2018 coverage year.”