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Reduced Resources for Insurance Navigators; Outreach Efforts will be Crucial to Encouraging Coverage

July 12, 2018

The Centers for Medicare & Medicaid Services (CMS) released its annual notice for federal grants to fund navigators that assist consumers in enrolling in the federal health insurance marketplace. For the second year, CMS reduced the funding available to support the outreach efforts.

During 2018, CMS will provide $10 million for awarded applicants, less than a third of the amount that was awarded during 2017. Since 2016, navigator funding has dropped 84 percent nationwide. In Pennsylvania navigator funding decreased 35 percent from 2016 to 2017 (from $3.1 million to $2 million).

Navigators are experienced in helping consumers understand their options and apply for coverage, and often work collaboratively with hospitals and other community organizations in conducting outreach.

The ongoing work to help individuals gain health coverage is critical to ensuring they have the appropriate access to health care services. There is uncertainty surrounding federal policy ensuring the stability of the insurance markets. As a result, it will be even more important for hospitals and health systems to partner with the navigators working within their communities to support outreach to uninsured individuals.

Open enrollment begins November 1, 2018, and will run for a six-week period.

Each of the 34 states that use the federal health insurance marketplace (Healthcare.gov) will receive a minimum of $100,000. CMS will look to award contracts to small businesses, trade associations, and faith-based organizations. Funding applications are due August 9, and awards will be announced September 12.

In the funding notice, navigator applicants are encouraged to “outline strategies that maximize their impact on the community” and use federal funds efficiently such as through strategic partnerships. Navigators will be expected to provide targeted assistance to elevate awareness of the full range of the different types of coverage options available—including qualified health plans, association health plans (AHP), and short-term, limited-duration insurance (STLDI).

The Administration has advocated for expanding access to alternative insurance options to the comprehensive coverage offered under Affordable Care Act (ACA) requirements. Consumers may be attracted to these policies because of their lower premiums, but may not understand the full details of the inadequate health insurance coverage and the potentially significant out-of-pocket costs they could experience with a serious illness or injury.

Also of concern, many coverage advocates have cautioned that healthier consumers will take advantage of less-costly, less-generous coverage, leaving the sicker and higher-cost patients to secure coverage through ACA plans. Such a shift will undermine the ACA insurance marketplaces.

HAP and Pennsylvania hospitals embrace the importance of expanding access to meaningful coverage, and will work closely with the Pennsylvania Insurance Department and other stakeholder groups leading into the open enrollment period. The goal is to provide information and resources to help guide consumers to secure comprehensive health insurance and convenient, timely access to needed health care services.

For information about the insurance market in Pennsylvania and the impact of coverage, contact Jolene Calla, Esquire, vice president, health care finance and insurance, or Phillip M. Burrell, director, research and data analytics.

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