CMS cuts ACA navigator funding down to $10M
- CMS announced it is slashing funding for navigators, citing enrollment data from 2016 and 2017 that it says shows navigators "failed to enroll a meaningful amount of people." Navigators received $36 million in grants during the 2018 open enrollment period and enrolled less than 1% of the Federally-Facilitated Exchange population.
- Funding for navigators has dropped significantly since 2016, when the program was allocated $62.5 million. While navigators only enroll a small percentage of insured Americans, their primary purpose has been to assist those who aren't familiar with the insurance market and require assistance selecting a plan.
- CMS administrator Seema Verma said it is "time for the Navigator program to evolve," adding that "the need for federally funded Navigators has diminished." Starting this fall, navigators will pilot a point system that rewards the promotion of association and short-term plans, which can exclude people with pre-existing conditions and have been known to cover less.
Curtailing navigator funding is the latest play by the Trump administration in its attempts to dismantle the Affordable Care Act and push for the expansion of association and short-term plans. Such plans are not required to comply with federal rules for individual health insurance, allowing them to charge more for members with preexisting conditions without providing what the ACA deems to be essential health benefits.
Senator Ron Wyden, D-Ore., denounced CMS' decision to cut navigator funding and push for association and short-term plans in a statement
“This move amounts to federally-funded fraud: paying groups to sell unsuspecting Americans on junk plans that allow insurance companies to deny care on a whim and charge whatever they want is nothing but a scam,” Wyden said. “Trump’s sabotage crusade is making it harder and harder for families to afford quality insurance that isn’t filled with loopholes and exceptions that benefit insurance companies.”
Families USA Executive Director Frederick Isasi was also critical of the decision in a statement, calling it "further evidence that the Trump administration is putting politics above the needs of families." The expansion and promotion of association and short-term plans, he said, can confuse consumers who are looking for comprehensive health coverage.
“This is a time when consumers need more help to understand the insurance options that are available to them —not less," Isasi said.
Opposition to CMS' recent navigators move is also concerned with a previous decision the agency made in its 2019 Payment Notice that removes the requirement for navigators to have a physical presence in each exchange service area. The agency said this decision was a push to help "lower operating costs and focus on enrolling consumers" through digital and online outreach.
In his statement, Isasi stressed the importance of having navigators in communities directly interacting with "the populations they serve best" rather than handing off their duties to "entities that are not physically located where people who need coverage live and work."
Follow Tony Abraham on Twitter