Key ObamaCare groups in limbo as they await funding

Local groups that help people sign up for ObamaCare and Medicaid have yet to hear from the Trump administration about their annual federal funding, leaving many in limbo and fearing the grants could be too small or might not come at all. 

“We really haven’t gotten any update or any deadline to submit applications or any knowledge at all about what the future is going to bring,” said Karen Egozi, CEO of the Epilepsy Foundation of Florida, one of the state’s larger health-care navigator programs. 

{mosads}The organizations typically hear from the federal government in April or early May with information about how much money will be available for grants, when key deadlines are and the expected award date. 

But several navigators contacted by The Hill said they have received no information from the Centers for Medicare & Medicaid Services (CMS), the agency that manages the program, about the exact timing of and details on the grants, making it difficult to plan for the upcoming health insurance open enrollment period.

When asked about the navigator grants, a spokesperson for the Department of Health and Human Services (HHS) wrote in an email that HHS did not have any details to share at this time. 

In the past, the department has referred to the sign-up program as “ineffective” and significantly cut its funding last year, basing the new lower funding levels on how well they met past enrollment goals. 

By now, “we would have normally submitted our plan to HHS and would have been waiting to see if we got the [funding] award, so we’re way behind at this point,” said Jodi Ray, director of Florida Covering Kids and Families, which is affiliated with the University of South Florida.

The navigator program was created under the Affordable Care Act (ACA) to provide outreach, education and enrollment assistance, and the federal government provides funds to keep the program running in the 34 states that use the federal marketplace, healthcare.gov. The vast majority of navigators are state and local nonprofits, such as community health groups and hospitals. 

In the past, navigators were given about 60 days to apply and HHS had 60 days to review applications. 

But current grants, which began in 2015, expire Sept. 12. With the delays, it’s not clear if the grants will be awarded in time to prevent funding lapses. Open enrollment begins Nov. 1, but navigators say they need the funding before then so they can hire people, complete training and other requirements and conduct and plan outreach events in their communities. 

“You can’t just put the money on the street Oct. 15 and expect these programs will complete everything they need to do to be operational when open enrollment starts,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. 

Navigator groups working with people on the ground in their communities are worried.

“We know this administration is not friendly to the ACA, and so they have no incentive to involve community-based groups in enrolling people,” said Catherine Edwards, executive director for the Missouri Association of Area Agencies on Aging.

The Trump administration has changed the program’s requirements for the upcoming enrollment season.

States are no longer required to have at least two navigator groups. The administration also removed the requirement that one group has to be a community-based, consumer-focused nonprofit and got rid of the mandate that navigator groups must have a physical presence in the states.

“Removing these requirements gives Exchanges more flexibility to ensure that grant funding goes to the strongest applicants,” the CMS wrote in its fact sheet on the final rule.

Though the Trump administration hasn’t indicated what this year’s grants could look like, community groups are worried that some consumers might be forced to sign up for health insurance without in-person help, which they say could negatively impact enrollees.  

“It’s very unfortunate for the consumer,” said Shelli Quenga, director of programs for the South Carolina–based Palmetto Project. 

“We know that consumers still need in-person assistance — and especially consumers who are not native English speakers, consumers who are living just above the poverty line who don’t have a lot of experience with making big financial decisions like this that also have long-term implications to their financial future for themselves and their family members.”

It’s hard to interpret exactly how the changes will affect navigators, Pollitz said, but more information will be available when the funding announcement for the grants is released. 

But she suggested dropping the requirement that navigators be based in-state could open the door to more call center assistance. 

The government already operates a call center, which Pollitz notes has run into several issues over the years. 

The Trump administration has been critical of the navigator program in the past, announcing a 41 percent funding cut last year right before the new grant period was supposed to begin in September. The groups had been anticipating level funding and were caught off guard when the total pot was
reduced from $62.5 million to $36.8 million. 

At the time, an HHS spokeswoman called the navigator program “ineffective.”

“Judging effectiveness by the amount of money spent and not the results achieved is irresponsible and unhelpful to the American people. Under the Trump Administration, we’re committed to more responsible, effective government,” Caitlin Oakley said in a statement last year. 

Democrats have charged the White House with “ObamaCare sabotage,” saying it is deliberately trying to hurt the law after Republicans failed to repeal and replace it last year — cutting navigator funds, repealing the individual mandate and expanding access to plans that are cheaper but cover fewer benefits, potentially raising premiums in more comprehensive plans. 

The administration counters that it’s trying to give states and consumers more flexibility with their health care and trying to decrease costs for programs they say don’t work. 

With the upcoming changes, the administration’s criticism of the program and its budget recommendation to cut it by 75 percent in the next fiscal year, some navigators are convinced they won’t be receiving federal funds for much longer. 

“We have no expectation of any federal money being available to us,” said Donna Friedsam, the director of Covering Wisconsin, a navigator program.

Her organization received a 42 percent reduction last year because of the funding changes. It previously offered enrollment services in 23 counties, but had to scale down to 12.