Rerouting Health Insurance Navigation

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The federal government restores a program aimed at expanding health coverage access among vulnerable groups.

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During the Trump Administration, 2.3 million people lost their health insurance between 2016 and 2019. The coronavirus pandemic exacerbated this trend, with over 6 million more individuals losing their employer-sponsored health insurance over the last year.

In an effort to “undo the damage” of his predecessor and address the detrimental effects of the pandemic, President Joseph R. Biden has reopened federally facilitated health insurance exchanges until May 2021. Although this special enrollment period gives millions of uninsured Americans an opportunity to access health coverage, many people still want and need assistance applying for and selecting an insurance plan.

To offer these consumers assistance, the Biden Administration has restored funding for health insurance navigation services—state programs that seek to help consumers overcome the challenges and complexities of choosing health coverage. This funding restoration marks a drastic shift from the Trump Administration’s repeated attempts to eliminate the navigator program.

The Affordable Care Act (ACA) created health insurance navigator programs composed of experts—or “navigators”—who are trained and certified in the ACA, federal and state exchanges, Medicaid, and other public forms of health coverage. Navigator services seek to fill the massive health insurance knowledge gap and increase health insurance enrollment.

Funded through grants from the Centers for Medicare and Medicaid Services (CMS), these historically bipartisan programs operate out of state agencies and private organizations such as public health nonprofits. To receive a navigator grant, organizations must comply with federal and state regulations, including licensing, certification, and program requirements.

Navigators are required to offer free, unbiased guidance to consumers on government health plans. For example, navigators might help consumers understand their qualifications for certain benefits, such as determining their income eligibility to receive subsidized coverage or premium tax credits that lower monthly insurance costs.

Federal regulation also requires that navigators offer “targeted assistance to serve underserved or vulnerable populations.” In addition to this direct assistance, navigators connect with vulnerable groups through community outreach and partnerships designed to increase enrollments and educate the public on health insurance.

Such outreach efforts have proven successful for some navigator programs. For example, over the course of its three-year grant, the Pennsylvania Health Insurance Navigator Program engaged with credit counseling agencies, social services organizations, and other community partners to enroll nearly 2,500 consumers in health insurance and answer over 24,000 consumer inquiries.

States—including those that partner with the federal government to operate federally facilitated exchanges—also regulate navigator program operations and bear primary responsibility for administering, managing, and supporting these programs.

For example, Indiana, which operates a federally facilitated exchange, has established separate state requirements for navigators. Along with meeting federal registration and certification standards, navigators in Indiana must also register with the Indiana Department of Administration, undergo a precertification process, and receive continuing education to maintain their licenses. As with other navigator programs across the United States, Indiana’s robust navigator network has addressed health coverage disparities in every county.

But navigators’ capacity to continue serving consumers decreased under the Trump Administration, which cut navigator funding by more than 80 percent in 2018. That decrease marked the largest cut to the program since then-President Donald J. Trump took office.

States across the country felt the effects of the Trump Administration’s funding cuts. Texas—which continues to hold the highest uninsured rate in the country, at almost 21 percent—did not even receive enough funding for its most populated counties. Other states received no funding at all, including states with high uninsured rates relative to their overall population.

To determine funding, the Trump Administration compared navigator programs’ performance to their initial enrollment goals in 2016. For example, states that achieved 20 percent of their enrollment goal would receive only 20 percent of the prior year’s funding level. Although the Administration called its funding formula an attempt to “ensure accountability” among programs, its strategy to reduce funding has faced criticism from health policy experts.

Such experts question the transparency of the formula. Navigators engage in various activities that affect their program goals—including public education events, enrollments, and direct inquiries, among other forms of assistance. But the Trump Administration failed to articulate which of these metrics, if any, factored into its funding determinations, these experts explain.

Other critics of the Trump Administration’s approach note that limited funding prevents states from adequately supporting the needs of uninsured individuals, undermining one of the main purposes of the ACA: expanding health insurance coverage.

Despite several years of insufficient funding, health insurance navigator programs are already taking a different route under the Biden Administration with a new stream of federal financial support.

CMS recently announced that it will devote an additional $2.3 million to current navigator program grant recipients that operate in federally facilitated exchanges in more than half of the states. These additional funds seek to help navigator programs enhance their current operations and assist the increased number of uninsured Americans during the special enrollment period. As these uninsured individuals turn to the exchanges over the coming months, CMS Acting Deputy Administrator Jeff Wu has emphasized the need for “consumers to have access to assistance with finding affordable, comprehensive coverage,” especially amid the ongoing public health crisis.

The Biden Administration also plans to devote $50 million to navigator outreach and education efforts, a step that some consumer advocates note will be essential to strengthen the insured rate in the United States. Allen Gjerfvig, director of navigator and enrollment services for Cover Arizona (the only navigator grantee in the state), explained that the Biden Administration’s increased funding for marketing and advertising will help his program reach more uninsured Arizonans.

The Biden Administration’s investment in navigators will likely extend beyond the special enrollment period, as CMS has pledged to expand upcoming grant opportunities significantly across the United States. With more navigator programs and more activity undertaken by each program, the federal government hopes that uninsured people will receive a more meaningful opportunity to travel a new path toward health care accessibility.