BY JESSIE HELLMANN
AND RACHEL ROUBEIN - 06/20/18 06:00 AM EDT 39
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.
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.
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.
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