Survey of Health Insurance Marketplace Assister Programs
Executive Summary
Under the ACA, if a state does not elect to operate a health insurance Marketplace, the federal government must do so. A third option, created by regulation, allows states to take on some of the Marketplace functions in partnership with the federal government. In this report, Partnership Marketplace refers to one where they state has agreed to provide consumer assistance services. In these Marketplaces, states must use exchange establishment grant resources to help finance Assister Programs. The federal government also assumes some responsibility for financing Assister Programs in FPMs. In this report, state grant-funded Assister Programs in FPMs are referred to as IPAs, while federally-funded Assister Programs in FPMs are referred to as Navigators.
or 2014 the FFM states are Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming. Iowa and Michigan are considered Partnership Marketplaces, but not with respect to consumer assistance duties.
The Consumer Assistance FPM states are Arkansas, Delaware, Illinois, New Hampshire, and West Virginia.
The SBM states are California, Colorado, Connecticut, DC, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington.
The ACA makes available to states a program of grants to finance the establishment of exchanges, or Marketplaces. These exchange establishment grants are unlimited in amount and are available through the end of 2014. To date more than $4.6 billion in state exchange establishment grants has been awarded. Establishment grants may not be used to finance Navigators, per se, but can be used to support other Assistance resources in the early years of state Marketplace operations.
During the first Open Enrollment period, FEAPs operated in Arizona, Florida, Georgia, Indiana, Louisiana, Montana, North Carolina, New Hampshire, New Jersey, Ohio, Pennsylvania, Texas and Wisconsin.
Section 1: Characteristics of Assister Programs
Some organizations sponsored Assister Programs in multiple states. In such cases, respondents were asked to answer survey questions with respect to a single state and were invited to re-take the survey to answer with respect to the other state(s) in which they operated.
Budget refers to the annual resources for the Assister Program, not the budget for the sponsoring entity as a whole.
Questions about Assister Program budgets produced the highest non-response rate; 29% of survey respondents did not supply an answer to this question.
Section 5: Challenges Facing Assister Programs
US Department of Health and Human Services, “Health Insurance Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period,” May 1, 2014. Available at http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollment.pdf
See “Helping Consumers Enroll in Special Enrollment Periods in the Health Insurance Marketplace,” available at http://marketplace.cms.gov/help-us/complex-cases-sep.pdf
Kliff S, “HealthCare.gov is having trouble signing people up for Medicaid,” Washington Post, December 4, 2013. Available at http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/04/healthcare-gov-is-having-trouble-signing-people-up-for-medicaid/
For more information about ACA Consumer Assistance Program grants to states, see https://www.kff.org/health-reform/state-indicator/consumer-assistance-program-grants/
Section 7: Looking Ahead
Life changes that can trigger a special enrollment period (SEP) include, among others, marriage, birth of a child, and loss of eligibility for other coverage due to job change, a move, or other circumstances. See Curtis R and Graves J, “Open Enrollment Season Marks the Beginning (Not the End) of Exchange Enrollment,” Health Affairs blog, November 26, 2013, at http://healthaffairs.org/blog/2013/11/26/open-enrollment-season-marks-the-beginning-not-the-end-of-exchange-enrollment/
Implications
Congressional Budget Office, Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014. Available at http://cbo.gov/sites/default/files/cbofiles/attachments/45231-ACA_Estimates.pdf
US Department of Health and Human Services, Fiscal Year 2015 Justification of Estimates for Appropriations Committees, Available at http://www.cms.gov/About-CMS/Agency-Information/PerformanceBudget/Downloads/FY2015-CJ-Final.pdf
The funding announcement says, “HHS expects to award $60,000,000 to recipients pending the availability of funds. If additional funds become available at the end of FY 2014 to award the Navigator cooperative agreements, HHS may award funds in excess of $60 million to applicants applying through this FOA…” See US Department of Health and Human Services, “Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Marketplaces,” Initial Announcement, Funding Opportunity Number: CA-NAV-14-002, CFDA: 93.332, June 10, 2014.”