Data Note: Limited Navigator Funding for Federal Marketplace States

Since taking office, the Trump administration has dramatically reduced funding for federal marketplace Navigators. The Affordable Care Act (ACA) created Navigator programs to provide outreach, education, and enrollment assistance to consumers eligible for marketplace and Medicaid coverage and requires that they be funded by the marketplaces. As recently as 2016, the Centers for Medicare and Medicaid Services (CMS) provided $63 million in funding per year for Navigator programs in federally facilitated marketplace (FFM) states. In 2017, however, CMS reduced federal Navigator funding to $36.1 million, then reduced funding again in 2018 to $10 million. The Trump administration has also reduced funding for outreach outside of navigator programs by 90%.

For 2020, total federal marketplace funding for Navigators was again limited to $10 million; 35 grants have been awarded to 30 organizations in 28 states. Two states, Maine and Virginia, that received awards last year have since converted to state-based marketplaces that use healthcare.gov and now fund their own Navigator programs. South Carolina continues as an FFM state but received no Navigator award this year, and for a second year, Utah did not receive any Navigator funding.  Compared to 2016, federal Navigator funding for the coming year marks an 84% reduction, on average (Table 1 and Map 1).

 

Table 1: Change in Navigator Funding in FFM States, 2016-2020
State 2016 Funding Award 2020 Funding Award Percent Change 2016-2020
Alabama $1,338,335 $200,000 -85%
Alaska $600,000 $100,000 -83%
Arizona $1,629,237 $373,424 -77%
Delaware $600,000 $100,000 -83%
Florida $9,464,668 $1,600,000 -83%
Georgia $3,682,732 $700,000 -81%
Hawaii $450,000 $100,000 -78%
Illinois $2,581,477 $305,368 -88%
Indiana $1,635,961 $300,000 -82%
Iowa $603,895 $100,000 -83%
Kansas $731,532 $213,317 -71%
Louisiana $1,535,332 $200,000 -87%
Maine $600,000 * *
Michigan $2,228,692 $339,452 -85%
Mississippi $907,579 $300,000 -67%
Missouri $1,815,514 $350,000 -81%
Montana $495,701 $100,000 -80%
Nebraska $600,000 $100,000 -83%
New Hampshire $600,000 $100,000 -83%
New Jersey $1,905,132 * *
North Carolina $3,405,954 $700,000 -79%
North Dakota $636,648 $100,000 -84%
Ohio $1,971,421 $476,880 -76%
Oklahoma $1,162,363 $373,424 -68%
Pennsylvania $3,073,116 * *
South Carolina $1,517,783 $0 -100%
South Dakota $600,000 $100,000 -83%
Tennessee $1,772,618 $373,424 -79%
Texas $9,217,235 $1,894,711 -79%
Utah $902,681 $0 -100%
Virginia $2,187,871 * *
West Virginia $600,000 $100,000 -83%
Wisconsin $1,338,306 $200,000 -85%
Wyoming $605,847 $100,000 -83%
Total $63,000,000 $10,000,000 -84%
NOTE: * Maine, New Jersey, Pennsylvania and Virginia were FFM states in 2016, but are transitioning to state-based marketplaces and will fund Navigators with state resources in 2020.

While most federal marketplace states will have Navigators operating statewide in 2021, in six states – Illinois, Kansas, Michigan, Nebraska, Ohio, and Texas – there will be extensive areas where no Navigators provide in-person service (Map 2). In many other states where the federal Navigators’ service area is statewide, funding reductions mean that only phone or on-line help can be offered in some areas where in-person help was once available. While the nature of navigator enrollment assistance will likely change this year because of the coronavirus pandemic, shifting away from in-person appointments to more phone and online assistance, navigators are unlikely to have the resources to be able to extend their service areas beyond those they have committed to serve.

Discussion

Despite limited federal funding for Navigators, the need for outreach and in-person enrollment assistance has not diminished. A recent KFF national survey on consumer assistance found that consumers highly value enrollment assistance and estimated that about seven million consumers received help shopping, applying for, and enrolling in coverage in the past year, while nearly five million more tried to find help but could not, The survey also found that most people seeking marketplace or Medicaid coverage experienced some difficulties with the process, and 40% of those who enrolled in coverage with help said it was unlikely they would have their coverage if not for consumer assistance. In addition, 60% of consumers who received no help said they would likely seek consumer assistance if it were available.

The survey findings suggest a shortage of consumer assistance resources, even as a lack of knowledge of ACA coverage options and how to apply persists. Most consumers, for example, do not know if the ACA is still in effect, or that enrollment in marketplace plans is generally limited to an annual open enrollment period while Medicaid is open for enrollment year-round. The survey also found that, overwhelmingly, uninsured consumers say they would sign up for Medicaid if they learned they were eligible. At the same time, the vast majority of consumers did not know if their state had expanded Medicaid eligibility.

As economic dislocation from the COVID-19 pandemic threatens jobs, and possibly health coverage, more people may need to explore replacement coverage options under the ACA in the coming year.  Limits on the consumer assistance capacity in federal marketplace states could add to this challenge.

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