Health Reform WK-EDGE CMS cuts spending on navigators, ACA enrollment education
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Tuesday, September 12, 2017

CMS cuts spending on navigators, ACA enrollment education

By Sheila Lynch-Afryl, J.D., M.A.

CMS has cut spending on educational activities for the 2018 open enrollment period by 90 percent to $10 million. In addition, navigators will receive funding based on their ability to meet their enrollment goals during the previous year, CMS announced.

Enrollment periods. Sec. 1311(c)(6)(B) of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) gives HHS the authority to set the dates for annual enrollment periods. In April 2017 CMS changed (Final rule82 FR 18346, April 18, 2017) the previous open enrollment period for the 2018 plan year (November 1, 2017 through January 31, 2018) to end on December 15, 2017 (see HHS finalizes rule to improve marketplace stability, April 19, 2017).

CMS will target its advertising and outreach activities to educate consumers on the new dates of the open enrollment period through digital media, email, and text messages. Outreach will also be targeted based on specific demographic and geographic data. In response to CMS’ announcement, Senate Minority Leader Chuck Schumer (D-NY) tweeted that the Trump Administration "is deliberately sabotaging our healthcare system."

Navigators. During the 2017 open enrollment period, navigators, created by Sec. 3510 of the ACA, received over $62.5 million in federal grants while enrolling 81,426 individuals. According to CMS, 17 navigators enrolled fewer than 100 people each at an average cost of $5,000 per each enrollee and 78 percent of navigators failed to achieve their enrollment goal.

For the upcoming enrollment period, navigator grantees will receive funding based on their ability to meet their enrollment goals during the previous year. For example, a grantee that achieved 100 percent of its enrollment goal for plan year 2017 will receive the same level of funding as last year. A grantee that enrolls 70 percent of its enrollment goal will receive 70 percent of its previous year funding level.

The new funding formula, said CMS, will ensure accountability within the navigator program. The House Energy and Commerce Committee lauded the change, claiming that the navigator program has "repeatedly fallen short of its purpose." The Committee has raised concerns about the program in the past.

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