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May 23, 2019 05:17 PM

CMS to expand requirements for ACA navigators

Robert King
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    The CMS will take more time to judge not-for-profit navigator groups tasked with Affordable Care Act enrollment outreach on their performance, which is tied to funding, the agency said Thursday.

    Starting in the 2020 open-enrollment period, navigator groups will be evaluated on a two-year performance period rather than one year. Federal funding is tied to how many people are signed up by the groups.

    The CMS said the change will help stabilize the program and improve consumers' experience.

    However, their funding won't change. Navigators in coverage year 2020 will get $10 million in funding, the same level as last year.

    The not-for-profit groups operate in the 34 states where residents use the federally run HealthCare.gov to buy ACA plans. The remaining states operate their own exchanges.

    The CMS gave grants to 39 organizations for the 2019 coverage year, a steep drop from the 90 organizations that received grants in 2018.

    The Trump administration has slashed funding for the groups, from $62.5 million in 2016 to $36 million in 2017 and now the current $10 million budget.

    Officials complained that navigators took in too many funds but did not sign up enough people.

    The Trump administration also adopted new criteria that ties funding to navigator enrollment numbers.

    Navigators have long argued that the criteria don't reflect the full scale of navigator duties, which can include referring walk-ins to other government assistance programs such as Medicaid.

    HealthCare.gov signed up 8.4 million during the 2019 open-enrollment period, down nearly 4% from 2018 coverage when more than 8.7 million signed up.

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        • - Hospital of the Future (Fall)
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