2022 Survey of ACA Marketplace Assister Programs and Brokers

Appendix: Characteristics of Assister Programs

Three types of Marketplace Assister Programs were surveyed for this report.

Navigator Programs – The ACA requires all Marketplaces to establish and fund Navigator Programs to provide outreach and enrollment assistance to all consumers. Navigators are required to have expertise in eligibility and enrollment rules, the range of qualified health plan (QHP) options, affordability programs – both QHP subsidies and Medicaid/CHIP – the needs of underserved and vulnerable populations, including individuals with limited English proficiency, and privacy and security standards. Navigators must offer objective advice to consumers. They must not be operated by insurance companies nor receive compensation from insurers; and they may not help with enrollment in any private health coverage offered outside of the Marketplace. At least one Navigator grantee in each state should be a community-based non-profit organization. Navigator Programs tend to be the consumer assistance workhorse – compared to other Assister Programs, they are more likely to operate statewide service areas, serve a higher number of clients, and operate with larger budgets; although some Navigator Programs are small, local, and have more limited resources. For the 2022 coverage year, state and federal Marketplaces provided a combined $162.2 million in funding for Navigator Programs. (Total does not reflect spending for New Mexico or Washington state.) Of this total, the federal Marketplace awarded $90.2 million and SBMs together awarded $72 million.

Certified Application Counselor Programs (CACs) – Marketplaces are also required to recognize, certify, and provide training for CAC Programs sponsored by non-profits and provider organizations. This Assister Program designation was created prior to the first Open Enrollment – when funding for Navigators, at least in the FFM, was still uncertain – to ensure that willing volunteer Programs would also be available to help. Under federal rules, CAC Programs are not required to engage in all activities required of Navigators, and do not undergo training as extensive as that required for Navigators. CAC Programs generally do not receive funding support from the Marketplace; they are primarily supported by their own sponsoring organizations and other outside sources such as foundations. For the 2022 coverage year, a total of 1,756 CAC Programs served Marketplace consumers.

Federally Qualified Health Centers (FQHCs) – The federal government supports a network of nonprofit health clinics in the US to provide health care to uninsured, low-income, and other underserved populations. Starting in 2014, the federal government required FQHCs to also provide outreach and enrollment assistance to consumers seeking coverage through the Marketplace and provided additional funding for this purpose. Of the 1,334 FQHCs surveyed, 85 are also certified as Navigators and shown as Navigator Programs in this report. The other 1,249 must complete CAC training to be Marketplace certified and are shown as FQHC Programs in this report. For the 2022 coverage year, the federal government provided FQHCs $150 million to support enrollment assistance.

While the size of Assister Programs varies, most had a relatively small number of full-time equivalent staff during the 2022 Open Enrollment. Most Assister Programs (73%) indicated that they had five or fewer FTEs during the 2022 Open Enrollment, while 15% had between 6 and 10 FTEs. Navigator Programs had somewhat larger staff compared to the other Program types. (Appendix Table 1) Assister Programs report nearly all FTE staff were paid, not volunteer. Most Assister Programs (66%) indicated that the number of FTEs in 2022 was about same as in prior year; 13% say FTE staff grew from 2021 while 21% of Programs said staff size is smaller than in the year before.

Staff continuity in Assister Programs is high. 77% of Programs say most or almost all staff this year worked for them during the previous year’s Open Enrollment. Program staff typically work year-round, not just during Open Enrollment; 71% of Programs say staff size held steady since the 2022 Open Enrollment Period ended; while 21% of Programs say the number of FTEs has since declined.

Assister Programs were confident that the current level of funding will be available for 2023.
Seventy-eight percent of all Assister Programs are very or somewhat confident current funding will continue for 2023. The highest rate of confidence is among Navigator Programs (93%), followed by FQHC (76%) and CAC Programs (68%). Following years of funding cuts, Federal marketplace Navigator funding was significantly increased for the 2022 Open Enrollment to $80 million, with a supplemental $10.2 million awarded shortly thereafter. For 2023, CMS has announced Federal Marketplace Navigator grants of $98.9 million (grants were announced after this survey closed.) Currently CMS cooperative agreements with Navigator Programs are for a 3-year period, through August 2024, though annual funding amounts are determined each year and not guaranteed.