Many navigator organizations responsible for helping consumers understand and sign up for health coverage in 2018 Affordable Care Act (ACA) marketplaces say steep federal funding reductions that recently took effect will likely force them to limit their geographic service area, cut back outreach and public education, lay off staff members, and curtail other assistance, according to a new Kaiser Family Foundation survey of such programs.

The navigators’ planned adjustments are in response to the government’s announcement, two months before the ACA open enrollment period, of a 41 percent overall reduction in funding for programs in the 34 states using the federal insurance marketplace. The Centers for Medicare and Medicaid Services (CMS) has indicated that funding for the year beginning in fall 2017 would be based on individual programs’ performances on enrollment goals set during the previous year.

The Foundation’s new survey compares funding changes for navigator organizations to their reports of how they performed on several metrics. For three quarters (77.5%) of the programs, funding changes did not align with the most direct measure of marketplace enrollment reported by navigators, the number of consumers assisted with qualified health plan selection.  Funding changes also appear not to align with navigators’ performances on other measures, such as one-on-one consumer interactions or help for consumers eligible for Medicaid/CHIP, as majorities of programs surveyed said they met or exceeded these goals. CMS may have relied on a different, automated data source for navigator performance on marketplace plan selections, though programs report that they do not all enter data into that system consistently.

Overall, nearly half (49%) of the survey’s respondents report the government didn’t provide a rationale for their program’s funding change, while 40 percent say it was unclear and 11 percent say it was very or somewhat clear.

In addition to the survey, the report also details the distribution of overall funding changes by state and by program, based on a list of preliminary awards that has become publicly available. The report finds that navigator funding reductions were uneven across states. In three states (Delaware, Kansas, and West Virginia), total navigator awards for the state were unchanged. In the other 31 states, total funding reductions ranged from 10% (North Carolina) to 80% or more (Indiana, Louisiana, and Nebraska).

Funding changes also varied widely across navigator organizations, with 18 percent seeing an increase or no change in funding; 33 percent seeing their funding reduced by less than half; and 49 percent seeing their funding reduced by more than half.

METHODS

The Kaiser Family Foundation conducted an online survey of FFM navigator programs from Sept. 22 – Oct. 4, 2017. All 94 continuing programs from 34 FFM states were invited to participate. Forty-eight programs from 32 states completed the survey, for a response rate of 51 percent.

Additionally, on Sept. 15, 2017, the Robert Wood Johnson Foundation and Kaiser Family Foundation co-hosted a navigator roundtable meeting. More than 40 navigators participated and discussed strategies for open enrollment and 2017 funding awards.