A 90% Cut to the ACA Navigator Program

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The U.S. Department of Health and Human Service’s announcement of a 90% cut in Navigator funding, while not surprising, is the biggest cut since the program began. The current plan year funding of $100 million will be reduced to $10 million for next year. Congress created the Navigator grant program to provide consumers with “fair and impartial information and services” related to ACA Marketplace coverage.

During the first Trump administration, funding was reduced by 84%, resulting in staff layoffs, reduced outreach, and limitations on the time these assisters can spend with individuals. These funds were restored in 2021 under the Biden administration and last year, the administration announced up to $500 million over five years, providing $100 million for the 2025 plan year– the largest grant amount since the program began. Grants awarded for plan year 2024 (as well as plan year 2025) disproportionately serve patients and consumers in Republican-led states and rural areas (Figure 1).

The ACA requires Navigators to perform functions much broader than enrolling individuals in ACA coverage. These entities also conduct public education and outreach activities, especially in underserved communities where people’s income can fluctuate during the year due to job loss and other circumstances beyond their control. For this population, Navigators provide important information about not only ACA eligibility and enrollment but also Medicaid and employer coverage for low-income populations—as many people with low incomes transition across these coverage types.

Insurance agents and brokers provide services to place consumers in ACA coverage. Navigators, and the consumer assistance they provide through nonprofit organizations, go beyond what health insurers or brokers do. For example, according to a 2022 KFF Assister Survey, brokers – who rely on commissions – were far less likely to help consumers sign up for Medicaid or CHIP (39% of brokers vs. 88% of assister programs) and far less likely to conduct outreach activities (27% vs. 62%).

The HHS announcement points to a high dollar cost per individual that Navigators enroll in ACA coverage as a reason to reduce funding. However, for Navigators, the quantity and quality of the services they provide directly to consumers year-round is a key measure of their value, not simply the number of individuals they enroll in an ACA plan. Not only are Navigators helping people enroll in Medicaid who are determined not eligible for Marketplace coverage, but they also assist with assembling documents needed for ACA income verification for subsidies and help with post-Marketplace enrollment issues such as claims and billing problems. The announcement of the funding cuts does not reference the 292,000 people who Navigators helped enroll in Medicaid or the millions of individuals helped with post-enrollment and health insurance literacy assistance.

These cuts come as enhanced Marketplace subsidies are set to expire at the end of this year and as Congress eyes potential funding cuts to Medicaid, both of which could result in significant coverage losses. Cutting funding for the trusted and impartial source of important information Navigators provide could have big impacts just as many consumers may need to re-evaluate their coverage options.