ACA Health Navigators Face Uncertain Future

Like agents, Affordable Care Act health navigators help people understand their health plan options, but there may be far fewer around this Open Enrollment season.

According to a report from The Wall Street Journal, the future funding for ACA health navigators is unclear. The Trump Administration has yet to elect to continue it, and navigators fear they may lose financial support.

Health care navigators are individuals or groups trained to help consumers looking for coverage on the exchanges, as well as guide Marketplace enrollment or determine eligibility for ACA subsidies.

The ACA lists five duties for navigators: (1) perform public education and outreach activities; (2) distribute fair and impartial enrollment information on health plans and the availability of federal subsidies; (3) facilitate enrollment in qualified health plans; (4) provide referrals to appropriate agencies for enrollees with questions, grievances, or complaints; and (5) provide all information in a manner that is linguistically and culturally appropriate for the consumer. By law, their services must be free and unbiased. While licensed agents receive compensation and payments from health insurance issuers at the rates set by that insurer, navigators are paid through grants.

The term “navigators” is commonly used to cover various navigator-like groups, but they are distinct from “certified application counselors” (CACs) who perform similar, but more limited functions. CACs also rely on federal funds and are primarily staffers of local health care organizations.

Due to the nature of their role, health navigators indirectly compete with the services of licensed insurance agents. A licensed health insurance agent or broker can become a navigator, however, that prohibits them from also acting as a traditional producer who receives payment from insurance companies.

Due to the nature of their role, health navigators indirectly compete with the services of licensed insurance agents.

The Centers for Medicare & Medicaid Services provided $63 million in aid to nearly 100 navigators last year, with backing slated to run through this September. But, the funding is “contingent on [navigator’s] performance” from one year to the next. It could be eliminated early next month.

A decision on the matter is expected within the next few weeks.

Marketplace Stability in Question

In other ACA news, the Trump Administration extended the deadline for insurers to submit their rate proposals by three weeks to September 5. Traditionally, an extended deadline would allow insurers to spend more time calculating rates, however, the Administration’s threat to end cost-sharing reduction payments (CSRs) is making the process more difficult.

CSRs compensate insurers for subsidizing the out-of-pocket costs of certain enrollees. In the past few months, the Administration has used them as a bargaining chip to motivate Republicans to repeal and replace the ACA.

Without guaranteed CSR payments, insurers are left proposing rates for two entirely different outcomes.

According to a KFF study, insurers would have to raise silver plan premiums by an average of 19 percent more to offset the loss of CSR payments.

Insurers participating in the federal marketplace,, must sign their final contracts by September 27. The Open Enrollment Period for those under 65 begins November 1 and ends December 15.

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