Centers for Medicare and Medicaid Services: 2019 Federally-Facilitated Exchange Navigator Cooperative Agreement Awards

WASHINGTON, Aug. 30 -- The U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services issued the following fact sheet:

Each year, the Centers for Medicare & Medicaid Services (CMS) makes Navigator Cooperative Agreement Awards to organizations who serve as Navigators in Federally-facilitated Exchange states. In 2019, CMS awarded a total of $10 million to 34 organizations, matching the annual level of funding awarded last year.

These awards will support the work of organizations that offer assistance to consumers searching, shopping for, and enrolling in health coverage on the Federal Health Insurance Exchange. Navigators are a part of a wide array of options for consumers seeking assistance in shopping for healthcare, including the Exchange Call Center, Certified Application Counselors, and private sector entities that can help consumers.

The Federally-Facilitated Health Insurance Exchange Navigator Program

Navigators help consumers prepare applications to establish eligibility and enroll in coverage through the Exchanges and potentially qualify for insurance affordability programs. They also provide outreach and education to raise awareness about the Exchanges. Navigators are funded through federal grants and must complete comprehensive federal Navigator training, criminal background checks, and state training and registration (when applicable), prior to assisting consumers.

Navigator grants are awarded to individuals and private and public organizations capable of carrying out the Navigator duties and other program requirements. Navigators are required to carry out, at a minimum, the following duties:

* Conduct public education activities to raise awareness about the Exchange;

* Facilitate qualified health plan selection;

* Provide information in a manner that is culturally and linguistically appropriate to the needs of the population served by the Exchange;

* Provide enrollees with a grievance, complaint, or question regarding their health plan, coverage, or a determination referrals to any applicable office of health insurance consumer assistance, agency or health insurance ombudsman;

* Comply with training and conflict of interest standards;

* Obtain the authorization of applicants prior to accessing their personally identifiable information; and

* Provide targeted assistance to serve underserved or vulnerable populations.

2019 Navigator Grant Awards

The 2019 Navigator Notice of Funding Opportunity expanded the period of performance for awardees from one year to two years, and funded cooperative agreement awards in 12-month increments in order to provide stability and improve the consumer experience. As required in previous years, funding for the second 12-month budget period will be contingent on continuing to meet all Navigator program requirements as well as the availability of funds. The total available funding for the first 12-month budget period was allocated among the Exchange states based on the size of the remaining eligible uninsured population in each state. A minimum of $100,000 was made available to organizations in each eligible state.

The HHS Notice of Benefits and Payment Parameters for 2020 also created new flexibility in the Navigator Program to help improve the effectiveness of the program. Certain types of assistance, including post-enrollment duties, for Exchange Navigators are now permissible instead of required. This change will provide awardees with more flexibility and allow them to allocate their grant funding based on the unique needs of their community.

The grants awarded this year have a period of performance of two years from the award date, August 30, 2019, to August 29, 2021. Organizations and individuals cannot serve as Navigators without receiving federal grant funding from CMS to perform Navigator duties.

The 2020 Open Enrollment Period for the Federal Health Insurance Exchange is November 1, 2019 to December 15, 2019.

For a list of 2019 CMS Navigator grantees, please visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance.html.