Insurance navigator grant recipient says cuts force groups to cease services in Ohio

Sept. 22--The Ohio Association of Foodbanks on Friday announced it will end its navigator program that assists with health insurance enrollment, citing deep and "unwarranted" federal cuts to the program created by the Affordable Care Act.

The Centers for Medicare and Medicaid Services last week informed the nonprofit, which is the largest navigator grant recipient in Ohio, of a 71 percent funding cut -- from nearly $1.7 million the previous year to just under $486,000 for 2017-2018.

Lisa Hamler-Fugitt, executive director for the food banks association, said in a statement that navigators "have been held hostage by what we believe is a political maneuver to damage the viability and stability of the Affordable Care Act."

The cuts prevent organizations from equitably providing services to all Ohioans, she said. The food bank association has in previous years distributed funds to nine nonprofits throughout the state that administer navigator services locally. Shuttering the program will eliminate 54 full-time positions statewide, she said.

This is the fifth year for the navigator program, which was created by the Affordable Care Act, commonly known as Obamacare. Navigators provide services during insurance enrollment, including determining what plans -- either on the marketplace exchange or through Medicaid -- clients qualify for and helping them enroll.

After enrollment, navigators can help with billing questions or finding a physician. The grants pay for staffing, travel for enrollment events, education sessions, and outreach materials.

Local effects

Navigator services in northwest Ohio will cease, said Julie Grasson, assistant director of Toledo-Lucas County CareNet, which administers the program for 21 counties in the region. Six navigators will be laid off, she said.

It is detrimental to consumers looking for help when signing up for health insurance, she said.

"It's a significant loss," Ms. Grasson said. "If individuals are not computer savvy, if they are not savvy with understanding health insurance plans, it can be very overwhelming to determine which doctors and which hospitals are included in the plans they are looking at."

The northwest Ohio program has met or exceeded its goals each year of the program.

Waiting for answers

Ohio navigators implored federal officials to explain how cuts were decided but have not gotten answers, Ms. Hamler-Fugitt said. Groups were surprised when Sept. 1, the expected funding award date passed and they didn't learn about the cuts until two weeks later.

Awardees were then notified CMS was withholding funds until groups re-applied and explained how they would use the smaller allocation. CMS has 30 days to reconsider applications.

Even if funds were released, Ms. Hamler-Fugitt said, it would be days before the Nov. 1 enrollment launch. That would provide no time for navigators to get required navigator licenses from the Ohio Department of Insurance, which does not give licenses without a valid contract between CMS and grantees.

"Unfortunately we see no viable path forward," she said of ceasing the program.

During a call with grantees and federal officals on Wednesday, Ms. Hamler-Fugitt said "it became crystal clear that there are two sets of grantees in the eyes of CMS," those who saw major cuts and those that didn't.

Centers for Medicare and Medicaid Services, which is under the U.S. Department of Health and Human Services, said in an Aug. 31 statement that the "performance-based adjustments will ensure accountability within the Navigator program and avoid rewarding grantees that have failed to meet their performance measures."

Ms. Hamler-Fugitt has said Ohio's navigators have "nearly met, met, or exceeded all of our goals," and has until recently received positive feedback from federal officials.

When determining funding amounts this year, CMS officials told grant recipients during the Wednesday call that they focused on enrollments in qualified health plans on the exchanges. It disregarded measures such as enrollments in Medicaid or the Children's Health Insurance Program, as had been the practice in previous years, Ms. Hamler-Fugitt said.

Because of Ohio's Medicaid expansion, marketplace plans made up a smaller share of total enrollments, Ms. Hamler-Fugitt said. Between 75 and 80 percent of navigator-assisted enrollments in Ohio were Medicaid, she said. About 700,000 Ohioans have gained health insurance in the expansion.

"It does appear that Ohio has been penalized as a Medicaid expansion state," she said of the new rubric. She criticized the opacity in changing performance measures, which she said have never been put in writing. Navigator groups were given technical assistance documents that were labeled "not for public release," and that threatened "prosecution to the fullest extent to of the law," if shared externally, something Ms. Hamler-Fugitt said she has never seen in previous years.

CMS also denied Ms. Hamler-Fugitt's request to concentrate the reduced funding for use during open enrollment and was told it must be spread out over the 12-month grant period. The open enrollment period was reduced to six weeks rather than three months as in previous years. Enrollment runs Nov. 1 to Dec. 15.

Sen. Sherrod Brown (D., Ohio), joined 11 senators signing a letter Friday to CMS Administrator Seema Verma asking that all navigator funding be restored and for more information about funding decisions.

"Ripping the rug out from these programs and then requiring additional work on a shoestring budget during their preparation for the most important time of the year is inexcusable and appears to be little more than conscious sabotage," the letter states. "Playing games with the stability of the [Affordable Care Act] will drive down enrollment and lead to higher health coverage costs, while causing additional job loss along the way."

CMS officials did not respond to questions from The Blade on Friday about how funding allocations were decided and if any navigator programs in other states have withdrawn. Ms. Hamler-Fugitt said federal officials did not answer if another nonprofit could apply and pick up navigator services in Ohio.

To find alternate enrollment assistance, visit localhelp.healthcare.gov, or call 1-800-318-2596.

Contact Lauren Lindstrom at [email protected], 419-724-6154, or on Twitter @lelindstrom.

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