By Juliet Eilperin and Amy Goldstein / The Washington Post
WASHINGTON — Health and Human Services officials have informed grass-roots groups that assist with enrollment under the Affordable Care Act that their funding will be reduced by as much as two-thirds, a move that could upend outreach efforts across the country.
The groups, which fund organizations known as “navigators,” had been braced for the cuts since the Trump administration announced two weeks ago that it would shrink overall program funding by 41 percent and slash the department’s ACA advertising budget from $100 million to $10 million. At the time of the announcement, HHS officials said the outreach effort wasted taxpayers’ money.
But advocates of the navigator program, including congressional Democrats and some Republicans from rural states, said the deep cuts would undermine any effort to help consumers get insurance coverage once open enrollment begins on Nov. 1. And in some instances, the funding reductions made official late Wednesday night were much deeper than 41 percent, raising questions about some state programs’ viability and the fairness of the administration’s method for deciding how much money each group gets.
Navigator groups perform a range of services during the ACA’s annual enrollment season. They help individuals learn which health plans offered on state and federal insurance exchanges would best suit them, walk consumers through the sign-up process and conduct general outreach to communities about how to obtain coverage under the law. The program’s supporters argue that it is particularly critical during the upcoming six-week enrollment period, which is half as long as last year and comes after Republicans’ high-profile attempt to repeal the 2010 health-care law.
But HHS officials have repeatedly questioned the value of paying navigators. Late last month, department spokeswoman Caitlin Oakley issued a statement calling it “ineffective” and saying that funding for this next enrollment period would be “in proportion to their performance.”
At the Missouri Association of Area Agencies on Aging, which spread nearly $920,000 in navigator money among seven agencies across the state last year, executive director Catherine Edwards learned early Thursday morning that amount would be cut by 62 percent.
“I’m a wee bit nauseous, truth be told,” Edwards said a short time later, adding she is now consulting with her colleagues to determine what they can do with just under $350,000.
Take Care Utah, a network of nonprofits focused on helping people obtain health insurance, consists of roughly 90 navigators, enrollment specialists and insurance brokers across the state. Its director, Randal Serr, learned Thursday morning when he got to his office that his organization had suffered a 61 percent cut, from $740,000 to $289,584.
“We will have to make some tough decisions, there’s no way around it,” Serr said in an email.
HHS officials could not immediately be reached for comment Thursday.
As recently as May, federal officials had told Edwards that her association could expect to receive a similar grant as last year, so it had prepared a budget based on the 2016 figure. She now is wondering how she can proceed with the digital and social media campaign already planned, especially if many individual navigators may be laid off due to the funding cut.
“At what point does it become ineffective to do any of that?” she asked. “What would I be advertising? I guess I could be advertising about navigator assistance. But in terms of the in-person help, we may not have those people.”
Even before the emails began popping up in organizations’ inboxes, HHS’s abrupt announcement about an overall funding cut had created havoc for enrollment helpers around the country. It came at the exact time of year when their work becomes intense, ramping up for the always feverish enrollment season, and left them with no money to spend during the first two weeks of September because their previous grants had expired as of Sept. 1.
In frantic phone calls the past two weeks with their liaisons within a sub-agency of HHS’s Centers for Medicare and Medicaid Services, most navigators were told that they could not depend on the new funding being retroactive to the start of the month — so they would be best off not spending any money in the meantime, they heard. The liaisons told the navigators they didn’t have any information because “higher-ups” were making all the decisions, leaders of several navigator groups said.
According to notices sent to organizations late Wednesday, these groups now have just two weeks to send HHS a revised budget and work plan, which federal officials then must approve. They will be allowed to use 10 percent of their award to cover costs they have incurred since Sept. 2, and the reimbursement will be restricted to certain expenses.
Administration officials said in late August that they would tie the grant awards to navigator groups’ past performance: While all would get at least $10,000, the size of a group’s grant would hinge on the percentage of its target enrollee total that it met last year.
Serr said in an interview this week that applying such a test is “absurd, for a number of reasons,” particularly because that in past years federal officials had encouraged his group and others to set ambitious goals. He noted that Utah had the country’s third-highest increase in federal marketplace enrollment last year, behind Hawaii and South Dakota.
“They don’t count all the other ways we help people,” he said. “This is completely a political decision, and not a decision made by people who do this for a living.”
While congressional Democrats have been most critical of the administration’s plan to cut navigator cuts, some GOP officials have warned it could hurt their constituents as well.
Lori Wing-Heier, director of the Alaska Department of Commerce, Community and Economic Development’s insurance division, testified on Capitol Hill last week that in some remote parts of the state “there’s not an insurance broker or a consultant to be found.”
“We are very concerned that it will have a major impact on our enrollment,” Wing-Heier told the Senate hearing. “This would be devastating, to our population.”