California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

CMS To Distribute up to $54M in Grants for ACA Exchange Navigators

On Tuesday, CMS opened the grant application process to help fund navigators, which will provide guidance to individuals enrolling in the federally run and partnership health insurance exchanges under the Affordable Care Act, Modern Healthcare reports (Block, Modern Healthcare, 4/9).

Background

Under the ACA, each exchange must have two certified navigators, one of which must be a not-for-profit.

The navigators are expected to provide "fair, impartial and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions among [qualified health plans] and helping qualified individuals make informed decisions during the health plan selection process."

They also will provide additional assistance to consumers who are disabled, do not speak English or who are unfamiliar with health insurance (Baker, "Healthwatch," The Hill, 4/3).

The costs to hire the navigators over the short term can be offset by federal grants, state budgets or private funding, but over the longer term, the bulk of the costs must be covered by the marketplaces. Such money will come from fees charged to health plans participating in the exchanges (California Healthline, 2/5).

CMS' Grants

The grants are available to self-employed individuals, private companies and public organizations that will serve as navigators in the 33 states with federally run or partnership exchanges (Modern Healthcare, 4/9).

Organizations and individuals that receive compensation from health insurers are not eligible to become navigators (Baker, "Healthwatch," The Hill, 4/9).

CMS said it expects to distribute up to $54 million to fund navigators for one year. According to Kaiser Health News, the grant money will be divided up based on the number of uninsured residents in each state (Galewitz/Gold, Kaiser Health News, 4/9).

The grant application process will remain open until June 7, and final award notices are expected to be released on Aug. 15 (Modern Healthcare, 4/9).

Grants Evoke Criticism

Some health experts and consumer advocates have said the $54 million will not be enough and raised concerns that states that have opted for federally run exchanges will receive less funding than those running their own exchanges, Kaiser Health News reports.

For example, Texas and Florida -- which are relying on the federal government to run all or part of their exchanges -- will receive $14 million to fund navigators for almost nine million uninsured residents.

Meanwhile, California -- which is creating its own marketplace -- has budgeted more than $50 million to provide in-person support for consumers for the first two years.

John Poelman -- a senior director of Leavitt Partners, which is working with many states to set up exchanges -- said, "There's no way that's enough money to make a difference."

Laura Goodhue, executive director of Florida CHAIN, said that although the federal funding can help community-based groups educate and enroll millions of uninsured residents, "additional support from state, local agencies, providers and others will be needed to make sure that everyone is aware of the opportunities" (Kaiser Health News, 4/9).

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