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CMS Ties 2018 Navigator Grants to 2017 Performance

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The Centers for Medicare and Medicaid Services will base the next round of grants for health insurance Navigator organizations on how well the organizations have been making their numbers, officials say.

A Navigator organization is an entity that helps consumers understand health insurance options and use the Affordable Care Act public health insurance system. The people who deliver Navigator services are not supposed to recommend specific plans or issuers.

CMS will link an organization’s grant amount for the 2018 open enrollment period to the organization’s success at meeting its 2017enrollment goals, according to a new memo from Randy Pate.

(Related: ACA Exchanges See New Signups Drop, Retention Rise)

An organization that achieved just 30% of its 2017 enrollment goal will get 30% of the funding it received for 2017, Pate writes.

An organization that met its 2017 enrollment goal will get 100% of its 2017 funding, Pate writes.

Pate did not give an example of how CMS would calculate the 2018 grant amount for an organization that exceeded its 2017 enrollment goal.

Pate is the director of the Center for Consumer Information & Insurance Oversight, the CMS division that runs the Affordable Care Act programs that affect the commercial health insurance market.

2018 (Image: iStock)

(Image: iStock)

The ACA exchange system helped about 12 million people enroll in private health plan coverage for 2017.

The open enrollment period for 2018 is set to start Nov. 1 and run until Dec. 15 in most of the country.

Pate said CMS expects to spend $10 million on digital media, email and text messages. CMS spent $100 million on outreach for 2017, according to Sacramento, California-based Health Access California.

For 2017, CMS spent $62.5 million on federal Navigator grants, and the Navigators ended up enrolling 81,426 people, Pate said. Navigator spending could fall to $36 million for 2018, according to Health Access California.

CMS spent an average of about $770 on Navigator program grants per enrollee who came in through Navigators.

Current ACA exchange plan agent and broker compensation figures are hard to find, but, before the exchange system opened for business, in October 2013, Vermont was hoping to set agent commissions at $180 per year per enrollee.

For the Navigators, “the new funding formula will ensure accountability within the Navigator program,” Pate writes.

In the past, some agents and brokers have reported having good relationships with the Navigator organizations. Many producers and producer groups, however, have objected to the idea that the Navigator program might be encouraging people without insurance agent licenses to handle the kinds of sensitive information and decisions that ought to be handled licensed producers.

Health Agents for America, for example, has expressed concerns that CMS might be encouraging Navigators to take too active of a role in helping consumers enroll in Medicare plans.

Pate did not address producer concerns about Navigator mission expansion in the new memo.

CMS as a whole may now have a deeper understanding of the Navigator community than it used to have: Seema Verma, President Donald Trump’s CMS administrator, previously ran a consulting firm that trained the people who provided Navigator services in Indiana.

Randy Pate, the head of CCIIO, has been a vice president of public policy at Health Care Service Corp., the Chicago-based parent of Blue Cross and Blue Shield of Illinois and Blue Cross and Blue Shield of Texas. He also worked at the U.S. Department of Health and Human Services, the parent of CMS, during  the administration of former President George W. Bush.

Read Nevada Exchange Spends $199 Per Sale on ThinkAdvisor.


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