HealthCare.gov managers might push the people and organizations in the nonprofit Navigator program to tell hard-to-insure consumers about short-term health insurance, association health plan coverage, and other products agents might like to sell themselves.
Navigators could help consumers go online to buy gap-filler products. But HealthCare.gov managers seem to be sketching out a framework that would make Navigators a source of referral business for insurers, and for agents and brokers, rather than gap-filler product enrollers.
Officials at the Centers for Medicare and Medicaid Services (CMS), the arm of the U.S. Department of Health and Human Services (HHS) that runs HealthCare.gov, talk about possible changes in Navigators’ role in a new Navigator program grant application package.
CMS announced Tuesday that it plans to award $10 million in Navigator program grants for the open enrollment period for 2019, which is now set to start Nov. 1 and end Dec. 15. CMS is cutting Navigator grant funding from $36 million for the 2018 open enrollment period, and from $63 million for the 2017 open enrollment period.
A copy of the grant application package is available here.
Here’s a look at three things agents and brokers might want to know about the 2019 Navigator program.
1. ACA English
Democrats in Congress developed the ACA public exchange system, and exchange plan subsidy system, to serve as an alternative to setting up a government-run single-payer health care for the United States.
The ACA exchange system is supposed to be a web-based shopping mall for commercial health insurance policies.
Some states run their own ACA exchange programs.
HHS and CMS set up HealthCare.gov to handle exchange enrollment and account administration services for states that are unwilling or unable to handle those tasks themselves.
The ACA drafters came to realize that the system would be hard for many consumers to understand. They then developed a system of Navigators, or ombudsmen, to give consumers advice about how to use the system.
The ACA itself provided funding for the Navigator program for only four years, in part because of a belief that, after four years, most consumers would know how to use the public exchange system without help from live humans.
Under the administration of former President Barack Obama, CMS developed rules that emphasized that the Navigators were simply supposed to help consumers understand the ACA public exchange system, without actually recommending specific plans, and without collecting commissions or other compensation from the exchange plan issuers.
Each state had to have at least two exchange Navigator entities, and at least one of the Navigators had to be a nonprofit entity based in the state.
Many of the Navigator entities were public health organizations and patient and consumer advocacy groups. CMS allowed agents to act as Navigators but imposed many restrictions that tended to shut out agents.
Over the years, Navigators have competed against agents and brokers in some cases in some markets and cooperated with licensed producers in others.
Up until this month, HealthCare.gov has published no data on Navigator or agent exchange plan performance.
Some states with state-run exchanges have published data suggesting that agents and brokers have been handling a growing share of enrollments, and that Navigators and other nonprofit enrollment workers and entities, such as “certified application counselors,” have had trouble keeping pace with agents and brokers.
In Colorado, for example, agents and brokers helped about 55% of all 2018 exchange enrollees, according to a Colorado exchange board meeting slidedeck.
2. Trump Administration Changes
The administration of President Donald Trump has put new pressure on the Navigators to show their work leads to people signing up for coverage, not just increased consumer awareness of health coverage options.
CMS Administrator Seema Verma said in a statement Tuesday that CMS wants to make sure the money it’s spending maximizes HealthCare.gov enrollment.