CMS Announces an $80 Million Funding Opportunity to Rebuild ACA Outreach and Enrollment Efforts

CMS Announces an $80 Million Funding Opportunity to Rebuild ACA Outreach and Enrollment Efforts

On June 4, 2021, HHS announced an $80 million dollar notice of funding opportunity (NOFO) to bolster Navigator programs in states with a Federally Facilitated Marketplace (FFM) for the 2022 plan year. The funding opportunity represents an eight fold funding increase in the Navigator program and reverses four years of dramatic cuts by the Trump Administration.

The Affordable Care Act created the Navigator program to provide outreach and education to consumers seeking health coverage through the ACA Marketplaces. Navigators are trained to provide free, unbiased, and comprehensive information about health coverage. They can help consumers assess their options, complete enrollment forms, and determine whether they might be eligible for programs such as Medicaid or CHIP.  Often they are based in local nonprofits, legal aid organizations or universities, offering services to underserved communities with high rates of uninsured people. Recognizing the vital role that navigators play, the Obama administration provided robust funding to the program, investing nearly $63 million in 2016.

Between 2016 and 2020 however Trump Administration slashed Navigator funding by 84%, down to $10 million dollars for the 2019 plan year. These cuts decimated the program, cutting the number of navigator grantees in half. The cuts left at least one FFM state with no navigator programs and left large regional gaps in several other states. Beyond this, the Administration cut ACA outreach funding outside the Navigator program by 90%, began steering consumers to agent and brokers who didn’t have the same requirements regarding provision of unbiased information, and relaxed rules on plans that provide less than comprehensive coverage. Navigators programs are funded entirely by grants and navigators must provide impartial information in a culturally and linguistically appropriate manner.  Agents and brokers, by contrast, often receive a commission or fee for promoting health plans.

It is clear that the 2021 Navigator NOFO announcement comes at a critical time. Evidence has shown that consumers highly value the assistance they receive through Navigator programs, but that millions of people looking for assistance were unable to find it. Further, many potential consumers remain unaware of their options for health coverage, making the need for outreach and education more imperative.

The current NOFO also represents a welcome shift in priorities from the Trump Administration, noting that preference will be given to grantees who offer services in diverse and underserved communities, considering factors “such as race or ethnicity, gender, education or income, disability, geographic location (e.g., rural or urban), or sexual orientation.” The NOFO stresses that Navigators must assist all consumers who seek assistance, even if the consumer is not a member of an underserved population. If a Navigator cannot serve a consumer in a timely manner or does not have capacity, they must be willing to make a referral or direct the consumer to other consumer assistance resources. The NOFO also stresses the value of the Navigator program, noting that Navigators operate year round and are expected to help consumers beyond the initial enrollment process.

The 2021 NOFO represents another important step by HHS to help rebuild and strengthen ACA outreach and enrollment efforts that were derailed during the Trump Administration. Eligible grantees have until July 6 to submit applications and can learn more by visiting and searching for #93.332. They can also read through the NOFO’s frequently asked questions here.

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