“Challenging … frustrating … difficult … but worth it.” These are the words used by several organizations that served as navigators to describe their experience during the Affordable Care Act’s first open enrollment period.
Navigators not only had to quickly get up and running ahead of the Oct. 1 launch of the ACA’s health insurance exchanges, but they also had to contend with a host of technical problems that plagued HealthCare.gov. Even so, the Obama administration has touted the role of navigators and other enrollment assisters, arguing that they were a significant reason why eight million people signed up for coverage through the exchanges.
As the federal government prepares for the second open enrollment period, “Road to Reform” takes a look at the role of navigators and what worked and what didn’t.
Who Are Navigators?
The navigator program was created to educate consumers about the availability of qualified health plans being sold through the exchanges. The idea was that navigators would offer impartial information about the plans, federal subsidies and then help enroll consumers in those plans.
For navigators operating in states where the federal exchange was operating, CMS specified that workers must undergo at least 20 hours of training before they can be certified. In addition, navigator organizations cannot be affiliated with the insurance industry. States running their own exchanges were able to establish more rigorous selection and training requirements for in-person assisters.
In August 2013, HHS awarded $67 million in federal grants to 105 groups chosen to serve as navigators. Those groups included:
- American Indian tribes;
- Local food banks;
- Patient advocacy groups; and
Overcoming Early Obstacles
About a year ago, facing just weeks before the launch of the health insurance exchanges, many groups struggled to hire, train and certify navigators.
Lisa Hamler-Fugitt — executive director of the Ohio Association of Foodbanks, which received one of the largest grants — told California Healthline that it was a race to get each of its 75 navigators trained, vetted and educated on time. By the start of the open enrollment period, Hamler-Fugitt said that her organization was the only Ohio-based grant recipient to have navigators in the field physically helping individuals enroll in coverage.
For some organizations, the short timeframe was further compounded by the passage of laws in at least 17 state legislatures — including Ohio — that require navigators and other assisters to obtain state licenses, complete additional training beyond what is imposed by federal law or limit what they can say to the consumers they are helping.
During the open enrollment period, navigators also struggled with the glitchy HealthCare.gov website, which crashed numerous times in the first few months of operation causing severe delays for enrollees.
The unanticipated technical glitches meant some navigators had to rely on the slower, more cumbersome paper-based processes, instead of the website’s easy-to-use design. In addition, Vicki Tucci — lead navigator at the Legal Aid Society of Palm Beach County, Fla. — in an interview with California Healthline said it was common for consumers to return several times to complete their enrollment because the system would shut down or crash.
However, the biggest obstacles navigators faced was being able to overcome “myth vs. fact” regarding the ACA and improve consumer literacy about health insurance, according to Hamler-Fugitt.
How Successful Were Navigators?
Beyond some federal reporting requirements, the level of oversight, data tracking and clear targets varied among organizations who served as navigators.
The federal government requires grantees to issue quarterly and annual progress reports to HHS detailing progress and compliance with required activities outlined in the Funding Opportunity Announcement.
For example, some organizations — such as the Pennsylvania Association of Community Health Centers — went as far as to create an online, HIPAA-compliant database to track enrollment data, while Tucci of the Florida Legal Aid Society told California Healthline that her organization compiled weekly updates to keep track of the number of people reached through in-person visits, education sessions and phone calls.
In an email to California Healthline, Cheri Rinehart — president and CEO of the Pennsylvania Association of Community Health Centers — said her organization was able to meet its goal of signing up 10,000 individuals and was able to use data from the database to track progress in various areas.
Laura Line, director of Resources for Human Development’s navigator program, in an interview with California Healthline said the total enrollment for Pennsylvania exceeded federal expectations, with about 318,000 individuals receiving coverage through the exchange. However, she said it is nearly impossible to know how many of those individuals were enrolled by a navigator or how many sought help from a navigator and then completed enrollment on their own.
However, Angie Remington, spokesperson at Planned Parenthood of the Heartland in Omaha, Neb., in an email to California Healthline said the various obstacles — including state licensing requirements, inadequate staffing levels and website glitches — prevented her organization from meeting its goal of enrolling 3,000 individuals.
Overall, a Kaiser Family Foundation survey estimates that navigators and other assistance programs helped to educate more than 10 million U.S. residents about their coverage options and apply for health plans during the first open enrollment period.
According to the Kaiser Family Foundation survey, navigators and other consumer assisters will play a “key role” in the upcoming enrollment period, and several navigators appear to be ready to assist yet another batch of applicants. The Congressional Budget Office has estimated that 13 million people could enroll in coverage through the exchanges in 2015, including both those who will be renewing plans and enrolling for the first time.
In June, CMS announced that it would make $60 million in federal grants available to navigators in federally run health insurance exchanges, less than the $67 million in grants for the first open enrollment period.
CMS also has ramped up its standards for the program, and will now:
- Require navigators to maintain a physical presence in their service area;
- Encourage applicants to conduct criminal background checks on all staff that will be handling sensitive or personally identifiable information; and
- Increase reporting requirements to include weekly and monthly progress reports.
July 10 was the deadline to apply for the new wave of funding. Despite the challenges and frustrations that accompanied the first round, several navigator organizations said they met the deadline and hoped to renew their efforts, including:
- Legal Aid Society of Palm Beach County, Fla.;
- Ohio Association of Foodbanks;
- Pennsylvania Association of Community Health Centers; and
- Planned Parenthood of the Heartland.
Rinehart told California Healthline, “The biggest reason we’re applying again is because we really feel like we are making a difference.” She added, “It was frustrating when we were ready and the system was not, but the enrollment assisters remained motivated because they saw faces, not just numbers, they felt strongly that they were making a difference in people’s lives and that they were living history.”
Around the Nation
Seeking Innovations: Ohio has applied for $98.6 million in grant funding under the Affordable Care Act’s State Innovation Model grant program to explore innovative payment models in Medicaid and Medicare, according to Columbus Business First. Officials at Ohio’s Office of Health Transformation say the funding, which would be divided equally over four years, will help bolster Medicaid and Medicare savings.
No failure here: Despite all of the negative reports surrounding the implementation of the Affordable Care Act, the law is “an immense policy success,” Paul Krugman writes in a New York Times opinion piece. He writes that the law is “improving the lives of millions of Americans,” citing a Commonwealth Fund report that found “the majority of the newly insured, including 74% of Republicans, are satisfied with their coverage.”
Attributing success: Recent data from polls and studies have attributed the decline in the uninsured rate at least in part to the Affordable Care Act, suggesting the law, and not the recovering economy, is responsible for the decline, according to the Wall Street Journal.