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The Centers for Medicare and Medicaid Services weighed in back in March, committing additional funding to support the Navigator Program. Under this platform, grantees participating in the ACA Marketplace will benefit from the increased funds. The goal, shared by CMS, is to support the outreach, information exchange, and enrollment efforts during the current Special Enrollment Period enacted by President Biden.

Today, we’ll peel back the layers to this announcement and explore three of the key advantages the insurance industry can expect to see. It’s more than just a surge in funds for this pivotal SEP. It’s a step toward investing in the future of the Navigator Program and participation efficiencies for Americans who need health insurance.

1. Advantages of the Special Enrollment Period for All

In response to the pandemic, and upon taking up residence in Washington, President Biden enacted a nationwide Special Enrollment Period for all Americans. And with the SEP, individuals could tap into increased premium tax credits to find affordable coverage. With so many unemployed and under-employed, the ACA Marketplace needed the support and funds to accommodate the nationwide need.

President Biden’s Special Enrollment Period

When President Biden first took office, one of his priorities included bringing back funding and support to improve the Affordable Care Act. In an executive order, he single-handedly authorized a Special Enrollment Period that would allow those not covered, as well as those currently covered Americans, to explore more affordable health insurance. He also took action in directing his administration to re-evaluate any regulations that would stifle or limit the ACA or Medicaid. The goal was to expand the reach of these necessary platforms so anyone in need of affordable health insurance could potentially be eligible.

Americans Need ACA Support & Relief

Millions of Americans lost their jobs, and along with those jobs, they lost their employer-sponsored health insurance. Others faced affordability issues, with furloughs and layoffs reducing household income. So there certainly was a need for boosting the availability of the ACA. The Government Accountability Office (GAO) also pointed to navigator program concerns. With so many people exploring their options on the Marketplace for the first time, there was an increase in consumer confusion, leading some to abandon enrollment efforts entirely.

CMS Responding with Navigator Funds

On March 2, CMS announced by email its initiative to offer an additional $2.3 million to support navigator grantees. In conjunction with the federally-announced SEP, CMS agreed with the White House that “every American deserves access to quality, affordable healthcare.” Navigators are designed to help individuals understand the coverage options, connect them with eligible financial assistance, and make enrollment in plans like Medicaid and CHIP easier.

2. The Benefits of Navigator Programs

For decades, millions of Americans relied on their employers to handle all the heavy lifting when it came time to shop and select health insurance. But in today’s environment, individual coverage is proving to be the more affordable and viable option. And while the ACA Marketplace intends to make those enrollment efforts available, sorting through the jargon, comparing plans, and understanding costs is overwhelming and confusing for those experiencing the platforms for the first time. That’s where navigators come into play.

Easier Access to Shop & Compare Health Insurance Plans

Navigator programs serve a critical purpose when it comes to connecting consumers with available health insurance. These help individuals calculate savings, compare various coverage options, and receive financial assistance for which they qualify. Getting people to the Marketplace is only half the battle. The navigators ensure those who need coverage can successfully enroll in the best-fit plans.

Deeper Discounts & Premium Tax Credits

Under the President’s SEP, consumers can tap into additional savings and premium tax credits. Even those individuals who already selected Marketplace coverage earlier in the year can re-apply and leverage any additional reductions. These incentives are driving more people back to the Marketplace and in additional need of navigator support.

30 Eligible Organizations

CMS said there are 30 organizations that qualify for eligibility in terms of receiving this new round of funding. These groups are in 28 various federally-facilitated marketplace (FFM) states. The agency also noted that these grantees would continue to have some flexibility in applying the funds, allowing them to address express needs. And for those groups that already submitted their budgets, this new round of funding also offers an additional timeline to rework those budget projections.

3. The Advantages of Investing in the Future of the Navigator Program

This latest announcement of new funding may have been in response to the SEP now. But CMS was also clear that its focus will remain on growing the support and accessibility of the ACA with navigator programs. The agency is looking well into the future and considering long-term viability.

CMS Plans Continue

This latest round of funding is only the “first step in providing financial support.” The Navigator Program can expect additional relief, including in the form of grants as part of the 2021 Navigator Notice of Funding Opportunity (NOFO.) According to the official announcement, the current grants are set to expire on August 29, 2021. But the effort to develop and enhance navigators will continue ongoing.

A Stark Contrast to the Previous Administration

Much of what’s happening now only reverses the previous administration’s steps to cut off funding to the ACA. Under the guidance and leadership of the Trump administration, the CMS actually cut navigator funding. At the time, these programs were already receiving $36 million in federal money, but only to support about one percent of the enrollees at the time. Of course, times are different now, and consumers need the ACA more than ever.

A Better Way to Health Insurance

For many businesses and millions of individuals, the Marketplace is presenting far more affordable and more flexible options for health insurance. Born out of necessity, innovations in healthcare, health coverage and associated costs will only become better. CMS is committing to a long-term approach of support with navigators. And it proves the ACA isn’t going anywhere anytime soon. In fact, it may be the best way forward.

Stay up to date on the latest insurance conversations with W3LL. As a trusted partner, we’re helping businesses, brokers, and individuals leverage every available benefit.


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