Why two ACA navigators dropped out of the program

Groups returned federal grants this week

At least two organizations have dropped out of the Affordable Care Act's (ACA) navigator program, which was intended to help millions of Americans obtain health coverage but has become a target of ACA opponents in recent months, Sarah Kliff writes in the Washington Post.

Background on navigators

The ACA requires that each health insurance exchange have two organizations certified as navigators, and one of those organizations must be not-for-profit. Navigators are expected to provide "fair, impartial, and accurate information" that assists residents with insurance applications and provide additional assistance to consumers who are disabled, do not speak English, or who are unfamiliar with health insurance.

In August, HHS Secretary Kathleen Sebelius announced that 105 groups—including a handful of hospitals—had been selected as navigators and would receive part of a $67 million federal grant.

Why navigators dropped out

According to the Commonwealth Fund, 17 states have passed legislation that prevents certain navigators from participating in the navigator program. Most of the restrictions involve requiring navigators to obtain certain licenses, Kliff writes.

As a result, at least two organizations that had been named as navigators have been forced to leave the program:

  • Ohio: This week, Cincinnati Children's Hospital Medical Center returned its $124,419 grant, according to spokesperson Terry Loftus. The decision was made after Ohio enacted new restrictions that significantly limited who could participate in the program. "We had to withdraw because of an Ohio law which makes us ineligible," Loftus told Kliff, adding that the law "says you can't be a navigator if you negotiate with health insurers. As a medical provider, we can't be a navigator. We have notified CMS."
  • West Virginia: On Monday, the West Virginia Parent Training and Information dropped out and sent back its $365,758 grant. Pat Haberbosch—executive director of the group—declined to comment beyond that it was done "due to unforeseen circumstances." Kliff writes that state Attorney General Patrick Morrissey (R) sent a letter to the group last month asking whether they would be conducting criminal background checks and to specify whether their navigators would "inform consumers of their data privacy rights."

  • Don't count on your 24 million new customers yet. With funds for the navigator program in short supply, providers are quickly becoming patients' primary—and preferred—source for health insurance exchange information. Here's what your organization can do.

Attorney generals, Congressional Republicans interfere

Morrissey also was one of 13 attorneys general that sent a letter to HHS in August describing the navigator program as a "security disaster waiting to happen."

The letter states that HHS will "be giving its stamp of approval to every counselor who interacts with a consumer" and "needs on-the-ground plans to secure consumer information, follow up on complaints and to work with law enforcement officials to prosecute bad counselors."

In response to a similar letter that Congressional Republicans sent to the agency, Jim Esquea—HHS assistant secretary for legislation—said that the department is "concerned about the timing" given its "potential to interfere with the navigators ability to carry out their crucial efforts in assisting Americans who lack health insurance" (Kliff, "Wonkblog," Post, 9/9).


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