Community health advocates in states that opted for the federally run health insurance exchange model breathed a tiny sigh of relief on Tuesday on news that the Centers for Medicare & Medicaid Services will award $54 million in grants to help states pay for the federally required navigator programs.
But the amount of money CMS is doling out isn't nearly enough to adequately help the number of uninsured Americans who are expected to enroll in the exchanges this October, hence the word tiny.
The Patient Protection and Affordable Care Act requires all insurance exchanges to have navigator programs, which must be comprised of at least two different entities, with one being a nonprofit, community-focused group. The intent of navigators is to help consumers understand the process, the plans, and the choices they have in regard to the exchange.
The rules change slightly according to which type of exchange a state has decided to develop. For example, all exchanges are required to have a navigator program. But, state-based exchanges and federal-partnership exchanges with a consumer assistance component, such as Arkansas, can also opt to have in-person assister programs. The only real difference between the navigators and IPAs is how they are paid.
State-based exchanges can pay for IPAs with establishment grants already given out by CMS to help pay for the program for the first year. Partnerships and some federally run exchanges don't have the option of IPAs. Furthermore, the grants CMS just announced are the only federal money a state will get to pay for the navigators of its federally run insurance exchanges.
What's the difference? Consider that California, with an uninsured rate of 23%, is spending $43 million on its IPA program for its state-based exchange, Covered California.
Texas, which will have a federally run HIX, and has a 28% uninsured rate, stands to receive $8 million for its navigator program from CMS. The formula CMS is using to determine the grant amount uses a state's uninsured rate as a primary factor.
Rachel Dolan, policy analyst for the National Association of State Health Policy, says even though the federally run insurance exchanges won't have as much money for the consumer assistance component, states can supplement the effort.
"If a state is willing to help or get the word out or use community partners in other ways, then they can make sure that people are still getting the information they need. It may just not be a formal program."
The likelihood of a state's willingness to help the federal government out on this component of PPACA will vary from state to state.
In Texas, a state vehemently opposed to the law , the disparity highlights the uphill climb federally run exchanges face. A state's stubbornness on the issue of consumer assistance could spell disaster for other HIX partners.
For example, if the money doesn't go far enough to help the uninsured understand what their choices are, insurers run the risk of enrolling the population they fear they most: the sickest, because it stands to reason they will need the most help the process of enrolling. In Texas and in other states resisting the expansion of Medicaid, this could be particularly acute.
States have until June 7 to apply for the grant money. For those who receive it, the grant requires that navigator programs provide up to 30 hours of training for the actual navigators carrying out the task of helping consumers understand the HIX and their choices. They'll also be given an exam to make sure they understand exchange-related information. CMS will award the grants by August 15th.
A program that is rooted in helping uninformed and uninsured consumers navigate the confusing path of health insurance could, ironically, turn out to be the talking point states opposed to PPACA use to help prove their case against the new law.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.