Consumer Assistance: Getting the Most Out of Limited Resources

As we count down to the second year of open enrollment under the ACA, one common theme among consumer assisters will be how to do more with less. Consumer enrollment assisters are already doing more than originally envisioned by helping consumers who purchased marketplace coverage understand and use their health insurance, as recently highlighted in the Washington Post. With few government resources for consumers’ post-enrollment questions, enrollment assisters are filling this gap. And since the close of open enrollment in April, they’ve also been helping thousands of people enroll in coverage when they qualify for special enrollment opportunities. Consumer assisters have stayed busy, but they will be stretched even further in the upcoming months. Not only will they have to reach and help uninsured individuals with open enrollment- projected by the Congressional Budget Office to be 13 million people in 2015, 5 million more than in 2014-they will also be helping existing enrollees renew health coverage, a process that some are predicting will be “super confusing.”

While open enrollment is less than three months away, marketplaces have taken varying degrees of action to ramp up consumer assistance. While all marketplaces – state-based and federally facilitated – are required to provide a navigator program, the law does not require them to devote a minimum level of funding to those programs. As resources for marketplace operations become more constrained, many may decide to reduce the amount they provide in navigator grants. In some states, navigators don’t yet know what, if any, resources will be available. For example, to date New Mexico’s marketplace appears not to have released any new funding opportunities for consumer assistance. And while Connecticut indicated that it will have an in-person consumer assistance program for this year’s enrollment, it currently only has $500,000 in expected funding, less than the $2.6 million the program had last year. Without certainty of funding some navigator organizations may need to lay off staff, leaving them ill-prepared for the start of open enrollment when and if funding is provided. California’s marketplace  has accepted applications for approximately $17 million in funding for enrollment and education programs, but that is $23 million less than was provided last year. On the other hand, Massachusetts’ marketplace expanded the number of navigators it funds from ten to fifteen and has increased funding by approximately $400,000. Consumer assisters in federally facilitated and partnership states will also be facing more limited funding, as the budget for navigators has dropped to $60 million for the 2015 open enrollment season, from $67 million in 2014. The federal government will continue to provide approximately $150 million for consumer assistance through community health centers.

With more limited funding available to operate, consumer assistance programs will need to get creative in reaching the remaining uninsured individuals and renewing current enrollees. Consumer assistance programs may need to establish or leverage partnerships with Medicaid agencies, local agents and brokers, certified application counselors, provider entities, and other consumer assistance programs to strategize on outreach and enrollment. Such partnerships can help ensure that all areas of the state and targeted populations benefit from outreach efforts, and limit duplication of effort. Assisters can also conserve resources by sharing training materials, lessons learned, and best practices with one another. While the upcoming open enrollment season is predicted to be challenging, consumer assisters will again play a key role to ensure that millions of more people enroll in affordable, high quality health insurance coverage.

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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.