Trump Health Overhaul

Agencies that help people navigate for insurance coverage are being hit with cuts in federal funding going into the enrollment period that starts Nov. 1.

The two nonprofits that help Louisiana consumers enroll in Obamacare health plans have had 80 percent of the $1.7 million in funding they receive slashed by the U.S. Health and Human Services Department.

With enrollments for 2018 coverage starting in November, the Southwest Louisiana Area Health Education Center saw its $1.1 million in previous-year funding chopped by 72 percent to a little more than $297,000.

Navigator funding for Family Road of Greater Baton Rouge, which got close to $462,000 last year, saw its funding cut 98 percent to $10,000.

"Right now I'm laying off 11 of our navigators. We'll only have five left in the state. That's going to be tough. There will be just huge areas of the state that will just not have any personal assistance," said Brian Burton, who heads the Southwest Louisiana Area Health Education Center.

Karla Sayer Wilburn, who headed Family Road’s navigator program, said the nonprofit went from eight navigators to just her.

Family Road and other navigator groups will have to rely on the mainstream media, social media and other community groups to get consumers information about enrolling through, she said.

The navigator grant funding period began Sept. 2. In early June, Health and Human Services required the navigators to file an application detailing their budget, goals and outreach plans.

Although some of the nonprofits had funding reduced, HHS told the Education Center its funding would not be cut, Burton said.

Two weeks ago, the White House announced plans to chop 41 percent out of the navigator program nationally and $90 million of the $100 million from the advertising budget for the Affordable Care Act, known as Obamacare.

The Trump administration, which has pushed unsuccessfully for a repeal and replacement of Obamacare, also cut the Affordable Care Act enrollment period in half to six weeks — Nov. 1 through Dec. 15.

ACA proponents say the shorter enrollment period makes funding the navigators even more important. 

"We're going to do everything we can to help people because I know it's going to be hard for people and confusing, especially with the open enrollment cut to such a short period," Wilburn said.

In the past, few consumers worried about enrolling during the first few weeks because they knew they had time and were more focused on the holidays, she said. The compressed enrollment period means the remaining navigators will have to make a big enrollment push to prevent people from missing their chance to get health insurance.

The amount of the cuts came as a surprise to navigators.

“When you take a hit like that, you’re in a little bit of shock and a little dismayed, but it’s the way things are, and so we’re moving forward,” Wilburn said. “But we’ll always continue to provide the services that the community needs to the best of our ability. That’s just who we are as a social service agency.”

At first the navigators thought the announcement two weeks ago was just formalizing the cuts made in June, Burton said. Instead the federal agency looked at the number of individuals the navigators enrolled in Affordable Care Act health plans. 

The problem that process created for the Education Center was that a large number of Louisiana residents became eligible for Medicaid coverage when the state expanded the program, so many of them moved from Obamacare policies to Medicaid.

A January HHS report showed 152,000 Louisiana residents were enrolled in ACA plans, about 18 percent fewer than the year before. However, more than 70,000 people who previously picked Affordable Care Act plans moved to Medicaid, a federal insurance program for the poor.

Burton said the navigators helped lots of those people learn that they could enroll in Medicaid. The center also advised people about their ACA plan options. The center also advised consumers already enrolled in ACA plans whether it made more sense to re-enroll in the same plan or to move to a different ACA health plan. Consumers often wanted to talk to their spouses before enrolling so the navigators would show them how to finish the online enrollment process, he said.

HHS didn't give the Education Center credit for that work, or for assisting people who chose to stick with the same plan or move to Medicaid, Burton said. He said the center didn’t keep track of how many people it worked with, but there were thousands of consumers. Wilburn estimated that Family Road helped more than 200,000 people through outreach, education and assistance efforts.

"If we had known that they were going to use this criteria, the number of people with QHPs (qualified health plans) only, we would have focused our efforts on making sure that those numbers were the right way," Burton said. "But we didn't. We worked toward reducing Louisiana's uninsured rate."

Even HHS's Centers for Medicare and Medicaid Services has said using the number of new enrollees in ACA plans to determine navigator grants is a flawed process, Burton said. He added that he's still unclear on how HHS decided to cut the Education Center's funding by 70 percent. The methodology involved in determining the grant amounts is unclear, and the center has had no communication with CMS.

"We're just going to do what we can do with what we get," Burton said.

Follow Ted Griggs on Twitter, @tedgriggsbr.