With open enrollment for Obamacare plans seven weeks away, the Trump administration has de-funded largest “navigator” organization in the state that helps people to enroll.
Instead, after cutting Georgia's navigator allotment from $1.4 million to $499,000 and changing the rules to allow fewer grantees, the administration has given the entire amount to a small Clarkston organization that focuses on the immigrant population.
“I’m a little astounded,” said Kathleen Connors, who founded the winning group, Georgia Refugee Health and Mental Health. “Grateful.”
About 480,000 Georgians enrolled last year on the health insurance exchange market for the Affordable Care Act, also known as Obamacare. The number was down slightly from the previous year, in spite of a shortened enrollment period and deep cuts to advertising and outreach.
Advocates for the program say they fear the new cuts to the Navigator program will make it harder to sign Georgians up for care. The Centers for Medicare and Medicaid Services (CMS), which administers the grant, said the funding for this year’s outreach effort was to focus on people who had been “left behind” by previous years’ navigator efforts and were still uninsured.
The bright spot is the unexpected ballooning of refugee resources. “Truly I didn’t expect that we would get the funding,” Connors added, acknowledging she will have a steep ramp to climb in scaling her operation statewide and setting up as the central Navigator information source. They don’t have an 800 number yet. “I thought we would get half of it at best and I would have been satisfied; and either (one of two larger Georgia organizations) would get the other half to do the statewide.”
The largest of those two other organizations, Insure Georgia, now must try to figure out whether it is even legally allowed to give sign up advice if people call them again this year. Up to now it has deployed scores of “navigators” across the state, run a 12-hour-a-day phone bank, responded to calls year round, and last year visited 135 counties to help people enroll.
“It is unfortunate that Georgia’s funding has been cut to an untenable amount to do navigation work,” said Fred Ammons, president and CEO of the parent organization for Insure Georgia. “We wish Georgia Refugee Health and Mental Health all the best in their efforts to try to do this.
“Inevitably,” he added, “regardless of who is funded to do this work, some individuals will be without assistance.”
Under the leadership of Seema Verma in the Trump administration, CMS has said it intended to be more data-driven and focus on activities with high return — numbers of enrollees — for the grant dollars spent.
However, critics have said CMS counts enrollees inaccurately, for example excluding phone bank callers from the number of enrollees assisted by an organization because the caller pushes the button on their application, not the call bank navigator. Insure Georgia’s call bank handled thousands of callers last year and the organization’s navigators helped more than 22,000 individuals overall, Ammons said.
A review released this summer by the federal Government Accountability Office found that CMS was using unreliable data, and knew that it was unreliable. For its part, Ammons’ organization sued CMS over the issue, and won a small settlement. But that didn’t help it get a grant this year.
Connors’ application for funding for her refugee organization was directly aimed at the administration’s data and stated goals. Since they deal with non-English speakers, her navigators are virtually always the ones to fill out the application for them and push the button, not the applicant. By that metric, Connors’ application said that last year they enrolled 777 people. Given their low grant amount that year, their efficiency dwarfed that of Insure Georgia or anyone else in the state. “Top Performer in Georgia compared to other agencies,” it noted in bold.
Significantly, in this year’s request for proposals CMS also asked organizations to focus on the population “left behind” from the Affordable Care Act, also known as Obamacare. Connors’ organization does just that, working with people who speak little or no English and often do not understand the health insurance system at all, much less whether they’re eligible to enroll in an exchange plan and how. She intends to add a focus on the Hispanic population, one that is in need of outreach.
CMS also said it was looking for organizations to be creative and innovative, and propose strategic partnerships.
The federal grant award to Georgia Refugee Health and Mental Health lists its “partnerships,” with statewide organizations such as the Catholic archdiocese and 14 major poultry plants (which employ a heavily Hispanic workforce). Connors said she has has not yet reached out to them, but she is optimistic they will partner on the effort.
Connors said she hopes that, for example, the poultry plants will put sign-up fliers in their employees’ paycheck envelopes.
Connors has spoken with the Hispanic Chamber of Commerce, which gave its enthusiastic support and said that among other connections, Spanish-speaking media would carry public service announcements.
It remains to be seen how much Georgia’s signups will be affected. Consumers can still go to the federal Obamacare website, healthcare.gov, and find an agent to sign up with. They may or may not have the expertise of Insure Georgia’s navigators; for example, at the request of a Congressman’s office the organization has spoken with one family 20 times about a blip in their income that caused them to be ineligible for insurance subsidies, and they hope to solve the issue.
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