By Rose Hoban

Health care advocates in North Carolina had something to cheer Friday when federal officials announced they would fund the state’s health insurance “navigator” program at the same level as last year.

The announcement comes after confusion over funding for this year’s navigator program, which provides volunteers to help people signing up for insurance on the online marketplace maneuver through a process that can be confusing, especially to first-timers.

“We have no inside scoop on this,” said Sean Driscoll, a spokesman for Legal Aid of North Carolina, which will receive $2.44 million to support enrollment activities around the state. That’s the same amount as was received last year by the NC Navigator Consortium, a group of 14 health care, social service and legal aid organizations around the state. Legal Aid is the lead agency of the group.

Driscoll said he and others had no idea what to expect amid the mixed signals from federal officials, even as the funding announcement was two weeks after last year’s funding stream ended on September 1.

“Far be it for me to understand what’s going on in Washington,” he said.

Meeting goals

Advocates and Democratic lawmakers erupted in outrage last month when federal officials announced their plan for funding this year’s enrollment activities for the Affordable Care Act health exchanges.

A late August announcement from the federal Centers for Medicare and Medicaid Services said that for the enrollment period beginning in November, organizations that trained and deployed navigators would be funded based on how well they signed people up during the 2016 enrollment period.

“For example, a grantee that achieved 100 percent or more of its enrollment goal for plan year 2017 will receive the same level of funding as last year,” read an August 31 press release from CMS.

The CMS release claimed that 78 percent of navigators failed to meet their enrollment goals.

CMS also announced that federal spending on education and advertising for ACA insurance plans will be cut by some 90 percent, only $10 million nationwide compared to last year’s funding level of about $100 million, the release said.

“We know that advertising plays a key role in getting the word out and helping people be aware of their options and deadlines,” said Jackie Kiger, who heads up ACA enrollment for Asheville-based Pisgah Legal Services, one of the consortium members. “We’ll be looking locally to our community for resources and help getting the word out.”

North Carolina was one of the nation’s success stories, enrolling more than its federal targets for each of the first four enrollment periods for ACA insurance.

“If anyone was going to get level funding, I’m not surprised it was us,” Driscoll said.

Nonetheless, North Carolina had 10.4 percent fewer enrollments by the close of the 2016 enrollment period, with a total of 549,158 signups, compared to 613,487 enrollees at the end of the 2015 open enrollment period.

Where consumers are

Mark Van Arnam, who heads up enrollment activity for the navigator consortium, said even as they waited for word from Washington on this year’s funding, members of the consortium were getting ready.

He acknowledged that this year will be more challenging as the Trump Administration has cut the enrollment period from 90 days, as it had been during previous years, down to 45 days. Enrollment begins Nov 1 and stretches through Dec 15.

Van Arnam said navigators and planners have been focusing on “pre-enrollment.”

“We have been doing enrollment, outreach and other activities year round in order help people be aware of their options,” Kiger said.

“We’re encouraging North Carolinians that need to reenroll, that need to update their information and find out plans that are right for them for the new year, or even folks who need to enroll for the first time to get in contact with navigators now,” he said.

“They can do things like setting up their account if they never set one up before or making sure that their passwords work. So, when the open enrollment period comes around, it’ll be just as easy as coming in and finishing up by selecting a plan and doing those last little pieces of it.”

Van Arnam said he hoped this approach will allow navigators to have the capacity to see extra people who need help during the enrollment period itself.

Last year, 31 percent the 12.2 million consumers signing up for plans were new enrollees. Of the people re-enrolling in coverage, only about a third of those people were automatically re-enrolled in plans. So there’s a lot of people who get on Healthcare.gov to look at plans and complete the process.

A survey conducted by the Kaiser Family Foundation in 2016 found that enrollment assistance is time intensive. The survey found it took 90 minutes on average to help consumers enroll for the first time and it took 60 minutes on average to help renewing consumers.

North Carolina has about 150 volunteer navigators who have gone through a 40-hour training program to help enrollees sign up on the federal website, which has a complex system for proving the identity of enrollees. The Kaiser survey found the system “poses challenges for consumers without established credit history, and those who cannot pass it can face significant delays in applying for Marketplace coverage.”

In addition, some organizations, such as community health centers, have employees who have become application counselors. Van Arnam said they’re ready to go.

Kiger said that Pisgah Legal Services plans to repeat some of the successful enrollment events from prior years, even as they brainstorm new ideas.

“In years past we have hosted an event in downtown Asheville at the US Cellular Center where we had many navigators on site to help enroll people,” she said. “We’re hoping to do the same this year.”

“There were a lot of navigators and assisters going to back-to-school fairs and backpack giveaways. We’ll also be going to more of the usual suspect kinds of events, flu shot clinics, health fairs,” Van Arnam said.

“We want to be wherever people are.”

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