Indiana sees deepest cuts as Trump slashes program to help Obamacare enrollment

Stethoscope.

 

In a move that some see as further imperiling the current health insurance landscape, the federal government has slashed funds to support its Navigator program, which helps consumers find coverage through the marketplace and enroll for Medicaid.       

No state received cuts as deep as Indiana, according to Kaiser Family Foundation data. Indiana saw an 82 percent cut in its funding, going from $1.6 million in 2016 to $296,704 for 2017.

Overall, the Trump administration cut funds to the program by 41 percent. Louisiana and Nebraska were also hard-hit, each weathering cuts of 80 percent, just under Indiana.

“Indiana gets the prize,” said Karen Pollitz, senior fellow at the Kaiser Family Foundation and author of the report. “I have no idea why.”

A Centers for Medicare Services bulletin dated August 31st that announced the cuts said that grantees would receive funding for this year based on how well they met enrollment goals last year in an effort to ensure accountability within the program.

Many fear that the move will leave people floundering with no idea of where to find assistance.

“Consumers are going to need assistance. Consumers are confused — where do I go, what do I do,” said Jessica Ellis, outreach and enrollment program director for the Indiana Primary Health Care Association, which saw an 87 percent reduction in its grant. “They will try to do it on their own, and they are going to be like, what’s going on, now I don’t have anyone to turn to.”

Last year the association received $506,987 from the program and had more than 13 navigators working throughout the state at the height of the enrollment season. These navigators helped more than 3,500 people sign up for insurance, about 3,000 of them for Medicaid.

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This year they will receive $66,189. That will cover three navigators, one of whom will work for nine months, another for three months and a third who will also work as a part-time administration.

This year’s enrollment season will consist of a more "scaled-back approach” for the organization, in which they will refer those they can’t serve to health center navigators, Ellis said. They have no community enrollment events planned for this year.  

Affiliated Services Provider of Indiana, the only grantee in Indiana with a statewide program last year, lost 81 percent of its funding, going from $906, 987 to $168,565 this year.

Last year the organization had 13 navigators covered by the grant that spanned the state. This year the grant will fund one fulltime navigator and three part-time navigators, said Julia Holloway, senior project director.

About 30 navigators worked for Affiliated Service Providers last year, including some not funded by the federal grant, and enrolled about 6,000 people. This year,18 people will serve as navigators for the agency.

Instead of working statewide, these navigators will focus on Marion County and surrounding areas and staff a call center weekdays from 8:30 a.m. to 4:30 p.m. to assist people with health insurance enrollment, Holloway said. The number is (877) 313-7215.

“We’re still here to help, we’re very passionate about this program,” Holloway said. “We’re going to do our best to help as many people as we can, but we have had to reduce our services.”

Community Action of Southern Indiana, which had six part-time navigators last year, saw funding dip from $221,987 last to $61,950 year this year. Not only will the cuts mean the loss of two part-time navigators, it will also reduce the number of counties to which they provide services from six to four, said executive director Phil Ellis.

The Jeffersonville-based non-profit will no longer serve Jefferson and Washington Counties, although its navigators will continue to offer services in Clark, Floyd, and Harrison Counties and part of Scott County, the places where they’ve served the most people in the past.

As for the other two counties?

“Wow that’s a good question,” Ellis said. “We might be able to stretch and do some outreach with existing navigators.”

Federal navigators are not the only people who provide this service, however. Of the 1,039 people currently certified as navigators in Indiana, only 57 of them hold the federal navigator designation. Another 388 are certified application counselors, according to Jenifer Groth, a spokeswoman for the state’s Department of Insurance.

Many federally qualified health centers have their own navigators and other entities also support individuals who can assist with enrollment.               

Eskenazi Health, for instance,  has 60 full-time navigators that staff its hospital and health centers. On Nov. 18, the hospital will host “Enroll Indianapolis Day” from 8 a.m. to 5 p.m.

“We rev up and try to get people signed up for whatever is out there,” said Eskenazi spokesman Todd Harper. “This is such an important part of who we are, to make sure there’s coverage for our patients.”

These non-federal navigators do provide much-needed help but the federal navigators, who work year-round and receive more extensive training, do have more of an impact.

About 10 percent of the 30,000 people who can assist with enrollment are federal navigators, Pollitz said. But this group aids about a third of all the people who need help.

In addition, another source of navigators may also see funding cuts in the future. Federally qualified health centers, which supports many navigators, are nervously eyeing Congress, which has let their funding expire for now.

“The clinics usually have some carry-over money, but they’re starting to get nervous,” Pollitz said.  

Another concern is that the enrollment period this year has been shortened from three months to six weeks.

Fewer people trying to get the word out in less time could lead to more people going without insurance, Ellis said. The navigators with whom he works regularly encounter people who are not aware of the Affordable Care Act.

“It just really hurts that I can see the negative impact it’s going to have upon the consumers we serve in all of this,” he said. “It just hurts.”

Call IndyStar staff reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter and on Facebook