Value-Based Care News

$67M ACA Funds to Help Affordable Health Insurance Enrollees

By Jacqueline DiChiara

- The Centers for Medicare & Medicaid Services (CMS) announced yesterday an abundant $67 million in Affordable Care Act (ACA) grant awards to aid outreach initiatives and help those individuals confused about health coverage and financial assistance options via HealthCare.gov find active in-person support within their community confines.

Marketplace Navigator grants

Awards were granted across 34 states to 100 organizations operating Federally Facilitated Marketplaces, State Partnership Marketplaces, and supported State-Based Marketplaces. Says CMS, these three year-long Marketplace Navigator grants ending in September of 2018 are intended to stimulate efforts to help consumers enroll in affordable health plans that best align with family needs. Such efforts neatly coincide with the upcoming Marketplace Open Enrollment commencement on November 1 of this year.

According to CMS, “In West Virginia alone, an additional 42 counties will be covered, providing improved access across the state.  These gains will enable more consumers to get the help they need with enrollment.” Expanding local access across various states, says CMS, means more counties will be covered under Navigator entities.

“There are a lot of choices when it comes to signing up for health insurance and we want to help make sure consumers feel confident that they’ve picked the right plan,” states Kevin Counihan, CEO of the Health Insurance Marketplaces. "In person assistance from Navigators and assisters has proven to be an incredibly important avenue for consumers to get the right coverage. I'm pleased that Navigators and assisters will be available in even more geographic areas this year," he added.

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  • According to CMS, trained specialists – navigators and assisters – will offer in-person assistance to clarify health insurance confusions and delineate financial assistance options during application completion. Navigators and assisters, required within all marketplaces, are “knowledgeable” about health plan options, public health insurance programs within their state, Medicaid, and the Children’s Health Insurance Program (CHIP) and are mandated to complete “comprehensive training” to best refer consumers with complaints and criticisms to their health insurance ombudsmen, consumer assistance programs, or state agencies.

    In addition to the assistance navigators can providers, CMS says Marketplaces also stand as valuable consumer resources for accessible Marketplace coverage. Such includes certified application counselors, non-navigator assistance personnel/in-person assisters, agents, and brokers.

    Although navigators may prove beneficial to help advance the healthcare industry, they may not be a foolproof solution within themselves. As HealthITAnalytics.com reported, while navigators may indeed help patients better comprehend and meet their healthcare needs, such is also the responsibility of hospitals and healthcare organizations. Electronic health record (EHR) adaptation, for instance, promotes the advancement of communication with greater ease. It is nonetheless imperative communication stemming from navigator encounters can be effective and efficient to best support coordination and execution of patient care across states.