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CMS Announcement on ACA Navigator Program and Promotion for Upcoming Open Enrollment

CMS Announcement on ACA Navigator Program and Promotion for Upcoming Open Enrollment

The Centers for Medicare & Medicaid Services (CMS) today announced the following plan related to the Affordable Care Act (ACA) Navigator program and enrollment promotion for the upcoming open enrollment period:

CMS plans to spend $10 million on promotional activities in order to meet the needs of new or returning ACA enrollees – consistent with promotional spending on Medicare Advantage and Medicare Part D. CMS will target its advertising and outreach activities to educate consumers on the new dates of the Open Enrollment Period through digital media, email, and text messages. These outreach methodologies have proven the most effective in reaching existing and new enrollees. During the most recent open enrollment period, CMS spent more than $100 million on promotional activities – nearly double what was spent in 2015 – but saw first-time enrollment decline by 42 percent and effectuated enrollment decline by approximately 500,000 individuals.

The PPACA requires the establishment of Navigators to help facilitate enrollment of individuals through the federally-facilitated exchange (FFE) or state-based marketplaces (SBM). Funding for the Navigator program and open enrollment promotional activities comes from user fees paid by issuers who are participating in the FFE. During the most recent open enrollment period, Navigators received over $62.5 million in federal grants while enrolling 81,426 individuals. Seventeen Navigators enrolled less than 100 people each at an average cost of $5,000 per each enrollee. Seventy-eight percent of Navigators failed to achieve their enrollment goal.

For the upcoming enrollment period, Navigator grantees will receive funding based on their ability to meet their enrollment goals during the previous year. 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. These performance-based adjustments will ensure accountability within the Navigator program and avoid rewarding grantees that have failed to meet their performance measures.

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