CMS awards $67M in 2016 ACA exchange Navigator funding

From Ye Olde Inbox...

September 2, 2015

CMS awards $67 million in Affordable Care Act funding to help consumers sign-up for affordable Health Insurance Marketplace coverage in 2016

With Marketplace Open Enrollment set to begin on November 1, 2015, the Centers for Medicare & Medicaid Services (CMS) today announced grant awards totaling $67 million to support outreach efforts designed to connect people with local help as they seek to understand the coverage options and financial assistance available at Awarded to 100 organizations located in 34 states that operate Federally Facilitated Marketplaces, State Partnership Marketplaces, and supported State-Based Marketplaces, the three year-long Marketplace Navigator grants will fuel efforts to help consumers enroll in a health plan that fits their budget and best meets their family’s needs.

This money is for the Navigator organizations, which effectively act as non-commissioned insurance brokers to help people enroll for healthcare policies via Healthcare.Gov.

Here's the full list of organizations receiving funding; for instance, here in Michigan it includes:

  • Arab Community Center for Economic & Social Services (ACCESS)
  • City of Garden City
  • Forest County Potawatomi Community*
  • Michigan Consumers for Healthcare
  • Midwest Asian Health Association (MAHA)

These organizations are gonna have their work cut out for them this year, of course. The last time I checked, the CBO was still projecting that 2016 exchange QHP enrollments would leap from 11 million this year to 21 million next year, a whopping 91% increase.

I honestly have no idea what makes them think the number will ramp up that much in a single year.

As you'll recall, back in May 2013 they were expecting the average monthly enrollment tally to play out as follows:

  • 2014: 7 million
  • 2015: 13 million
  • 2016: 22 million
  • 2017: 24 million

...after which it would level off at the 24-25 million level each year for the next 5-6 years straight.

In reality, the monthly average enrollment last year ended up coming in at around 5.5 million, and is very likely to be somewhere between 9.8 - 10.0 million for 2015.

In the March 2015 update, they dropped their 2015 projection from 13 to 11 million...yet are still expecting a massive spike in enrollments for 2016, just as they were in the earlier report:

  • 2014: 5.5 million (actual)
  • 2015: 11 million
  • 2016: 21 million
  • 2017: 24 million

I'm not sure what makes the CBO continue to be so confident in such a dramatic spike this fall. The biggest factor I can think of is the Shared Responsiblity Penalty (aka the Individual Mandate Tax) leaping up from just $95/person (or 1% of household income) to $325/person (or 2% of income). Obviously that will prod some people off the fence, but 11 million more seems like a pretty tall order.

I haven't made any official (or even unofficial) projections myself, but this sounds awfully optimistic to me. At the moment I'd imagine QHP selections to come in more around the 15-16 million area, with the monthly average coming in at perhaps 13 million or so...but that's still gonna require another 4 million people to be added udring the open enrollment period, which is where these navigators (along with traditional brokers) will be crucial.

NOTE: That is not my official projection (that is, that may be what it ends up being, but a lot could change between now and November 1st, when Open Enrollment kicks off again).