CMS Announces $10M Budget to Promote ACA Open Enrollment

September 2017 ~

CMS has announced its plans for the Affordable Care Act (ACA) Navigator program and enrollment promotion for the upcoming open enrollment period.

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.

The agency has stated it will spend $10 million on promotional activities in order to meet the needs of new or returning ACA enrollees. During the most recent open enrollment period, CMS spent more than $100 million on promotional activities, but states that first-time enrollment decline by 42% and effectuated enrollment decline by approximately 500,000 individuals.

CMS says the revised budget is consistent with promotional spending on Medicare Advantage and Medicare Part D and plans to target advertising and outreach activities on consumer education on the new dates of the Open Enrollment Period through digital media, email, and text messages. According to CMS, these outreach methodologies have proven the most effective in reaching existing and new enrollees.

Additionally 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. 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.

CMS intends for the new performance-based adjustments to ensure accountability within the Navigator program and avoid rewarding grantees that have failed to meet their performance measures.

Source(s): CMS; CMS Press Release; Healthcare Payer News; HealthPayerIntelligence; Health Affairs Blog;