AHA promotes healthcare navigators in letter to CMS
Part of the reason navigators are so valuable, the group says, is that health insurance coverage falls short for many Americans.
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In a letter sent this week to the Centers for Medicare and Medicaid Services, the American Hospital Association voiced its support for healthcare navigators, who are used by hospitals and health systems to help patients navigate through the financial assistance programs that are meant to pay for healthcare services.
"Hospitals and health systems welcome the opportunity to partner with assisters, who are already key resources for consumers navigating the complex health care system, to ensure all patients understand and are accessing available financial assistance," the AHA wrote.
Part of the reason navigators are so valuable, the group said, is that health insurance coverage falls short for many Americans, often featuring high out-of-pocket costs that push more of the financial burden onto patients and make them more financially vulnerable when seeking care.
WHAT'S THE IMPACT
The AHA cited a report detailing evidence that patients are often hesitant to pursue financial assistance. This is either because they believe they won't qualify or are apprehensive about providing the information required to complete the application. Other hospitals report difficulties connecting with patients who may be eligible for financial assistance following care, requiring them to reach out several times, often without success.
"This results in eligible patients not receiving financial assistance and adds an administrative burden to an already-strained healthcare workforce," the AHA wrote.
Moreover, the AHA said that financial assistance programs were originally designed to support uninsured patients, not those who need help closing coverage gaps.
Navigators, the group said, are already trusted community resources for navigating health insurance coverage and would be a great asset in helping to reach patients who are otherwise not accessing financial assistance.
The AHA encouraged navigators and assisters to expand their enrollment counseling to help patients enroll in plans with affordable deductible and cost-sharing requirements based on the patient's financial resources.
"We appreciate CMS exploring how to expand the responsibilities of navigators and non-navigator assistance personnel to include helping patients access available financial assistance," the AHA wrote.
THE LARGER TREND
Navigators offer free assistance to people exploring health coverage options through HealthCare.gov, from reviewing available plans to assisting with eligibility and enrollment forms, to post-enrollment services, such as using their coverage to get care. They can also assist people in helping enroll in or renew Medicaid and Children's Health Insurance Program (CHIP) coverage.
President Barack Obama signed the ACA into law in 2010 and navigators were announced in 2013. Under President Donald Trump in 2019, the Centers for Medicare and Medicaid Services cut navigator funding from $36 million to $10 million for 2019. CMS said at the time that the number of people who enrolled through the program didn't justify the millions of federal dollars spent.
In August the White House awarded a new round of $100 million to organizations deemed "vital" to helping underserved communities, consumers and small businesses enroll in Affordable Care Act marketplace coverage.
CMS awarded the grants in advance of this year's Marketplace Open Enrollment – which runs through January 15 – to 44 navigator grantees in states using HealthCare.gov.
The grants are part of a commitment of up to $500 million over five years.
During the plan year 2024 Marketplace Open Enrollment Period, about 21.4 million people selected plans through HealthCare.gov and state-based marketplaces, including with the help of navigators, CMS said.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
