Facing Federal Cuts, Health Insurance Navigators Scramble to Fill Service Gaps

Wisconsin’s health insurance navigator agencies are facing significant funding cuts and a dramatic reduction in services that could affect cancer survivors and others who need help finding affordable health insurance coverage.

Last month the Centers for Medicare and Medicaid Services announced it would be cutting federal grant funds for programs that offer in-person enrollment assistance (known as navigators) by about 40 percent, as well as federal funding for Affordable Care Act advertising by 90 percent. The details of these funding cuts were released Sept. 13.

Three navigator agencies currently serve Wisconsin. The largest, Covering Wisconsin (previously known as Covering Kids and Families), received a 42 percent cut. As a result the group has announced it will need to eliminate services in at least 12 of the 23 counties it serves and reduce services statewide outside of the open enrollment period, shortened this year to run only six weeks, Nov. 1-Dec. 15.

The Northwest Wisconsin Concentrated Employment Program, the navigator program that primarily serves northern Wisconsin and rural areas, received a funding cut of 44 percent.

These funding cuts and service reductions mean fewer people could enroll in health insurance and premium costs could rise. Eighty-percent of people helped by navigator programs say they would not have the confidence to apply for health insurance on their own. And cuts to outreach and enrollment assistance can lead to increased premiums throughout the market, according to the Congressional Budget Office.

In addition to direct enrollment assistance, navigator agencies perform community outreach, educate consumers on complicated health insurance concepts, and provide technical assistance and support before, during, and after enrollment. This assistance is especially critical for cancer patients and survivors who have the added stress of finding a plan that covers their doctors or treatments, and helps them best manage the high costs of their care.

What happens next

Navigator groups are still working to provide Wisconsinites with the information they need to navigate the health insurance system. Covering Wisconsin, for example, is currently looking for ways to fill service gaps through other funding sources and by joining with partners. Funding for navigators and other outreach and enrollment efforts has been proposed as part of bipartisan solutions to stabilize the health insurance marketplaces, like that proposed by Govs. Kasich and Hickenlooper, currently stalled within the Senate.

Increasing the quality, availability, and effective use of health insurance coverage for cancer prevention and treatment is a goal of the WI Cancer Council Policy Agenda, and a priority integrated throughout the WI Comprehensive Cancer Control Plan 2015-2020.

The WI Comprehensive Cancer Control Program is monitoring the impacts of these funding cuts on these goals, and will continue to update WI Cancer Council members on ways that they might support navigator groups and other outreach and enrollment efforts in the coming months. In addition, we are currently partnering with Covering Wisconsin to develop a “how-to” sheet for cancer patients and survivors to help select the best insurance plan for them, which should be released this fall.