Navigating in Challenging Times

When we think of the public health workforce, we don’t often think of health insurance navigators. However, navigators play an important role in advancing the public’s health through comprehensive health care coverage for all. (The MCHB National Performance Measures for the Title V block grant includes a measure on increasing children’s health insurance coverage).

Patient navigators rose to prominence following the passage of the Affordable Care Act (ACA), when every health insurance Marketplace was required to establish a navigator program to help individuals and families navigate health insurance options in a very complex system. According to healthcare.gov, a navigator is “an individual or organization that’s trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased. Their services are free to consumers.”

Navigators serve as a trustworthy bridge between individuals and their health care options – from fostering consumer understanding of the various health plans, to empowering them to pick the plan most appropriate for their needs. Navigators are especially important in underserved communities that experience health disparities associated with language, cultural differences and other barriers.

Despite the critical role navigators play in increasing access to healthcare coverage, federal funding for the program has decreased in the first two years of the Trump administration. Funding fell from $63 million in FY2016 to $23 million in FY2017 and continued to go down. For fiscal years 2020 and 2021, funding is slated at $10 million.

Even with cuts in funding and limited resources, Title V programs continue to work with navigators and are thinking creatively about partnerships and funding streams in order to carry out this important work:

• To meet the needs of the community with a diminishing funding stream, the Title V-funded community health centers in New Hampshire are braiding funding sources to maintain full-time navigators. The navigators work closely with the state’s Medicaid Case Workers to better serve the community.
• In Arizona, the Children with Special Healthcare Needs staff participate in the Cover Arizona Coalition – a group consisting of the state’s two federally-funded navigator organizations and various community-based organizations, health providers, tribal representatives, advocates and faith communities to help with enrollment, public awareness and outreach, and consumer information.
• Families served by the Title V family visiting program in Rhode Island are made aware of health navigators in their communities. This is to ensure that families receiving home visiting services have adequate health insurance.
• In Tennessee, the Title V program developed a map that includes state agencies and partners who can help with insurance enrollment and outreach. This map was shared with local staff to assist clients in in finding health navigators and other application assistance programs.

Even with creative approaches, the cuts to the navigator funding are felt deeply across cities, counties, and states. Several states have reduced the number of navigators or the areas where they operate. In some cases, the navigator program is only available over the telephone instead of in-person.

It is important for the public health workforce and private citizens to serve as champions of access to healthcare coverage. We can take small actions such as: promote the open enrollment season (Nov. 1 through Dec. 15); remind people  that Medicaid and the Children’s Health Insurance Program (CHIP) are available for enrollment year-round; verify that your state’s MCH web pages and hotline numbers link to the federal exchange or state marketplace; and guide individuals and families seeking help to the navigator program, consumer assistance programs, or any other resources available in the local area.

Share these resources with colleagues and families.

• To search for local help in your state, Go to localhelp.healthcare.gov and enter your city and state to find local partners who can help.
• To learn more about healthcare plans in your state or on the federal exchange, start at healthcare.gov/get-coverage and select your state.
• And for assistance over the phone call (800) 318-2596 (TTY for hearing impaired: (855) 889-4325) with questions or to apply by phone. This line is open 24 hours a day, seven days a week, and closed on federal holidays.