Navigators face steep funding reductions as CMS shifts focus to premium savings and efficiency
On February 14, 2025, the Centers for Medicare & Medicaid Services (CMS) announced a significant reduction in funding for the Affordable Care Act (ACA) Navigator program, decreasing the annual budget from $100 million to $10 million. This decision marks a 90% cut in funding, aiming to reallocate resources towards strategies that CMS believes will more effectively improve exchange outcomes and reduce premiums for consumers, particularly those not receiving subsidies.
Why the Funding Cut?
CMS cited concerns over the cost-effectiveness of the Navigator program. In the 2024 plan year, Navigators assisted approximately 92,000 consumers, accounting for just 0.6% of plan selections through the Federally-facilitated Exchanges (FFEs). The average cost per enrollment was $1,061, with some grantees exceeding $3,000 per enrollment. In contrast, during the 2019 plan year, Navigators enrolled a similar percentage of consumers at a significantly lower average cost of $211 per enrollment.
Additionally, CMS noted a decline in post-enrollment assistance provided by Navigators, from approximately 205,000 consumers in 2019 to about 86,000 in 2024, despite increased funding and higher enrollment levels.
The agency plans to use the $360 million saved over the next four years to lower user fees, which could translate into reduced premiums for consumers and decreased federal spending on premium subsidies.
Impact on Enrollment Assistance
The funding reduction is expected to significantly impact the availability of Navigator services, particularly in states that rely on the FFEs. Navigators play a crucial role in assisting consumers with understanding their health coverage options, determining eligibility for programs like Medicaid and the Children’s Health Insurance Program (CHIP), and providing post-enrollment support.
With fewer resources, Navigator organizations may face challenges in maintaining staff and outreach efforts, potentially leaving underserved communities with limited access to enrollment assistance.
How American Exchange Can Help
In light of these changes, organizations involved in health insurance enrollment may need to explore alternative solutions to continue supporting consumers effectively. American Exchange offers comprehensive enrollment support services designed to fill the gap left by reduced Navigator funding.
Our platform provides tools and resources to assist consumers in understanding their coverage options, determining eligibility, and completing the enrollment process efficiently. We also offer training and support for organizations to enhance their outreach and enrollment capabilities.
Call to Action:
To learn more about how American Exchange can support your organization’s enrollment efforts, schedule a demo today.
Source:
CMS Announcement on Federal Navigator Program Funding
https://www.cms.gov/newsroom/press-releases/cms-announcement-federal-navigator-program-funding
