Ohio Navigator program defunded



For the Troy Daily News

TROY — For the past four years, Health Partners Free Clinic in Troy has offered the assistance of a Certified Marketplace Navigator to help its patients and outside members of the community apply, enroll-in and actually utilize health insurance. This year, the federal Department of Health and Human Services has drastically cut funding to the Navigator Program by 71 percent in Ohio, leaving Health Partners, who had previously received a grant for the position trickling down from the Ohio Association of Free Clinics and the Ohio Association of Food Banks, in limbo with the future of the program.

In a statement released on Aug. 31, CMS, the Centers for Medicare and Medicaid Services, the division of HHS that is responsible for doling out Navigator funds, reported that, “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. These performance-based adjustments will ensure accountability within the Navigator program and avoid rewarding grantees that have failed to meet their performance measures.”

Though this is certainly a reasonable way to gauge federal spending and ensure the proper distribution of tax payer dollars, when it comes to Ohio, the numbers do not quite add up, according to Ohio Association of Free Clinics Director Deborah Miller.

“We have met or exceeded every goal CMS has set for us over the past four years,” Miller said. “We have enrolled over 1.5 million Ohioans in appropriate healthcare plans.”

After hearing from the Ohio Association of Food Banks, it seems the word “appropriate” is of utmost importance in CMS’s decision, according to Justin Coby, executive director of Health Partners of Miami County. Ohio is a state that expanded Medicaid in 2013 to include all adults with yearly earnings up to 138 percent of the Federal Poverty Level, or approximately $16,653 for an individual, he said. This means those Navigator hours in Ohio were spent not just enrolling people in subsidized healthcare plans on Healthcare.gov, but also in dealing with the state’s Medicaid program and the department of Job and Family Services, according to Coby.

“Over the past few weeks, it’s become more and more clear that members of the Administration have chosen to wage war against Medicaid expansion states and penalize us for providing equitable services that connect individuals to QHPs (Quality Health Plans) as well as to Medicaid coverage,” declared representatives from the Ohio Association of Food Banks, before it announced that they would not continue seeking funds from CMS. “(We) do not feel comfortable moving forward with a project that does not provide equitable access to Navigator services for all Ohioans, within the intent of the law and with respect to the varied needs of the different regions our consortium members serve.”

Though it is certainly honorable for the Ohio Association of Foodbanks to take this stance and stick with the convictions of the organization, cutting the program completely does not do much for the citizens of Ohio who still need help understanding the how the American healthcare system operates, Coby said. Last week, an article from NPR echoed many of the concerns that come with cutting the Navigator program. “Some customers don’t know how to use a computer. Many don’t understand insurance lingo — what’s a deductible, anyway? — and don’t know how to pick the best plan for their needs. Consumers get confused about how to estimate income and determine household size to qualify for premium tax credits,” NPR reported. “What if you’re self-employed and have no idea how many hours of work you’ll get next year? If Grandma is a dependent, does she count as part of the household? What about mixed immigrant families, in which one member is undocumented and ineligible for health insurance? These are the types of vexing questions navigators say they routinely field.”

In Miami County, the Navigator program has taken on a critical role for Health Partners Free Clinic and within the community, according to Coby. This past year alone, the Navigator at Health Partners has filled out 244 Medicaid applications, saving the already hectic and overworked Department of Job and Family Services thousands of dollars in initial appointments alone, and has enrolled families from 64 Healthcare.gov applications, out of the many completed, Coby said. These numbers do not include follow up appointments, time corresponding with insurance companies, employers and physicians to gather documents for applicants, and coordinating care with Health Partners and all of its available resources. “Knowing the ins-and-outs of the healthcare system is what the navigator program is for.

Translating this information into laymen’s terms, and actually making it usable in everyday life, is what the Navigator program actually does,” Coby said.

Coby said, after learning about the system’s cuts, “Whether it’s working with HealthCare.gov, the Medicaid system, which can take up to 60-90 days to hear back from, or even Cobra, the program has become essential to patient-centered health care.”

With all of these factors at the forefront of today’s health care climate, Health Partners Free Clinic’s Board of Directors has decided to continue to fund the Navigator position at the clinic through at least 2017, when it will once again be up for review, according to Coby. Coby said that though the position will no longer be called a Navigator because of the change in funding, Health Partners’ Navigator for the past four years, Stephanie Morris, will continue to fill the position, and Health Partners itself will become a Certified Application Counselor site. Health Partners is one of four sites, out of the seven previously funded through the Ohio Association of Free Clinics, that has decided to continue and sponsor the program on its own.

“Helping people connect to healthcare is critical in these times, when healthcare in general is so confusing. Without this position, many people would be lost on how to obtain needed care,” said Aimee Shannon, full time social worker at Health Partners Free Clinic.

For questions about the program, possibilities in assisting to fund the position or for an appointment to discuss healthcare options or receive care, Health Partners is located at 1300 N. County Road 25-A, Troy, and can be reached by contacting Stephanie Morris at (937) 332-0894, Ext. 207.