The Centers for Medicare & Medicaid Services (CMS) said Thursday it would reduce funding for the Affordable Care Act (ACA) Navigator program to $10 million.
Navigators help consumers browse and select health coverage in ACA plans and conduct outreach and education events in local communities to explain their insurance options.
In the announcement, CMS said that the program received $98 million for the 2024 plan year and enrolled 92,000 consumers during the open enrollment period. The agency, under the Biden administration, said in early January that 23.6 million consumers selected plan year 2025 coverage through the marketplaces since the start of the 2025 Marketplace Open Enrollment Period, including 3.2 million new consumers. It didn’t provide a breakdown of how many of those consumers were helped by navigators.
The agency said the reduction in funding will allow Federally-facilitated Exchanges (FFEs) to focus on effective strategies to improve exchange outcomes and to reduce the user fee in future years, which would translate into a reduction in premium. The agency said this change will provide a direct benefit to people enrolled without subsidies who pay the full premium for their health insurance. In addition, it said lower premiums will reduce the burden on taxpayers who fund the premium subsidies through the FFEs.
The Navigator program is funded by user fees. CMS said that the decrease in funding to $10 million per year will save $360 million over the next four years of the five-year period of performance, which began August 27, 2024, and runs through August 26, 2029. “Because the user fee is directly passed through to the premium that health insurers charge, the savings from the Navigator program supports lower premiums for consumers in the individual health insurance market. People who do not qualify for federal premium subsidies will directly benefit from lower premiums. Lower premiums will also translate to less federal spending on premium subsidies,” CMS said.
This change is for Navigators in the states with FFEs in the next grant period for plan year 2026. States operating state-based exchanges and state-based exchanges operating on the federal platform are responsible for determining the funding available for Navigator programs in their states.