North Carolina will see a drop in federal funding to promote subsidized health insurance in the second year of the Affordable Care Act as “navigators” focus on signing up the more challenging uninsured residents who had opted out of coverage this year.
Only three organizations will receive $2.8 million to promote subsidized insurance coverage, down from the $3 million awarded last year to five organizations, the U.S. Department of Health and Human Services announced Monday.
One of the three groups hired to enroll North Carolina residents is an Illinois company that is currently in a pending bankruptcy reorganization. Waukegan, Ill.-based R&B Solutions was awarded $76,795 to set up operations in North Carolina, and also received more than $700,000 in federal grants to provide navigators in Iowa, Illinois and Indiana.
Meanwhile, Mountain Projects in Waynesville, a nonprofit now promoting subsidized coverage in seven western North Carolina counties under a $359,750 grant issued last year, was turned down for funding this year.
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“There were funding decreases, that’s the reason we were given,” said Patsy Dowling, the group’s executive director. “We were told we were doing a great job and we were one of the best grantees they had, but they had to make funding cuts.”
Federal funding for navigators nationwide dropped to $60 million this year, from $67 million last year.
Adam Linker, a health policy analyst with the N.C. Justice Center, an advocacy group for low-income people, said selecting an out-of-state company over a local organization is inexplicable.
“Whoever was reviewing the applications lost their mind temporarily,” Linker said. “It’s just ridiculous when we have a well-known nonprofit that’s doing a great job with vulnerable populations in the mountains of North Carolina.”
The DHHS announcement cited several factors for selecting grant recipients, including a stipulation that “Navigator grantees must maintain a physical presence in the Marketplace service-area, so that consumers can easily access face-to-face assistance.”
Ryan Brebner, manager of business development for R&B Solutions, said by email he was unavailable to discuss R&B’s navigator strategy in North Carolina, but said the bankruptcy was prompted by a change in federal law that undermined the company’s student loan business.
R&B’s health care division helps uninsured patients secure charity payment and other financial resources for hospital services.
R&B received the smallest navigator grant in North Carolina this year. The biggest grant went to the Legal Aid of North Carolina, which received $2.3 million to coordinate the state’s consortium on nine organizations, and has about 40 navigators statewide. The consortium is currently managed by N.C. Community Care Networks with a $2 million grant that expires this fall.
Alcohol/Drug Council of North Carolina, based in Durham, received $427,610, up from $324,798. Navigator program director Nyi Myint said the organization will extend its outreach to Hispanics and veterans this year.
The navigators face numerous challenges this year, said Lee Dixon, who is overseeing the consortium for Community Care Networks until Legal Aid takes over this fall.
The navigators reached much of the low-hanging fruit in the first year, and will now focus on enrolling young people and others who were not interested in buying health coverage. Dixon also said the open enrollment period, which starts Nov. 15, runs three months this year, compared to six months in the first year of the Affordable Care Act.
“It is going to be an extra challenge,” Dixon said. “This is a population that for the most part has never had to deal with enrollments, so it’s completely new to them.”
North Carolina’s enrollment under the health care law exceeded 357,000 people and was the fifth-highest in the nation, surprising experts around the country. The high enrollment was attributed to the state’s network of more than 400 navigators and 200 in-person “assisters,” and to organizers using two toll-free numbers to coordinate scheduling across the state.
Navigators and assisters are trained to explain subsidized health insurance to the public and can include nonprofit employees, hospital workers, lawyers, social service workers or retirees and other volunteers. Navigators became the focus of criticism by opponents of the Affordable Care Act, prompting some states to pass laws creating stricter training and oversight for navigators.
North Carolina lawmakers didn’t pass such legislation, even though Mountain Projects was mentioned by name for alleged misconduct in a December 2013 Congressional report entitled “Risks of Fraud and Misinformation with ObamaCare Outreach Campaign: How Navigator and Assister Program Mismanagement Endangers Consumers.”
The report said Mountain Project was illegally mailing paper applications on behalf of residents when the federal application website was malfunctioning, based on reporting by Kaiser Health News. But the news service later said its reporting about Mountain Project mailing applications was mistaken, and the applications were mailed by the applicants themselves.
A month later, National Public Radio featured a resourceful Mountain Projects navigator in a January story about enrollment efforts for the Affordable Care Act entitled “In North Carolina, Workarounds Help The Poor Find Health Coverage.”