Balancing Financial Adjustments & Patient Care Amidst Recent Cuts to the Federal Navigator Program

On February 14, CMS released a statement announcing cuts to the Federal Navigator Program. These cuts highlight the Trump administration's broader efforts to reduce federal spending on healthcare programs, which will negatively affect patient care and the financial stability of healthcare systems across the country.

The CMS Federal Navigator Program is an initiative designed to aid individuals seeking health insurance coverage through the Health Insurance Marketplace through Federally-Facilitated Exchanges (FFEs). Navigators offer free, unbiased help with understanding healthcare options, applying for coverage, and understanding eligibility for financial assistance. This program aims to improve access to health insurance and help consumers make informed decisions about their healthcare options. Revenue cycle leaders will need to adapt to the changes in enrollment patterns and understand the broader impact on reimbursement models while prioritizing access to free and affordable healthcare.

Reduced Navigator funding could lead to fewer enrollments in health plans through the FFEs, affecting the number of patients covered by marketplace insurance and altering payer mix. This shift may require mid-revenue cycle leaders to closely monitor enrollment patterns and adjust revenue projections. While lower premiums might benefit individuals without subsidies, those relying on subsidies could face higher out-of-pocket costs, impacting their ability to afford care. Healthcare providers will need to adapt billing and collections strategies to account for fluctuations in premiums and subsidies, while also managing potential changes in reimbursement rates. To navigate these challenges, providers may need to invest in patient education, outreach, and additional support staff to assist with the enrollment process and handle increased claims-related inquiries.

In addition, the recent reduction in funding for the ACA Navigator program has several implications for low-income families, particularly those who rely on the assistance Navigators provide to access affordable health insurance. The reduction in funding for the Navigator program will make it more difficult for low-income families to access enrollment assistance, creating barriers that could result in missed opportunities or coverage gaps. While some individuals may benefit from lower premiums, those relying on subsidies will likely face challenges navigating changes in the marketplace, which could lead to confusion and increased out-of-pocket costs if they select the wrong plan. Without the personalized support Navigators provide, families may turn to less effective resources, exacerbating stress and potentially worsening health disparities, ultimately impacting long-term health equity and outcomes for low-income individuals.

Mid-revenue cycle leaders can take proactive steps to prepare for the changes in the ACA Navigator program while ensuring that patient care for low-income households remains a priority.

1. Strengthen In-House Patient Support Services

Given the reduced funding for Navigators, mid-revenue cycle leaders can enhance in-house support services to help patients navigate the enrollment process. This can include:

• Hiring or training dedicated enrollment assistance staff: Building a team that can assist low-income families with enrollment, understanding coverage options, and verifying eligibility for subsidies or plans.
• Expanding patient education initiatives: Offering workshops or one-on-one consultations to educate patients on health insurance options, eligibility for subsidies, and plan selection.

2. Partner with Local Community Organizations

Since Navigators historically worked closely with local organizations, mid-revenue cycle leaders should consider forming partnerships with trusted community-based organizations that already serve low-income populations. These partnerships can help ensure families continue to receive the help they need in understanding and accessing coverage options and could include:

• Collaborative outreach programs: Leveraging existing community networks to disseminate information about open enrollment, new subsidies, and ACA updates.
• Shared resources: Working with nonprofit organizations, churches, and other local services to provide enrollment guidance and ensure low-income families aren’t left without support.

3. Implement Streamlined Enrollment Processes & Leverage Technology

To help reduce barriers, mid-revenue cycle leaders can streamline their own enrollment and registration processes for low-income patients. By making the process easier to navigate and embracing streamlined technology, healthcare organizations can minimize the confusion that might arise due to fewer available Navigators. This can involve:

• Simplified documentation and dedicated enrollment windows: Simplify documentation and verification with self-service tools, pre-populated forms, and assistance, while offering flexible enrollment windows to accommodate patients' work and daily schedules.
• Automated reminders and enhanced online tools: Ensure your patient portal includes user-friendly tools for browsing insurance options, checking subsidy eligibility, and enrolling in ACA plans, while using automated reminders and follow-ups to keep patients on track with deadlines and required documentation.

4. Monitor and Adjust Payer Mix and Reimbursement Strategies

As changes to ACA enrollment and funding affect the payer mix, mid-revenue cycle leaders should closely track and forecast shifts in their patient population. By keeping a close eye on the financial side, mid-revenue cycle leaders can help their organizations remain financially stable even if enrollment numbers shift.

Preparing for the potential drop in enrollment via the Navigator program means:

• Reassessing payer contracts: Ensure that reimbursement rates align with changes in patient demographics, including any shifts between subsidized and unsubsidized patients.
• Planning for financial impacts: Work closely with finance teams to account for potential reductions in subsidies and how this might impact overall revenue.