The Impact of Healthcare Navigator Funding Cuts in Texas

Dr. Kenneth Goodgames is searching for alternate funding to continue Community Services’ work with healthcare navigation.

The state of Texas has 4.8 million adults who don’t have health insurance, or about 17.3 percent of the population. That ranks the state dead last in the country in insured adults, according to Community Services. As a part of the Affordable Healthcare Act, the Centers for Medicare and Medicaid Services awards grants to organizations called navigators, who help uninsured Americans work through the healthcare exchanges in each state. But since 2013, the funds for those navigators have decreased by more than 80 percent in Texas, which also voted not to expand medicare.

In 2013, CMS awarded more than $10 million to eight organizations across Texas, with Dallas County one of the many counties that were covered by these navigators. By 2017, that number had been reduced to just over $6 million. For this year’s enrollment period, which extends through Nov. 1, there are only two organizations funded less than $2 million in the Lone Star State. Dallas County is not one of the counties included in this year’s grant recipients coverage areas.

Nationwide, CMS awarded $10 million to 39 navigator organizations this year, an 84% reduction compared to 2016. “We are committed to making sure that consumers have a positive experience. The grants announced today mark a new direction for the Navigator program aimed at providing a more cost-effective approach that takes better advantage of volunteers and other community partners,” said CMS Administrator Seema Verma via media release.  “This new direction will increase accountability and ensure the grants are effective in helping consumers find health coverage that meets their needs. We will continue to monitor the impact of these changes with the primary goal of ensuring consumers have the resources to select a health plan that best fits their needs.”

Organizations applying fro CMS funding were encouraged to partner with public and private organizations in their community, provide more targeted outreach to vulnerable communities, utilize technology, and to be more cost-effective.

One of the unfunded navigators this year was Community Council, a 76-year-old community services organizations that helps connect providers with needs and promotes awareness of access to services. Last year, they received a grant of $1.2 million.

Community Services CEO Kenneth Goodgames says that eight out of 10 individuals can be insured for around $75 a month, but that vulnerable communities without access to or knowledge of technology need assistance accessing the healthcare exchange to get insurance. He says the organization helped 3,000 people find health insurance last year through one-on-one meetings and classes where uninsured Texans were walked through the insurance registration process.

The Kaiser Family Foundation reports that in 2013, the cost of uncompensated care provided to uninsured individuals was $84.9 billion, and $53.3 billion was paid to healthcare providers to help pay for that shortage. Most of this funding comes from the federal government, with $19.8 billion paid by states and local municipalities.

Goodgames says the loss of funding will cause them to make some difficult decisions about staffing and offering services, but that they are looking for alternate funding sources. They hope to raise $1.2 million to provide healthcare enrollment services to 56 counties and 1.5 million people in Texas.

“As an organization we are going to do what we can do,” Goodgames said. “We are still going to do the work and somehow it is going to be what it is going to be.”

CMS has not responded to inquiries, but we will update the story if they do.