By John Reichard, CQ HealthBeat Editor
August 15, 2013 -- The grants totaling $67 million that the Department of Health and Human Services announced last week to help educate people about their new coverage options will go to 34 states that frustrated architects of the overhaul by declining to set up their own insurance exchanges.
The health care law (PL 111-148, PL 111-152) generously funds outreach grants to other states—those that chose to set up their own exchanges. Drafters of the overhaul did not anticipate that so few states would create their own marketplaces, however, so they made relatively little provision in the law's mandatory funding provisions for states that decided to let the federal government operate exchanges, in whole or in part, for their residents.
That means the 34 states in that category won't get much federal money to help people get in-person assistance with understanding their coverage options when insurance expands in 2014 under the health care law, including help with finding out whether they qualify for subsidies and how to apply for them.
Although a relatively small amount, the $67 million announced was a bit more than expected. HHS originally said it would award only $54 million in so-called navigator grants.
The 105 organizations receiving the money include Ascension Health, the nation's largest Catholic nonprofit health system; Samford University in Alabama; the University of South Florida; the University of Georgia; a coalition of 11 Missouri health care and social service organizations; the Baptist Church Ministries in Mississippi; the University of Mississippi Medical Center; and an association of food banks in Ohio.
United Way organizations in Texas, one of the states most resistant to the health care law, will receive $6.5 million in navigator grants.
"Navigators are trained to provide unbiased information in a culturally competent manner to consumers about health insurance," the exchanges, Medicaid and the Children's Health Insurance Program, according to an HHS news release. "Navigators will be required to adhere to strict security and privacy standards—including how to safeguard a consumer's personal information," the release said.
During a telephone press briefing to announce the grants, an HHS official said she could not disclose how many organizations actually applied for the grants, but she said the response was "robust." She had no estimate of the number of people who would be trained with the grant money. Training would begin later this month, she said.
Republicans critical of the health care law are casting doubt on the navigator program. They say it will put people at risk of identity theft. Rep. Diane Black, a Republican from Tennessee, said that navigators won't have to have a background check to get access to sensitive taxpayer information. And "even worse" are hundreds of thousands of dollars in grants to Planned Parenthood affiliates "despite assurances from the President when the law was passed that Obamacare would not give federal funding to abortion providers." Black has introduced a bill (HR 2087) to prevent funding of the Navigator program.
Navigators won't get adequate training, attorneys general from 13 states wrote in an Aug. 14 letter to HHS Secretary Kathleen Sebelius. They also complained about the issue of background checks, though unlike Black they did not say there would be none but rather that they would not be "standardized."
The AGs' letter also suggested that HHS has cut back the number of hours of required training for navigators from 30 to 20.
A final rule on the navigator program lacks specific standards for training navigators to ensure data privacy, according to the letter. It was spearheaded by West Virginia Attorney General Patrick Morrisey, a former GOP staffer on the House Energy and Commerce Committee. The other AG signers are from Louisiana, Alabama, Michigan, Florida, Montana, Georgia, Nebraska, Kansas, North Dakota, Oklahoma, Texas and South Carolina.
House Energy and Commerce Committee Republicans complained that the timing of the grants leaves "a short training window for the navigators."
HHS also released the names of 113 organizations designated as "Champions for Coverage" that have volunteered to help inform people about new insurance exchanges and coverage options.
"They will be doing many things," said Anton Gunn, director of external affairs at HHS. Among them are posting widgets to their websites linking people to healthcare.gov, the site where people can see coverage options and sign up for plans; providing numbers of call centers; distributing posters and fact sheets about insurance exchanges; and hosting webinars and conference calls for their members.
The 113 organizations include the American Medical Association, the American Nurses Association, the American Hospital Association, the Federation of American Hospitals, the American Academy of Pediatrics, the NAACP, the National Council of Jewish Women, the National Baptist Convention and Lutheran Services in America.
In response to Black's charge that there would be no criminal background checks in the navigator program, an HHS official said background checks are not a statutory requirement but some organizations perform them and some states have laws requiring them for navigator programs. The official added that HHS may terminate grants for noncompliance, including fraud, waste, or criminal activity. Grantees have gone through a strict selection processs, the official added.
Chiquita Brooks-LaSure, deputy policy director at the CMS Center for Consumer Information and Insurance Oversight, said during the press briefing that HHS never said navigators would have 30 hours of training but rather that they would get up to that amount. She said there would be 20 hours of initial training and additional training later, thus explaining the department's statement that navigators would receive 20 to 30 hours of training.