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No Takers For Federal Health Care 'Navigator' Grants In Montana

Navigators help people shop for health coverage on Healthcare.gov, and from other sources
Navigators help people shop for health coverage on Healthcare.gov, and from other sources

Montana won't be getting any federal money to help people find health coverage this fall. Since 2013, Washington D.C. has offered grants to non-profits to hire so-called 'navigators' who help people enroll in coverage that's required under the Affordable Care Act.

This year, no Montana organizations applied for the funding. Bozeman Daily Chronicle reporter Katheryn Houghton broke that story and joins us now to tell us more.

Eric Whitney: Kathryn, thanks for joing us on MTPR.

Katheryn Houghton: Sure thing, thanks for the invite.

EW: These federal grants to hire navigators were established by the Obama administration. president Trump is famously hostile to the Affordable Care Act, and you report there's been a big drop in the amount of money available for navigators since President Trump took office, right?

KH: Yeah, exactly. So, grant funding shrunk from roughly $63 million in 2016 to $10 million this year.

EW: Your reporting says navigator grants have been targeted at so-called "left-behind populations," people who in the past have disproportionately had trouble getting health coverage. Where were navigators typically deployed?

KH: That varies, for example in 2016 one Montana program, the Montana Health Network embeded navigators in hospitals and health clinics throughout 24 counties. Simultaneously, another organization, Planned Parenthood of Montana focused on reaching rural Montanans and Native Americans throughout 29 counties.

EW: What does the Trump administration say that less funding for navigators is necessary?

KH: CMS, which is the agency that oversees the program says that navigators are just one way that people can get help shopping for coverage, and that's true. CMS has also said that, as the marketplace has evolved, there's more awareness around peoples' options, and people on the ground say to some extent that is true. But, tracking polls show that most people who don't have insurance at this point are still pretty disconnected from the hoops around enrolling for coverage.

EW: You mentioned that Planned Parenthood has done navigator work in Montana in the past, and they were one of several non-profits that received grants to provide navigators, those include the Montana Primary Care Association, the Montana Health Network out of Miles City, as well as Planned Parenthood of Montana. Your report says this year none of those organizations applied. You talked to someone at Montana Planned Parenthood about why they chose not to, what did they tell you?

KH: Planned Parenthood of Montana has been the longest standing navigator program in the state, even as others dropped out they were still there last year, and they say that on top of the cuts, new federal rules make it unethical to take the job.

For example, some of those rules pushed navigators to list short term insurance plans as an option for people shopping for coverage. Those plans are typically less pricey, and they're designed to cover temporary coverage gaps. But they also don't have to follow Affordable healthcare Act regulations, meaning they can reject people with an illness or limit their coverage, and for a lot of providers, Planned Parenthood of Montana included, they're considered risky.

The rules also required grant applicants to inform people of their option not to purchase plans that cover abortion services, and the spokesperson I chatted with with Planned Parenthood said the fact that they would have to hold out a plan that didn't cover a safe and legal medical procedure felt unethical.

Katheryn Houghton writes about health for the Bozeman Daily Chronicle. Here's a screen capture of the Chronicle story, September 13, 2018.
Credit Bozeman Daily Chronicle
Katheryn Houghton writes about health for the Bozeman Daily Chronicle. Here's a screen capture of the Chronicle story, September 13, 2018.

EW: So, Planned Parenthood declined to apply for the grants this year because they would be required to help people find plans that didn't cover pre-existing conditions and didn't cover reproductive health services, including abortion, is that right?

KH: Yes, that and on top of two years in a row of shrinking grant funding.

EW: In your story you also talked to a couple of people with Community Health Partners, which has clinics for low income people in Gallatin and Park counties. They said that there are still people out there who can help people in Montana find coverage. Do they feel like not having navigators, though, is going to be a big loss?

KH: Well, for starters, no navigators mean that counselors won't have a place to refer complicated cases. Navigators had typically had more training involved and more requirements for their title, and that means that stretched-thin places will have to spend more time connecting people to coverage. I talked to a gal at Community Health Partners who said that, honestly, connecting somebody to coverage means sitting in front of a computer for an hour or two and walking through how that happens and what their options are.

And the counselors I heard from also said that they'll do their best to get the word out, but any time such a rural, spread out state such as Montana loses resources it's not a good thing. If those navigator positions aren't replaced, those are fewer people working to connect Montanans to coverage.

Eric Whitney is NPR's Mountain West/Great Plains Bureau Chief, and was the former news director for Montana Public Radio.
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