Navigating the System: Not Enough Health Care Signup Help in Texas

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The Affordable Care Act (ACA) created a “Navigator” program launched in 2013 to provide outreach, education, and enrollment assistance to people looking for health insurance through the ACA Marketplace or Medicaid. A federal grant pays for the Navigator program in Texas.

On August 30, 2019, the Centers for Medicare and Medicaid Services announced the entities that will run the 2019-2020 Navigator program. In Texas, the following two organizations will remain the only Navigator organizations in the state:
Change Happens!, which serves the Houston, Gulf Coast area
MHP Salud, which serves Southwest Texas from the Rio Grande Valley to El Paso.

While the funding coming to Texas increased slightly compared to last year, the funding is still a fraction of what is needed and is smaller than previous funding levels. For 2019, Texas will have a mere $1.5 million available statewide compared to the $9 million awarded in 2016 and the $6 million in 2017.

Under the previous grants, as many as nine Texas organizations received funding including organizations in Austin, San Antonio, Dallas/Fort Worth, East Texas, and the Panhandle. However, even at the height of the funding, there were large portions of the state with little to no access to Navigators or other Certified Application Counselor (CAC) organizations. The devastating cuts to the program beginning in 2017, were a giant leap in the wrong direction. Access to qualified in-person enrollment assistance across the state was greatly reduced at a time when we should have been working to improve access in underserved areas.

The Trump administration’s refusal to properly fund the Navigator program hurts the many Texans who need specialized in-person assistance to enroll in the Marketplace and to keep their health insurance.

 “Research shows consumers seek help for many reasons. Most who seek help have low incomes and low insurance literacy. Many have complex income and family situations that make it more challenging to apply. Some lack internet connection at home, or limited English proficiency. Many learn through the marketplace that they are eligible for Medicaid, or [the Children’s Health Insurance Program (CHIP)], and then require help enrolling in that coverage. Navigators help all such individuals, as the law requires.”

Kaiser Family Foundation

The Trump administration should fund the Navigator program at a level which would not only ensure metro areas receive adequate funding to meet needs but also to improve access to in-person assistance in severely underserved rural areas of the state. Congress should also support legislation to adequately fund the Navigator program and improve health insurance coverage in Texas. In May, the U.S. House of Representatives passed the ENROLL Act, which included a minimum funding level for the program. The bill has not moved forward in the Senate.

Melissa joined the Center in 2015 and works remotely from Houston. She focuses on policy and practice related to outreach and enrollment for the Affordable Care Act (ACA) health insurance Marketplace, Medicaid, and the Children's Health Insurance Program (CHIP), including access to coverage for immigrants. Melissa has provided policy analysis, training, and troubleshooting guidance to health care enrollment assisters across Texas. Prior to joining the Center she worked as a Senior Policy Analyst for the Texas Health and Human Services Commission on the team that implemented eligibility changes to the Medicaid and CHIP programs required by the ACA. Melissa earned a Master of Science in Social Work from the University of Texas at Austin and a Bachelor of Science in Sociology from the University of Central Arkansas.