Vermont’s free clinics say a reduction in state funding to help people sign up for health insurance could force the state’s rate of uninsured people to go up in 2018.
Laura Hale, the executive director of Vermont Coalition of Clinics for the Uninsured, said the state has lowered funding for Vermont Health Connect navigators from $200,000 in fiscal year 2017 to $50,000 in the current fiscal year.
That’s one-tenth of the $500,000 per year that Vermont Health Connect spent on navigators in previous years, according to Hale. But despite the budget cuts, she said there are still Vermonters who need access to navigation services.
Navigators are people the state trains to help members of the public sign up for commercial insurance or Medicaid through Vermont Health Connect. Navigators have historically been staff members for places like hospitals, local free clinics, and Planned Parenthood.
The federal government required states to have navigators when the exchanges first started in late 2013, early on in the Affordable Care Act, but the federal government no longer requires them. The state has funded navigators since the federal government stopped requiring them, but has been phasing them out.
“It’s been slashed pretty much every year for the last couple years,” Hale said. “I understand there should be less and less uninsured to get navigated, but the issue is that now the people” will need to go through the insurance enrollment process on their own.
Hale said seven of the free clinics in her organization used to have Vermont Health Connect navigators on staff. This year, she expects a maximum of two clinics—in Bennington and Springfield—to have navigators.
“What we were doing was the intense follow-up to get people through the system when there were any sort of issues,” Hale said. “I think fewer people will be able to get through the Vermont Connect insurance process” without that follow-up.
The open enrollment period for the 2017 plans was one the of the busiest that her team has ever had. She said the Legislature should have level-funded Vermont Health Connect navigators going into the 2018 open enrollment period.
Open enrollment for Vermont Health Connect for the 2018 plan year starts Nov. 1 and runs through Dec. 15. The open enrollment period is six weeks shorter than in previous years. President Donald Trump’s administration made the decision to shorten it.
Trump’s administration has also lowered spending on national outreach to encourage people to sign up for health insurance during open enrollment, and decided to allow people to file their tax returns without paying the Affordable Care Act’s fine for not having health insurance.
Trump has also personally threatened on Twitter to stop making payments that help low-income people afford coverage. That would affect 13,000 people, including an individual making between about $17,000 and $30,000 a year, or a family of four making between $34,000 and $62,000.
“We’re on our way into an open enrollment period that’s significantly shorter than previous open enrollment periods, so the combination of a six-week open enrollment period with fewer supports in the community is of course concerning,” said Mike Fisher, the chief health care advocate for Vermont Legal Aid.
He said of Vermont Health Connect navigators: “There’s a set of people across Vermont who really need somebody to sit down to help them understand the decisions about how to apply for health care.”
Cassandra Gekas Madison, who handles eligibility and enrollment for Vermont Health Connect, said states across the country have been cutting back on the number of in-person navigators they fund and instead training application counselors, who do not get money from the state.
Madison said while the navigators help the general public access health insurance, application counselors take online seminars to help their own organization’s clients apply for health insurance.
“Relying on trained individuals within embedded organizations … is one of the most effective ways to do outreach around Vermont Health Connect,” Madison said.
“From our perspective, we want everybody that’s interacting with someone who may need health coverage in the state to have training as a certified application counselor,” she said.
Peter Youngbaer, a former Vermont Health Connect navigator who runs the People’s Health and Wellness Clinic in Barre, said it’s not enough for clinics to help only their own patients. He said more than half of the people his clinic helped in fiscal year 2017 were members of the general public.
Youngbaer said navigators work with people who aren’t computer savvy, who don’t have a computer, who may not be able to apply by phone because of a lack of cell phone service, or who may only use temporary cell phones with limited minutes available.
Others have complex situations, he said, or need a navigator to help fill out parts of the form differently from instructed because of technical problems. “It takes someone who’s savvy and trained to help through the process,” Youngbaer said.
He used the example of an adult with children who gets divorced and then remarried to another person with children, creating a mixed family, where the adult may not be sure which parent should sign up for health insurance for which children.
To compensate for a glitch in the website, Youngbaer also said he has routinely told users who are going to lose their health insurance at a future date to write in the form that they will lose their health insurance immediately.
That’s because the system does not work if people put in a future date as opposed to the current date, he said. Without that work-around, the person could lose their health insurance for a month, he said.
If instructed to do the work-around without in-person guidance from a navigator, the person may not want to do it, because the application requires the applicant to sign their name attesting under penalties of perjury that there is no false information in the application, Youngbaer said.
“There are many things that remain non-intuitive about that site, and so … people will continue to need assistance, and now there is no statewide navigation (program) out there,” Youngbaer said.
“They’ll give up if assistance isn’t there, and they’ll go uninsured,” Youngbaer said.
Madison said the plan would not reduce the number of people who have health insurance. She said the state is confident with the plan for Vermont Health Connect enrollment that her team put together.
“I don’t think that we would have made the decision that we made to switch the program if we thought it resulted in fewer people being insured,” Madison said.