CAPs critical to Navigator success

July 23, 2013

We have not talked much about the federal health care law’s Consumer Assistance Programs (CAPs), but they are key to helping Navigators deal with tricky insurance problems and questions – something families who have children with serious emotional challenges know only too well and will likely face as they sign up for health insurance under the Affordable Care Act.

This past week Elizabeth Warren (D-Mass.) and nine other US Senators sent a letter to HHS Secretary Kathleen Sebelius pointing out the critical role these programs will play in open enrollment this fall and advocating for the extension of funding for these programs which are currently scheduled to expire in August.

CAPs are up and running in 22 states now. They had about $20 million in federal funding last year. In an interview with Politico, Christine Barber, senior policy analyst at Community Catalyst, which works closely with groups assisting in the health care law’s outreach said that “HHS is the only source of funds for some of the programs, which may be forced to close if the funding isn’t renewed, she said, and others are working to cobble together alternative funding on their own.” She went on to say that “CAPs also help with general outreach but are in the law as the places navigators would refer people to for help with more complex issues.”

Here is the text of the letter to Secretary Sebelius from the group of US Senators that details the critical need for these programs:

  • Dear Secretary Sebelius,

    We write to request that the Department of Health and Human Services (HHS) continue to fund state Consumer Assistance Programs (CAPs) for the remainder of2013—these grants are currently set to expire in August 2013. This fall, a lapse in CAP funding will deplete these vital programs of necessary resources, just as our nation implements the enrollment provisions ofthe Affordable Care Act (ACA).

    CAPs are already playing a particularly important role for consumers who need assistance with health care coverage, navigation and billing. Without continued funding, programs in as many as 23 states could begin to close this August—precisely at the moment when they are most needed.

    Although the Navigator program and other entities will provide certain consumer assistance functions beginning in October, there are numerous functions performed by CAPs which will not be duplicated.

    Underthe ACA, Navigators are required to provide “any enrollee with a grievance, complaint or question regarding their health plan, coverage or a determination under such plan or coverage” a referral to his or her local CAP (ACA § 131l(i)(3)(D)). Absent on-going financial support for CAPs, it is unclear where Navigators will refer enrollees who have problems with their coverage or accessing particular health services after September 2013.

    CAPs are uniquely positioned to assist consumers with appeals of Health Insurance Marketplace eligibility decisions and health plan coverage determinations. The CAPs inform both employers and employees about their rights and assist them with health insurance enrollment, utilization and dispute resolutions, all services which will be in even higher demand when the exchanges become operational in October 2013. Finally, CAPs will contribute to the success of the ACA by rapidly identifying common implementation problems so that policy makers are able to more promptly resolve them.

    Altogether, CAPs have provided a critical lifeline for hundreds of thousands of consumers in need of assistance with health care coverage issues. They are already a trusted source of information for many consumers, and their value will only increase as enrollment in the Health Insurance Marketplaces begins.

    We recognize that there are many important demands on the HHS budget as ACA implementation moves forward. However, supporting CAP services can make a tremendous difference in ensuring a smooth launch ofthe Health Insurance Marketplaces and other ACA programs. We urge you to continue their funding when current grants end in August 2013.

  • Download a copy of the letter here.
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