Grants for Obamacare's 98 navigators, organizations that help people with enrollment and other medical questions, expire Friday, and some groups fear they will have to put preparations for open enrollment on hold if they don't get word on funding soon.
The deadline comes a day after the Trump administration announced it will cut navigator grant funding by nearly 40 percent for 2018 as compared with 2017, and that funding will be given based on how many people a navigator signs up.
The Department of Health and Human Services has not returned a request for comment on when it will send out navigator grant awards for 2018. Given that uncertainty, navigators are putting any activities on hold after Friday.
"It's full stop for us," said Shelli Quenga, director of programs for the Palmetto Project, a statewide nonprofit in South Carolina that receives navigator grants. "There isn't other funding available in our organization right now to just switch everybody to say ‘hey we can pay you off of this money instead.'"
"We're in financial limbo hell," she added.
The navigator Florida Covering Kids and Families at the University of South Florida "can't do much of anything," said director Jodi Ray. The navigator is the biggest in the country and got $5.4 million in grant funding this past year.
She said if she doesn't get the award letter outlining funding for the 2018 open enrollment grant period, she will have to put training new navigators on hold. The navigator had also planned to start scheduling public service announcements on Saturday for Obamacare's open enrollment.
Quenga said she got permission from HHS to dip into her 2018 funding to pay for reservations at booths at local events.
"Sometimes you lose your slot and can't get a booth at a particular event," she said, using an example of a fair or other community event to perform outreach.
It isn't uncommon to get a late notice on the grant awards. Quenga said she got a grant award letter for the latest grant period on Sept. 2, after the grant expired last year on Sept. 1. But she said that she hasn't heard back yet from HHS about the timing of the new grant award letter.
Navigators also need to know how much funding they will get under the new performance formula that the Centers for Medicare & Medicaid Services will use to determine funding.
HHS announced a new funding formula that gives out funding on the basis of how well a navigator meets its enrollment goal. For example, if a navigator met 100 percent of its enrollment goal for the 2017 coverage year, then it gets the same amount for 2018, but if it only got 70 percent then will get 70 percent of its 2017 funding.
HHS officials said Thursday the reason for the cuts and new funding formula is to improve efficiency in the program and said too much money was going to navigators that didn't sign up enough people.
But navigators chafed at the criticism, and some said the law specifically calls for navigators to do activities beyond just enrollment.
Quenga said her navigator is required to help anyone who comes through her doors, whether it is for non-Obamacare related items such as a Medicaid referral or Medicaid application.
"We answered 79,938 inquiries in the past 12 months," she said. "We know the legal role of navigators is much broader than just enrollment in a qualified health plan."
Some navigators also plan to boost marketing and advertising efforts, anticipating that the federal government would cut ad funding for the 2018 open enrollment. HHS announced Thursday it was cutting Obamacare ad funding by 90 percent from $100 million for the 2017 open enrollment period to only $10 million for 2018.
Ray said navigators provide education with consumers on how to use health insurance, check if they qualify for financial assistance, help understand drug formularies and other assistance.
"Enrollment is important, but it is not the only important role," she said.