CMS Announces Cuts to ACA Navigator Program

The Trump administration will slash funding to the Affordable Care Act (ACA) navigator program to $10 million from $98 million, according to a CMS news release. This release states that this will reduce spending on Federally-facilitated Exchanges (FFEs) and in turn lower FFE premiums by $360 million over the next four years, but an outside expert says this move will also leave thousands of Americans confused about their healthcare coverage. Changes will take place in the states with FFEs for the 2026 plan year.

“A majority of Americans get health insurance through their jobs and millions have never had to enroll in a plan on their own - not so for people who do not have the luxury of an employer plan and must buy coverage on their own,” Sara Collins, senior scholar and vice president of Health Care Coverage and Access at The Commonwealth Fund said in an email to Managed Healthcare Executive. “This is the point of the navigator program. Its value cannot be boiled down to a simple statistic of federal funding divided by marketplace enrollee since navigators also help inform people about Medicaid and employer coverage they might be eligible for and assist people throughout the year with claims and billing issues.”

The current administration argues that the navigator program was wasteful, according to the release, posted last Friday. During the 2024 plan year, the navigator program had a $98 million budget and enrolled 92,000 members at a cost of $1,061 per enrollment. In 12 of the 56 navigator grantee organizations, the average cost per enrollment was more than $3,000. Examples of 2024 navigator organizations include the Ohio Association of Food Banks, Great Plains Tribal Chairmen’s Health Board and the Legal Aid Society of Hawaii, the release reads.

Additionally, despite a difference in budget, gators enrolled the same number of consumers through federally facilitated exchanges – 0.6% - in 2024 with a $98 million budget and in 2019 with a $10 million budget, the release continues.

Navigators have been a part of the ACA since 2013. During his last term, President Donald Trump decreased spending in 2019 from $36 million to $13 million. Each year, CMS grants money to organizations to enlist them as navigators who then guide healthcare customers during Marketplace enrollment, answering questions about eligibility and affordability. Navigators also provide outreach and educate uninsured communities.

The release states that the current navigator performance data does not represent a reasonable return on investment to justify the amount of federal funding they receive.

“The U.S. has an incredibly complicated health insurance system,” Collins continued. “Providing people with the help they need to enroll in plans they are eligible for and use those plans effectively is critical to realizing the full value of the coverage they are investing in.”