Navigators to receive $190 per enrollment from Covered California

Covered California has award $17.1 million dollars to 66 organizations to be known as Navigators to enroll 93,467 individuals from October 2014 to June 2015. The average cost per enrollment for the Navigator program is $190 per person with some Navigators receiving as much as $435 per enrollment. For each additional 100 enrollments above the Navigators goal, they will receive an additional $7,500.

$17.1 million in Navigator funding

From the Executive Summary of the Navigator Grant Funding Announcement Report presented at the September Board meeting the highlights of the program were covered.

Executive Summary

On June 19, 2014, the California Health Benefit Exchange Board approved $16.9 million to distribute in grants to eligible entities through a competitive grant application process. A total of $14.65 million was allocated to provide grants to community organizations to reach an estimated 100,700 new Covered California subsidy eligible consumers. An additional $2.25 million was allocated for a bonus pool that is estimated to reach an additional 30,000 Covered California subsidy eligible consumers. Grantees who meet their enrollment goals would be eligible for a $7,500 bonus payment for each additional 100 effectuated enrollments.

Covered California selected 66 organizations for funding, which includes an additional 161 subcontractors. Navigator Grants total $17.1 million, which includes $14.65 million in new Navigator funding and $3 million in roll over funding from the Outreach and Education Grant Program for the 18 Outreach and Education Grantees that are receiving Navigator grants.

The 227 organizations selected to participate in the Navigator Program are estimated to enroll 93,467 individuals in Covered California Health Plans. The selected Grantees will reach consumers in 13 languages which include: Arabic, Armenian, Chinese, English, Farsi, Hmong, Khmer, Korean, Laotian, Russian, Spanish, Tagalog and Vietnamese. Many of the selected Grantees have proposed to provide services to multiple populations.

Medi-Cal enrollments not included

The Navigator Grant Funding Announcement, available for download at the end of the post, covered not only who received the awards, but the location, types of grantees, and the minority populations targeted. The Navigator enrollment goals are for Covered California tax subsidized health plans. Medi-Cal enrollments will not counted toward meeting their goal. Consequently, we can expect Navigators to be aggressive in marketing to populations served by Certified Insurance Agents. Included in the Navigator awards is a certain portion of the funds to be used for marketing such as radio, TV, billboards and print media.

Recipients of the largest Navigator grants

Recipients of the smallest Navigator grants

Great marketing tool for associated products

Five tax preparation companies received $850,000 in grant money. The largest grant to a tax preparer went to Kelly Rolfe Financial Services. These companies will not only be paid to enroll people they will be able to market their other services and build name recognition along the way.

25% allowance for over-head

Covered California will allow the Navigator to spend the grant money within five different categories. There are specific maximum percentages for each expense category. If we apply the expense funding allocation tothe total grant amount of $17,724,796 we get the following maximum expenditures for the total Navigator program.

No MLR for Navigators

Its interesting to note that the health plans must spend no more than 20% of their premium revenue on non-health care related services such as administration, profit, and marketing under the Medical Loss Ratios established by the ACA. Navigator will be able to spend 50% of their funds on non-enrollment activities.

Navigator oversight?

The presentation to the Covered California Board did not mention how the Navigators will be monitored beyond their enrollment goals. We dont know if they go outside their target population and enroll individuals and families in another Navigators demographic if they will be penalized. Either way, look for lots of marketing during open enrollment from these Navigators and their contractors.