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Affordable Care Act Outreach Remains Spotty in Some Parts of NJ

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With seven weeks to go until the March 31 deadline for state residents to buy health insurance or face federal tax penalties, gaps remain both in the outreach effort to let people know about the new federal health insurance marketplace and in the programs to enroll them.

One of the largest gaps: six New Jersey counties that did not receive federal funding for so-called Navigators, organizations that get the word out about ACA coverage and help residents sign up for what they need.

The problem can be traced back to Gov. Chris Christie's decision to rely on a federally run marketplace, rather than setting up a state-operated system, which severely limited the state from qualifying for federal funds that can be used for outreach.

What makes the situation particularly frustrating for healthcare advocates is that federal money may be available. The feds originally gave New Jersey $7.67 million to build its own exchange, but when the administration opted not to, the funds were off the table.

Or are they? State and federal officials are deadlocked over how to use the money -- which must be spent by February 22.

Somerset County's Uninsured

Meanwhile, Somerset County’s estimated 26,732 uninsured residents aren’t directly served by either of the two largest federally funded Navigator organizations. The federal government selected the initial Navigators, since the state has avoided any involvement with the marketplace.

In fact, none of the five organizations that were awarded contracts under the federal Navigator program have been assigned to Somerset or five other counties -- Hunterdon, Middlesex, Passaic, Sussex, and Warren.

That means Somerset residents must travel to a neighboring county to receive assistance at a federally qualified health center.

Healthcare advocates say that other nonprofit organizations have stepped in to partially fill these gaps. They noted that the federal government has hired two additional firms to assist with insurance applications, and that the work of volunteers and other organizations means that there are enough people to assist uninsured residents through the enrollment process.

There are a total of 175 offices in the state that provide assistance to residents looking to enroll, including organizations that operate multiple locations.

But advocates are concerned that not enough residents may ever learn that assistance is available. They are strongly urging the state Department of Banking and Insurance to spend $7.67 million on outreach.

That would be in addition to the $2.02 million available through federal Navigator grants for enrollment assistance.

Had Christie opted to build a state exchange, even more money would likely be available. For example, the feds awarded New York $27 million in grants to 50 organizations to provide in-person insurance assistance to people in all of the state's 62 counties.

New Jersey's $2.02 million, in contrast, only paid for Navigators in 15 of its 21 counties.

When he chose not to build a state exchange, Christie cited potential costs to the state.

Gaps in Coverage

“Some of us were a little surprised that there were some gaps” in the geographic coverage provided by the Navigator grants, said Raymond J. Castro, senior policy analyst for New Jersey Policy Perspective.

Maura Collinsgru, health policy advocate for New Jersey Citizen Action, noted that federal contracts with information technology companies Cognosante and SRA International have supplemented the Navigator grant recipients. Cognosante has an office in the Basking Ridge section of Bernards Township, Somerset County, while SRA International is operating an office in Wayne, Passaic County. Both counties aren’t served by a federally funded Navigator.

“That’s been a big boost in the supply chain,” Collinsgru said.

In addition to the Navigators, the federal government funded $5.18 million for the state’s 20 federally qualified health centers to assist with enrollment. Other organizations, such as hospitals, have offices where residents can receive help from certified applications counselors, although some of these organizations didn’t receive federal funding.

Collinsgru said her largest concern is that residents won’t be aware of the help that’s available before it’s too late for this year. Residents must have insurance by March 31 to avoid paying a penalty when they file their 2014 income tax return by April 2015. Open enrollment for the marketplace will open again on November 15.

Through December 28, nearly 35,000 state residents enrolled in a health plan through the marketplace, while more than 70,000 have learned through the marketplace that they’re eligible for New Jersey FamilyCare, the state’s Medicaid program.

On Track or Falling Short?

While that may put the state on track to reach a federal target of 96,000 marketplace enrollees by March 31, it would still leave many New Jerseyans without insurance. The Kaiser Family Foundation has estimated that 628,000 state residents are eligible to purchase insurance through the marketplace, with 400,000 of those qualifying for federal subsidies to help defray costs.

“At this point, I feel like the capacity is there” in terms of organizations assisting residents, Collinsgru said. “What’s lacking is awareness.”

Collinsgru noted that the state could use $7.67 million increase public awareness. State and federal officials have been in talks for nearly a year over the funding. If the two sides don’t agree on how the money will be spent, it will revert to the federal government.

Uninsured residents “don’t have the information about what’s available and there’s no effort on the part of the state to make that happen on any sort of broad scale and that’s a problem,” Collinsgru said, adding: “Largely what we’re hearing from the assisters is they are not full all day, every day.”

Collinsgru said the remaining task is a matter of “connecting the dots -- connecting the resources and the people it. What you need in New Jersey is clearly a grassroots campaign to make that happen.”

She expressed frustration that the state hasn’t matched its effort to work with federal officials to enroll residents newly eligible for Medicaid with a similar push to coordinate enrollment in the marketplace. This reflects Christie’s decisions early last year to agree to the Medicaid expansion but to leave marketplace enrollment to the federal government.

A spokeswoman for the federal Centers for Medicare and Medicaid Services said the Navigator program is similar to the Medicare counselor program, adding that the Navigator grant recipients are “one more resource for Americans to learn about their options.”

CMS officials noted that despite the absence of Navigator organizations in some counties, there is at least one organization offering in-person assistance with marketplace enrollment in every county in the state, and that residents wouldn’t have to travel farther than to a neighboring county to meet with a Navigator grant recipient. Residents can find assistance at the federal marketplace website.

CMS officials noted that Navigator applicants were assessed by objective review panels and received a score based on their ability to meet federal criteria, including the organization’s expertise and track record working with underserved populations. The Navigator organizations must file quarterly and annual financial reports with the CMS, which will be monitoring their work to ensure that they’re meeting requirements.

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