Most Covered California 2015 Navigators failed to meet enrollment goals, but still collected 50% of their grant award.
A review of Covered California Navigator enrollment and payment data for 2015 reveals that a majority of organizations awarded grant money to enroll individuals and families in qualified health plans failed to meet their enrollment goals stipulated in the grant award agreements. Fifty-five of the Sixty-five organizations listed that received Navigator grants failed to meet their enrollment targets. Some of the organizations enrolled as few as 5% of their enrollment goal and were still able to collect 50% of the total grant award. The cost to enroll a single individual in a Covered California health plan through the Navigator program was as high as $3,000 for some of the Navigators grantees.
A brief overview of the Covered California 2014 – 2015 Navigator grant program.
2014 Grant Announcement
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. – Navigator Grant Award Announcement Executive Summary
2015 Navigator progress payments tied to enrollments
A Navigator grantee would only realize the full amount of the grant if they met or exceeded their enrollment goal based on the assigned enrollment target in their agreement. Progress payments were made to the Navigators quarterly based on effectuated enrollments. (An effectuated enrollment is one where the individual or family selects a health plan and makes their first binder or premium payment to put the health plan into effect). Grantee organizations were allowed to spend certain percentages of their award on administration, equipment, marketing, enrollment activities and post enrollment consumer support. (See Covered California approves Navigators soliciting health insurance). Only enrollments in Covered California Qualified Health Plans eligible for the Premium Tax Credit were counted. Medi-Cal enrollments did not count.
Some Navigators enrolled less than 20% of goal, received 50% of grant money
Out of sixty-five organizations receiving Navigator grants, fourteen of those entities did not succeed in enrolling over 20% of their enrollment goal. Yet, all of these organizations, with the exception of University of Southern California, received 50% of their original grant award. University of Southern California (USC) was the worst performer of all grantees. They were awarded up to $100,000 to enroll 700 individuals. USC enrolled just 13 people, or 2%, but they received 25% of their original grant award.
Cost per enrollment over $2,000 for some Navigators
The cost per enrollment for the USC final $25,000 grant payment was $1,923.08 ($25,000 divided by 13 individuals). But USC didn’t have the highest per individual enrollment cost. That dubious honor goes to the California Council of Churches with an enrollment cost per individual of $3,022.73 for 22 enrollments based on total grant payments equaling $66,500.00. Second place for the most expensive Navigator enrollment goes to Bienestar Human Services, Inc. who enrolled 63 people at an average cost of $2,724.02 based on final grant payments of $171,613.50.
| 2015 Navigators | Total Payments | Grant % | Enrollment Goal | Actually Enrolled | Enrollment % | Cost Per Enrollment |
| University of Southern California | $25,000.00 | 25% | 700 | 13 | 2% | $1,923.08 |
| Bienestar Human Services, Inc. | $171,613.50 | 50% | 1400 | 63 | 5% | $2,724.02 |
| Young Invincibles | $100,000.00 | 50% | 1200 | 71 | 6% | $1,408.45 |
| California Council of Churches | $66,500.00 | 50% | 350 | 22 | 6% | $3,022.73 |
| Asian Pacific Self-Development and Residential Association | $26,134.00 | 50% | 350 | 34 | 10% | $768.65 |
| Bienvenidos Community Health Center | $25,000.00 | 50% | 350 | 41 | 12% | $609.76 |
| The Green Foundation | $50,000.00 | 50% | 500 | 64 | 13% | $781.25 |
| Quinn Community Outreach Corporation | $75,000.00 | 50% | 1000 | 137 | 14% | $547.45 |
| Kelly Rolfe Multipurpose Senior Center | $250,000.00 | 50% | 3200 | 503 | 16% | $497.02 |
| Health Access Foundation | $225,000.00 | 50% | 2475 | 390 | 16% | $576.92 |
| California Black Chamber Foundation | $250,000.00 | 50% | 2800 | 474 | 17% | $527.43 |
| Community Health Centers of the Central Coast | $150,000.00 | 50% | 2100 | 397 | 19% | $377.83 |
| California NAACP | $132,781.00 | 50% | 900 | 176 | 20% | $754.44 |
| Hub Cities Consortium | $75,000.00 | 50% | 800 | 162 | 20% | $462.96 |
Some Navigators exceeded enrollment, received extra bonuses
Ten of the Navigator grantees exceeded their enrollment goals and nine of them received performance bonuses because of the extra enrollments above their target numbers.
| 2015 Navigators | Total Payments | Grant % | Enrollment Goal | Actually Enrolled | Enrollment % | Cost Per Enrollment |
| INFO LINE of San Diego County | $272,050.00 | 109% | 350 | 703 | 201% | $386.98 |
| D’Acces Central Inc. | $57,500.00 | 115% | 200 | 300 | 150% | $191.67 |
| Solano Coalition for Better Health | $116,700.00 | 107% | 350 | 498 | 142% | $234.34 |
| Community Medical Centers, Inc. | $115,000.00 | 115% | 700 | 924 | 132% | $124.46 |
| Herald Christian Health Center | $107,500.00 | 108% | 700 | 885 | 126% | $121.47 |
| Family Health Centers of San Diego | $322,500.00 | 108% | 1400 | 1749 | 125% | $184.39 |
| St. Francis Medical Center of Lynwood Foundation | $231,672.00 | 100% | 350 | 429 | 123% | $540.03 |
| Redwood Community Health | $815,800.00 | 106% | 3000 | 3660 | 122% | $222.90 |
| AltaMed Health Sevices Corporation | $787,500.00 | 105% | 4650 | 5162 | 111% | $152.56 |
| Central Valley Health Network Inc. | $545,121.00 | 101% | 2800 | 2993 | 107% | $182.13 |
Total California Navigator program fell short of enrollment goal
The California Navigator program had an overall goal of enrolling approximately 92,367 consumers in Qualified Health Plans offered through Covered California. As of the conclusion of the 2015 Navigator grant period in June, only 49,037 people were enrolled by Navigators. On the bright side, because the Navigators failed to meet their enrollment goals, Covered California only released $10,761,569.00 in payments to the contracted organizations. Oddly enough, that is roughly the same amount that Covered California has budgeted for the 2016 Navigator program.
Navigators lobbied for change to payment rules
By early January 2015 it was obvious that the Navigators were struggling to meet their enrollment goals. Acting Deputy Director of the Sales Division, Mary Wantanabe, requested at the January 2015 Covered California Board meeting to amend to the Navigator agreements to make it easier for them to receive the grant progress payments. The modification, approved by the Board, based payments not on effectuated enrollment but on consumer assistance. Essentially, at the discretion of Covered California staff, Navigators were able to count assisting applications through the plan selection process of the CalHEERS program as an enrollments. But if the Navigator was showing no aptitude for actually enrolling or assisting consumers, they could still get part of their grant money by showing they were “ready” to implement a campaign strategy. (See Covered California Navigators complain about compensation).
No Navigator credit for Medi-Cal
What was not in the data on Navigator performance for 2015 was the number of Medi-Cal eligible families and individuals the Navigators helped enroll. They received no credit toward meeting their enrollment goals for Medi-Cal assistance. Covered California is funded by a per-person-per-month fee paid by the health plans for each individual enrolled in a Covered California health plan. (See Hidden fees that support Covered California). The Navigators complained that, for some, a considerable amount of time was consumed by helping people enroll in Medi-Cal and answering questions about the 1095-A tax document.
Navigators provided vital assistance for Medi-Cal
There is little doubt that the Navigators, in some circumstances and locations, provided valuable consumer assistance to Californians trying to figure the new health insurance Marketplace. Covered California has reworked the Navigator program for 2016 to place an emphasis on outreach, education, assistance by the Navigators and less on effectuated enrollment.
Low performing Navigators get another shot at grants in 2016
2016 Navigators tentatively include forty-one of the 2015 Navigators. Of the returning Navigators, six of them had enrollment figures of fewer than 20% of their enrollment goal. California Council of Churches, California Black Chamber of Commerce Foundation, Hub Cities Consortium, Kelly Rolfe Multipurpose Senior Center, Quinn Community Outreach, and The Green Foundation all failed to enroll more than 20% of their target. Twenty of 2015 Navigators failed to enroll over 50% of their goal number.
The analysis of this data was provided by two Covered California documents acquired through the a Public Records Act Request.
- [wpfilebase tag=fileurl id=776 linktext=’2014-15 Navigator Funding and Payments’ /]
- [wpfilebase tag=fileurl id=777 linktext=’2015 Navigator Production Report thru June 2015′ /]
The final analysis was created using the information from the two documents above on an spreadsheet.
- [wpfilebase tag=fileurl id=778 linktext=’Navigator Payments and Enrollment Data 2014-2015′ /]
Additional information was gleaned from the following documents relating Covered California’s 2015 and 2016 Navigator program.
- [wpfilebase tag=fileurl id=439 linktext=’2015 Budget Navigators presentation’ /]
- [wpfilebase tag=fileurl id=440 linktext=’2015 Navigator Grant Funding Announcement’ /]
- [wpfilebase tag=fileurl id=438 linktext=’2015 Navigator Lead and Subcontractors Contact’ /]
- [wpfilebase tag=fileurl id=441 linktext=’2015 Navigator Outline Presentation’ /]
- [wpfilebase tag=fileurl id=442 linktext=’2015 Navigator-Funding’ /]
2015 California Navigator Payments and Enrollment Data