Research indicates that one of many challenges in addressing the opioid epidemic is getting people who are theoretically eligible for government-funded drug abuse treatment through CHIP or Medicaid to actually make use of those programs when their sickness or circumstances give them a window of opportunity to try to get help. The hassle of actually enrolling in these programs—knowing they are there, filling out the paperwork, having access to available information, and having the patience to navigate the process—is one impediment. The ACA’s sometimes-overlooked “Navigator” program could help. The ACA provision creating the program is broad enough for HHS to use it to award grants to community groups to serve as recovery navigators, enrolling addicts in Medicaid, CHIP, or Exchange coverage for substance abuse treatment.
The ACA’s Health Reform Navigators
The ACA faced a problem in some ways analogous to that presented by the challenge of getting individuals addicted to opioids or other drugs into treatment: how to get people to go through the work of signing up for this new entitlement program, previously foreign to them, and actually make use of it? As I previously wrote on the Health Affairs’ Blog, the ACA’s answer came in section 1311(i): “Health Reform Navigators.” Anyone who met certain minimum requirements and thought they had an idea, a talent, or an infrastructure for getting people covered in their community—trade groups, fishermen’s organizations, ranchers, community non-profits, and so on—could apply for a grant of federal funds to become a “Navigator.” HHS would review these grants and decide which ones showed enough promise to make an award; then it was up to the awardee group to put its plan into action.
The Navigator program struggled with limited funding as a result of the controversy surrounding the ACA, but it nonetheless showed real promise, particularly in the extent to which it fostered innovation and leveraged existing community groups and relationships. A particularly successful grant went to the Maine Lobstermen’s Association, which was uniquely positioned to reach out to potential enrollees in the communities it served and helped Maine rank among the top states in the country in signing people up. The HHS official overseeing that grant described what made the Lobstermen successful: “Congress can pass the Affordable Care Act, President Obama can sign it, but it really comes to life when the enrollment assistance is in your neighborhoods and your communities.”
Flexibility in the ACA
The statutory language in section 1311(i) creating the Navigator program is still on the books, and it is flexible enough to permit HHS to repurpose this program as a way to get people eligible for Medicaid or CHIP into treatment for addiction. Most importantly, HHS has for years interpreted the provision to permit Navigators to enroll individuals either in coverage through the ACA or in Medicaid or CHIP, depending on eligibility. 76 Fed. Reg. 41878 (July 15, 2011). So while Navigators must at the very least help people enroll in insurance on the ACA’s Exchanges, they can also help enroll in Medicaid or CHIP coverage, depending which program a person is eligible for. Furthermore, in addition to actually enrolling people, Navigators can conduct education and outreach to bring them in the door. And lastly, the statute leaves HHS discretion to determine which community organizations to give grants as long as awardees meet certain minimum requirements (the requirements go to an entity’s competence and avoidance of conflicts).
That means HHS could repurpose the ACA’s “Health Reform Navigator” program as a “Recovery Navigator” program, focusing grants toward those community groups it judges to be best poised to make immediate headway getting people who are addicted to opiates or other substances enrolled in coverage and treated in their region. Of course, the extent of any grants would depend significantly on appropriations, so appropriators would need to consider increasing funding for FY 2018. And navigators would be far from a silver bullet—they could do little, other than increasing paying demand, to address the lack of availability in treatment centers that is itself the biggest barrier to care in many areas. But given the significant national interest in addressing this problem, this existing program is one promising path of least resistance for the government to empower communities to get help to those who need it as soon as possible.