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No one in Montana is stepping into the role that reaches isolated populations to help connect people to health coverage. Planned Parenthood of Montana, which has historically filled that position, says new federal rules make it unethical to take the job.

Health Navigators help steer people through the jargon that comes with shopping for and enrolling in the Affordable Care Act marketplace. Those plans covered more than 14 million people this year.

Navigators need federal approval and funding. According to the Centers for Medicare and Medicaid Services, which hands out those grants, navigators have to target “left behind” populations — people disproportionately without access to coverage or care or who may not know their options.

Since the Trump Administration rolled into place, navigators have had less time and money to do that work. Navigator grant funding shrunk from $63 million in 2016 to $10 million this year.

Since then, Montana has steadily lost navigators.

In 2016, the Montana Health Network embedded navigators in hospitals and clinics throughout 24 counties. Planned Parenthood focused on reaching rural Montanans and Native Americans throughout 29 counties. By 2017, Planned Parenthood was the state’s sole navigator program.

Wednesday, the Centers for Medicaid and Medicare (CMS) announced its navigators for 2018 — no one from Montana applied for the funding.

Laura Terrill, the vice president of external affairs with Planned Parenthood of Montana, said that’s partially because new rules push navigators to list short-term insurance plans as an option for consumers. The rules also required grant applicants to inform people of their option not to purchase plans that cover abortion services.

“The fact we would have to hold out which plan didn’t cover a safe and legal medical procedure felt unethical to us,” Terrill said. “I think the rule changes are designed to empower insurers … and at the end of the day, I think that’s detrimental to people who need and deserve quality health care.”

Short-term plans are typically less expensive and offer coverage that’s designed to fill temporary coverage gaps. They also don’t have to follow Affordable Health Care regulations, meaning they can reject people with an illness, or limit coverage.

The Navigator program’s decrease in funding and added rules parallel a massive drop in organizations willing to offer the service across the nation. Last year, there were 90 navigator programs compared to the 39 programs CMS announced Wednesday.

“Navigators are one of many ways individuals can get help shopping for, and enrolling in, health insurance coverage,” according to a press release from CMS on Wednesday.

The agency has said as the marketplace has evolved, there’s more awareness around consumers’ options. But according to the Kaiser Family Foundation, tracking polls show most people, especially those without insurance, have limited understanding around open enrollment.

While navigators have the most training to do the job, they’re not the only professionals answering questions around coverage. Certified insurance agents and application counselors are on-call throughout Montana.

Terrill said the difference is navigator training is more comprehensive. And while counselors can choose to provide services that fell to navigators, they’re not required.

Lander Cooney with Community Health Partners said the health center has certified application counselors in its medical clinics in Belgrade, Bozeman, Livingston and West Yellowstone.

Jen Vero, a resource coordinator with the health center, said no navigators means counselors won’t have a place to refer complicated cases.

“So those may be a little more time consuming, but we will do our best,” Vero said.

Cooney said the demand for help enrolling in plans leveled out a bit five years into the Affordable Care Act. But she said the need for help is still there, and loss of navigators could hurt if no additional professionals fill the gap they left.

“We do our best to get the word out, but the reality is you need an appointment and to sit in front of a computer for an hour or two,” she said. “It’s not great for enrollment to not have navigators — anytime we can put resources behind a program that helps Montanans.”

The 2019 Open Enrollment Period for the marketplace runs from Nov. 1, 2018, to Saturday, Dec. 15, 2018. Go to www.healthcare.gov for more information. For more information around certified counselors in Montana, visit covermt.org or montanahealthanswers.com.

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Katheryn Houghton can be reached at khoughton@dailychronicle.com or at 582-2628. Follow her on Twitter @K_Hought.

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