New Jersey will lose more than 60 percent of the federal funding it expected to receive this year to help enroll vulnerable citizens in health insurance plans, a new report found, a change advocates fear will make it harder to reach those most in need of affordable care.

Officials at the federal Centers for Medicare and Medicaid Services announced more than $26 million in funding cuts in September that will impact the Affordable Care Act navigator programs in all but three states (Delaware, Kansas, and West Virginia); more than a dozen states lost at least half their funding.

New Jersey saw support drop to nearly $721,000 from the roughly $1.9 million received last year, according to a detailed analysis of these cuts released Wednesday by the nonprofit Kaiser Family Foundation. The money is distributed among five nonprofit programs that will see between 10 percent and 86 percent less funding this fall than they had to work with in 2016, the foundation determined.

Cultural and language barriers

While the dollar amount may seem small, supporters said the funding finances community-based organizations that provide a critical link to underserved populations, where cultural and language barriers have made it difficult to enroll people in public insurance programs, regardless of their qualifications.

This year’s work is further complicated by continuing questions over the ACA’s future and a shortened enrollment period; the sign-up process for 2018 policies runs only six weeks, from November 1 through December 15, while in the past it extended through January. Republicans have launched several failed attempts to repeal and replace the ACA, or Obamacare, and President Donald Trump’s administration continues to tinker with some of the regulations.

And last month, Kaiser also revealed that the healthcare.gov website that provides access to marketplace plans will be closed for maintenance on all but one Sunday morning during the open enrollment period. The closures are planned for scheduled maintenance, CMS said.

Fewer navigators

“There will be fewer navigators to help people figure out the best plan for them — it’s a lengthy and complex process — and confusion reigns due to the multiple failed attempts to repeal the ACA,” said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, who published a blog post today that includes tips and tools for organizations looking to spread the word about ACA enrollment.

New Jersey now enjoys an uninsured rate of 8 percent, the lowest on record, thanks in large part to the ACA, which expanded Medicaid to cover another 550,000 residents. The 2014 law also enabled more than 266,000 to obtain policies through the ACA marketplace, where qualified commercial policies are sold at a discount; eight in 10 of these marketplace customers qualify for subsidies to help pay for their premiums and more than half have received help with other out-of-pocket costs, according to a recent report by New Jersey Policy Perspective.

That said, a federal study released last fall found that some 6.9 million Americans — including 44,000 Garden State residents — are eligible for Obamacare programs but were not then participating. Many of these are considered among the hardest to reach.

Sounding the alarm

In August, NJPP joined healthcare advocates at New Jersey Citizen Action to sound the alarm about the shortened enrollment period and encourage federal officials to maintain the navigator grants and resources to support this process. At that time, the federal government had already cancelled contracts for some agencies that had assisted with the enrollment process and the advocates worried aloud about the future of the navigator funding.

Those fears were confirmed a few weeks later, when the CMS announced it was cutting the navigator program by more than 40 percent nationwide and told navigator agencies that it would scale back funding for 2017 based on past performance of each agency. Kaiser learned through interviews with these groups, however, that it was not clear what factors federal officials considered and nearly nine out of 10 nonprofits said they were not given a clear reason for their funding reduction.

“The timing and amount of these cuts will make it difficult for consumers to access local enrollment assistance when and where they need it. The Trump administration seems intent on sabotaging efforts to get and keep people enrolled in ACA coverage” said Maura Collinsgru, healthcare program director at Citizen Action. “Collectively, these cuts will have a devastating impact on consumers who need assistance to enroll.”

Citizen Action has partnered with labor leaders, business organizations, and others to create the New Jersey for Health Care Coalition, which recently launched the Cover NJ website designed to help people find a quality policy they can afford. “While we can’t fill the void created by the significant loss of federal support, we hope to be able to minimize the damage,” Collinsgru said.

Education about options

The navigators work in various ways to help educate the public about their healthcare choices, assisting them in the process of selecting a plan on the marketplace, or enrolling them in Medicaid or other public programs if they qualify. Kaiser found most organizations plan to continue operating, despite the funding cuts, but will likely have to scale back their service area and limit help to rural residents.

Nearly nine out of 10 navigators said they would probably be forced to lay off staff and reduce marketing — which can be a critical tool to reaching uninsured residents, according to the study. More than half said they would have to limit the time staff spent on complex cases, reduce the number of months in which they worked, or cut services for non-English speakers.

For one navigator, Fulfill New Jersey — previously known as the FoodBank of Monmouth and Ocean Counties — the work will go on, despite a roughly 10 percent cut in funding. “We remain committed to having our Navigators out in the community assisting people at the same level as in previous years.  We are not cutting staff, but we hope to reduce costs elsewhere,” said Barbara Scholz, Fulfill’s director of advocacy and programs. “Health coverage is critical for families to remain financially stable and food secure.”