The People Who Help You Sign Up for ACA Coverage Lost 90% of Their Budget

Every year, a small federal grant program pays nonprofits and community health centers to sit down with people, in person or by phone, and help them shop for ACA marketplace coverage — for free, with no commission and no plan to sell.▸ Congress created the Navigator program in the ACA itself, and for the current five-year cooperative agreement cycle (August 2024 through August 2029), CMS funds it out of the Federally-facilitated Marketplace (FFM) user fee. In February 2025 CMS announced it would cut that funding to $10 million a year going into the program's second budget period. The two award documents CMS itself has since published show what that meant in practice: the organizations mostly stayed, and the money mostly didn't.

CMS runs Navigator funding on a rolling cooperative agreement: the five-year cycle that began August 27, 2024 is split into 12-month budget periods, re-funded each year.▸ CMS's own awardee summary document lists every organization funded for the first budget period — 45 of them, across the 28 states with an FFM, totaling $99.9 million to support outreach for Plan Year 2025. The second budget period's document, covering Plan Year 2026, lists 39 "returning organizations" splitting $9.97 million — a 90.0% cut in dollars.

The organization count fell far less: 45 to 39, a 13% drop.▸ That gap is the story. Almost every grantee that existed in PY2025 still exists in PY2026 — CMS's own $360 million four-year savings estimate assumes exactly that, the same footprint running on a fraction of the fuel. What changed per-organization is the money each one has to do the same outreach across the same map.

CMS's announcement didn't justify the cut by pointing to the new budget period's own numbers — it pointed backward, to Plan Year 2024 performance data from the prior five-year cycle.▸ That year, Navigators received $98 million, spread across 56 grantee organizations, and completed 92,000 Marketplace plan selections — just 0.6% of all FFM enrollments — at a cost of $1,061 per enrollment. CMS contrasted that with Plan Year 2019, when $10 million in funding produced the same 0.6% enrollment share at $211 per enrollment, a quarter of the 2024 cost.

That comparison counts one thing: ACA plan selections.▸ It leaves out work CMS's own data tracks separately. Post-enrollment help — resolving claims and billing problems, fixing enrollment errors, walking people through how to actually use a plan they already have — fell from about 205,000 consumers assisted in 2019 to about 86,000 in 2024, according to the same CMS announcement, but that decline (itself partly a funding effect) isn't in the cost-per-enrollment figure either. And per KFF's analysis of the same performance period, published the same day as CMS's announcement, Navigators helped 292,000 people enroll in Medicaid — consumers who apply through the Marketplace, get found ineligible for ACA subsidies, and get routed to Medicaid instead. None of that shows up in a metric that only counts ACA plan selections.

The clearest single before-and-after sits in Ohio.▸ The Ohio Association of Foodbanks led Ohio's Navigator consortium for PY2025 with $2,711,549 in CMS funding, seven subawardee partners, and a footprint covering 78 of Ohio's 88 counties. Its PY2026 award is $271,155 — the same 90% cut applied nationally — with two subawardees left (Charitable Healthcare Network and Freestore Foodbank) and a footprint of 12 counties, clustered around Cincinnati, Columbus, and Cleveland. The other 66 counties that had a funded Navigator organization a year earlier now don't, at least not through this grantee.

Figures span two different Navigator grant cycles: the "2024 plan year" data CMS cited as its rationale is a prior five-year agreement's final year, while the PY2025-to-PY2026 funding and county figures are the first two budget periods of the current 2024–2029 cycle. Each is labeled with its specific plan year in the text and should not be summed across years.