Nevada Health Exchange May Be Overpaying For Navigator Outreach

A state audit released Tuesday raised questions about whether Nevada’s health insurance exchange is using its money wisely, citing outreach organizations that are being paid tens of thousands of dollars but haven’t provided proof that they were promoting the exchange for much of that time.

The Silver State Health Insurance Exchange needs to better scrutinize its marketing arm and “navigator” organizations, which seek to promote health insurance to hard-to-reach, uninsured populations, state auditors told members of the Legislative Commission’s Audit Subcommittee. Their audit also asked whether navigators are participating in the most relevant events, pointing to their attendance at a lingerie convention and belly dance festival.

From May 2015 through October 2015, the exchange paid $368,000 to nine organizations that contracted with the health exchange as navigators. They billed for 17,900 staff hours, but only offered documentation verifying they were at events for about 3,000 of those hours, or 17 percent.

Six of the nine navigator organizations offered explanations for the time they weren’t at events, saying they were working on social media posts, emails, training or helping with walk-in customers, but auditors said it was still unclear whether those paid hours were spent on exchange-related activities.

In a written response, Bruce Gilbert said the exchange he leads “appreciates the need to appropriately manage our revenues and expenses, and has already begun to implement operational changes to improve these processes.”

But, he said, “as a small agency with limited staff and resources, our primary focus cannot be second-guessing our navigators as to the events they believe they should attend.”

Gilbert also took issue with auditors singling out one navigator organization’s attendance at the belly dance and lingerie events, saying the exchange needs to target women who are self-employed or operate small businesses and prioritize women’s health issues. He said the exchange’s success came in part because it appeared at less-traditional events.

Auditors also recommended officials ensure navigators aren’t taking exchange pay but spending their time doing other work, such as running drug rehab programs or teaching computer classes.

The audit noted that navigator organizations have other primary missions aside from helping people sign up for health insurance. Last year’s navigators included the Three Square food bank, the Financial Guidance Center and the addiction-recovery organization Foundation for Recovery.

“It is important for the exchange to be able to differentiate between the time navigators spend specifically representing the exchange and providing these other services to ensure the entities are only compensated for exchange-related activities,” the report said.

Gilbert defended the exchange’s outreach work as “an unqualified success,” but said he accepted auditors’ findings and is working to improve its processes.

The Silver State Health Exchange, created by the Nevada Legislature as part of President Barack Obama’s health overhaul, is funded by federal grants and a 3 percent user fee on the insurance premiums it offers. It directly employs 13 people and offers $4 million in contracts each year to groups that do marketing, outreach and enrollment assistance.

There were about 88,000 people enrolled in the health insurance exchange at the end of the latest open enrollment period earlier this year. That’s up from about 74,000 the year earlier.

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