State-based exchanges can pay for IPAs with establishment grants already given out by CMS to help pay for the program for the first year. Partnerships and some federally run exchanges don't have the option of IPAs. Furthermore, the grants CMS just announced are the only federal money a state will get to pay for the navigators of its federally run insurance exchanges.
What's the difference? Consider that California, with an uninsured rate of 23%, is spending $43 million on its IPA program for its state-based exchange, Covered California.
Texas, which will have a federally run HIX, and has a 28% uninsured rate, stands to receive $8 million for its navigator program from CMS. The formula CMS is using to determine the grant amount uses a state's uninsured rate as a primary factor.
Rachel Dolan, policy analyst for the National Association of State Health Policy, says even though the federally run insurance exchanges won't have as much money for the consumer assistance component, states can supplement the effort.
"If a state is willing to help or get the word out or use community partners in other ways, then they can make sure that people are still getting the information they need. It may just not be a formal program."