Bill Overview
Title: Patient Navigation Assistance Act
Description: This bill requires state Medicaid programs to cover patient navigator services for enrollees.
Sponsors: Rep. DeSaulnier, Mark [D-CA-11]
Target Audience
Population: People reliant on government healthcare programs for access to medical navigation services
Estimated Size: 50000000
- The bill focuses on Medicaid programs, which serve low-income individuals and families, individuals with disabilities, pregnant women, and the elderly.
- Globally, many countries have programs similar to Medicaid, reaching millions who also need patient navigation assistance.
- Patient navigation is crucial for improving healthcare outcomes, especially for those who face difficulties in accessing healthcare services.
Reasoning
- The Patient Navigation Assistance Act targets Medicaid beneficiaries, a diverse group including low-income families, the elderly, individuals with disabilities, and pregnant women. This population experiences various barriers in healthcare access, such as lack of understanding of complex medical systems, transportation issues, and financial constraints.
- The $2 billion budget for the first year might limit the program's reach, considering the large size of the Medicaid patient population. However, the inclusion of patient navigators could lead to significant improvements in health outcomes for those who do receive assistance by enabling better management of chronic conditions, reduced hospital visits, and improved preventive care measures.
- The interviews consider variations in impact based on different demographics and personal circumstances, reflecting the policy's potential differing levels of utility among subgroups.
Simulated Interviews
Unemployed (Detroit, MI)
Age: 45 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- I often struggle to manage my diabetes because I don't know which services I can access through Medicaid.
- Having someone guide me through the system would be so helpful, especially to arrange transport for appointments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Retired (Phoenix, AZ)
Age: 68 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 15/20
Statement of Opinion:
- It's hard to keep track of my medical appointments.
- If someone could help me coordinate my care, I think I could manage my health much better.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 4 |
Part-time worker (New York, NY)
Age: 25 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- It’s really overwhelming to sort out what doctors to see.
- A navigator could help make sure I get the treatment I need.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 8 | 4 |
| Year 3 | 8 | 4 |
| Year 5 | 9 | 4 |
| Year 10 | 9 | 3 |
| Year 20 | 7 | 3 |
Part-time head cashier (Rural Georgia)
Age: 55 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 6.0 years
Commonness: 6/20
Statement of Opinion:
- After cancer, I don't understand what comes next for my ongoing care.
- Having navigation aid could reduce my stress about future check-ups and treatments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 6 | 2 |
| Year 20 | 5 | 2 |
Construction worker (Chicago, IL)
Age: 30 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 4.0 years
Commonness: 17/20
Statement of Opinion:
- Navigators are a good idea; I often miss how to access the help we qualify for.
- I think this will mean better health management for my family.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 3 |
Retired (Miami, FL)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 4.0 years
Commonness: 14/20
Statement of Opinion:
- I'm on a fixed income, so navigating Medicare and Medicaid is confusing.
- It'd be a blessing to have someone walk through it with me and make it clear.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
Small business owner (Seattle, WA)
Age: 48 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 1.0 years
Commonness: 10/20
Statement of Opinion:
- Patient navigation might not be immediately necessary, but it’s good to know that help is there if I suddenly need it.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
Retired teacher (Austin, TX)
Age: 60 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 13/20
Statement of Opinion:
- Managing my own health and my parents' appointments is a lot.
- Navigation services could really help ease the burden.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 8 | 5 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 3 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 2 |
Freelance artist (Las Vegas, NV)
Age: 37 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 8.0 years
Commonness: 9/20
Statement of Opinion:
- I have constant pain, and keeping all my specialist appointments straightforward is difficult.
- A navigation service would be a game-changer for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 3 |
| Year 3 | 7 | 3 |
| Year 5 | 8 | 3 |
| Year 10 | 7 | 2 |
| Year 20 | 6 | 2 |
Healthcare aide (Denver, CO)
Age: 50 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 18/20
Statement of Opinion:
- I understand well the benefits because I work with older adults who often need this service more.
- This would make my job easier and get patients better care which helps everyone.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Cost Estimates
Year 1: $2000000000 (Low: $1800000000, High: $2200000000)
Year 2: $2040000000 (Low: $1836000000, High: $2244000000)
Year 3: $2080800000 (Low: $1872720000, High: $2288880000)
Year 5: $2163243200 (Low: $1946918880, High: $2379565920)
Year 10: $2357900000 (Low: $2122110000, High: $2593690000)
Year 100: $5000000000 (Low: $4500000000, High: $5500000000)
Key Considerations
- Medicaid funding is primarily shared between federal and state budgets, so cost-sharing impacts will be relevant.
- The effectiveness of patient navigators relies significantly on their integration within healthcare systems and cooperation from healthcare providers.
- Potential differences in state-by-state implementation of the services, affecting the cost structure.