Transcript Alaska Tribal Health System

Tribal Technical Advisory Group
Update
NIHB Consumer Conference
September, 2011
Outline
• Introduction to the TTAG
• Why Medicaid, CHIP and Medicare are Important
• Successes
• Opportunities / Challenges of ACA
• Medicaid and Medicare Policy Committee
invitation
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Tribal Technical Advisory Group
• Tribal advisory committee to CMS
Administrator
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Enhance Government-to-Government relationship
Honor Federal trust responsibilities
Increase understanding between CMS and Tribes
Does not substitute for tribal consultation
• Representatives
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Tribal leader or designee from each IHS Area (12)
National Indian Health Board (1)
Tribal Self-Governance Advisory Committee (1)
National Congress of American Indians (1)
Urban Indian Health Program (1)
Indian Health Service (1)
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TTAG Membership
• Don Warne (Aberdeen)
• Valerie Davidson (Alaska),
Chair
• Carolyn Finster (Albuquerque)
• Kathy Hughes (Bemidji)
• Patricia Enos-Bergie (Billings)
• Jim Crouch (California)
• Donita Stephens (Nashville)
• Rex Lee Jim (Navajo)
• Judy Goforth Parker
(Oklahoma)
• David Reede (Phoenix)
• Pearl Capoeman-Baller
(Portland)
• Grace Manuel (Tucson)
• W. Ron Allen (TSGAC), CoChair
• H. Sally Smith (NIHB)
• Jason Dollarhide (NCAI)
• Carmelita Skeeter (NCUIH)
• Carl Harper (IHS)
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TTAG Alternates
• Cecelia Fire Thunder
(Aberdeen)
• Jim Lamb (Alaska)
• TBA (Albuquerque)
• Phil Norrgard (Bemidji)
• Donna BucklesWhitmer (Billings)
• James Russ (California)
• Dee Sabattus
(Nashville)
• Roselyn Begay (Navajo)
• Rhonda Butcher
(Oklahoma)
• Pam Thompson
(Phoenix)
• Jim Roberts (Portland)
• Chester Antone (Tucson)
• Mickey Peercy (TSGAC)
• TBA (NIHB)
• Juana Majel-Dixon
(NCAI)
• Toni Lodge (NCUIH)
• Dorothy Dupree (IHS)5
Why focus on Medicaid, Medicare,
and CHIP?
• Indian Health Service only receives half of
the level of funding needed to provide basic
health care services.
• No medical inflation increases.
• Due to the gap between IHS funding and
need, health services (including Long Term
Care services) to AI/ANs are severely
rationed.
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Authority to Bill
• Due to this disparity, Congress authorized
IHS facilities to recover reimbursements from:
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Medicaid,
Medicare,
State Children’s Health Insurance Programs, and
Private insurance
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States Benefit with Medicaid
• For average Medicaid beneficiary, CMS pays:
– Federal Medical Assistance Percentage (FMAP) to
States to help pay for Medicaid services
• States make up the difference.
• For a $1,000 service in a state with 58% FMAP:
– $ 580 federal dollars
– $ 420 state match
$1,000 total
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States Benefit with Medicaid
• For AI/AN Medicaid beneficiaries:
– States receive 100% FMAP,
– For care receive in an IHS facility in recognition of the
federal trust responsibility
• For a $1,000 service in a state with 58% FMAP for
AI/AN who receives care in IHS facility :
– $1,000 federal dollars
– $
0 state match
$1,000 total
• $420 savings to the State General Fund when AI/AN
Medicaid patients use the Indian Health System.
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What does this mean?
• In order for AI/ANs to be able to access
Medicaid, Medicare, and CHIP programs in a
meaningful and sustainable way, cooperation
is required by all three:
– IHS / Tribally Operated Programs / Urban
Programs
– CMS
– States
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Example of LTC implementation
challenge in Indian Country:
• Sustainability: 4 must-haves for SelfGovernance Tribes
– Tribe
• Design program to meet needs
• Negotiate language in Funding Agreement (FA)
– Indian Health Service
• Negotiate acceptable FA language
– CMS
• Provides 100% Federal Medical Assistance to the State
for Medicaid
– State
• Provides Medicaid reimbursement to the Tribe
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New Reality
• For 100% FMAP to apply, it must be included
in the State Plan
• Some States are cutting budgets
– Reimbursements
– Programs
• Educate states about opportunities for
savings:
– Enhance I/T/U ability to provide care
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Some Progress
• Children’s Health Insurance Program
Reauthorization Act (CHIPRA)
• American Recovery & Reinvestment Act
(ARRA)
• Patient Protection & Affordable Care Act
• Indian Health Care Improvement Act
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Recommended PPACA measures
• Significantly increase rate of health care
coverage for AI/AN
• Financially strengthen Indian Health
providers so programs can expand service
capacity and access to health care
• Significantly reduce AI/AN health disparities
• Ensure that tribal leaders and staff receive
PPACA training and resources to enroll people
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Recommended PPACA measures
• Ensure that our communities benefit from
new grant and other funding opportunities
• Implement Indian specific provisions
effectively and efficiently
• Expressly mention I/T/Us in regulation to
protect the Indian Health system from adverse
unintended consequences
• Require all HHS agencies to engage in
meaningful tribal consultation on
implementation
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Opportunities
• Cost Sharing under an Exchange Program
– No cost-sharing for AI/ANs who receive their
care through I/T/U or through Contract Health
– No cost-sharing for AI/ANs up to 300% FPL
• Income exemptions for certain property
• Reimbursement from VA/DoD
• Stronger reimbursement language
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Challenges
• Benefits are dependent on the definition of
Indian
• Income/incentive payments and penalties
• Need Indian addendum for Exchange Plans
• Data requirements
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Want more?
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Medicaid and Medicare Policy Committee
(MMPC) of the NIHB
Sally Smith, Chair of the MMPC
Conference calls held to discuss all
Medicaid, Medicare, and CHIP policy
issues.
To join, contact Tyra Baer at NIHB at
[email protected]
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Questions?
Valerie Davidson, TTAG Chair
Ron Allen, TTAG Co-Chair
ANTHC
Ph: 907-729-1900
Email: [email protected]
Jamestown S’Klallam Tribe
Ph: 360-681-4621
Email: [email protected]
Kitty Marx
Tyra Baer
CMS Tribal Affairs Group
National Indian Health Board
Ph: 410-786-8619
Email: [email protected]
Ph: 202-507-4070
Email: [email protected]
www.cmsttag.org
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