Friday, September 14, 2012
AIPC the Leadership institute and NMCLP Medicaid Expansion
THE ALL INDIAN PUEBLO COUNCIL,
THE LEADERSHIP INSTITUTE AND THE
NEW MEXICO CENTER ON LAW AND POVERTY
Invite you to a convening to discuss the
MEDICAID EXPANSION - What would it mean for Tribal health care services?
October 17th - 9:00am to 1:00pm at the Indian Pueblo Cultural Center, Silver & Turquoise Room
Registration form and agenda will be sent to you next week.
In the next months Governor Susana Martinez will decide if the State of New Mexico will take advantage of a provision of the Affordable Care Act (ACA) to expand Medicaid services that will provide health care for 170,000 low-income citizens who now have no health care coverage. Of the 170,000 uncovered persons are approximately 24,000 adult Native people and 13,000 Native children. The All Indian Pueblo Council, the Leadership Institute and the New Mexico Center on Law and Poverty are convening a discussion to examine the impact of Medicaid Expansion on Native communities. The convening will be held at the Indian Pueblo Cultural Center on October 17 at 9:00am to 1:00pm.
Medicaid expansion would strengthen the Indian health care system. The ACA included the permanent authorization of the Indian Health Care Improvement Act (IHCIA). It updates payment systems so that Indian health facilities can get reimbursement from private insurance, Medicaid and Medicare without losing other federal appropriations. The expansion of the Medicaid program in our State would be a real boon to IHS, tribal and off-reservation health care facilities. Services to our people are often limited by scarce Contract Health Services (CHS) dollars and Medicaid can cover the costs of services that many do not get from clinics and CHS. Increased Medicaid funds flowing into Indian facilities will also provide a stronger foundation for health care. The IHCIA requires IHS to expand new programs for behavioral health, prevention and treatment, and authorizes hospice, long term care, and home and community based care, and provides new grant opportunities to expand services, improve primary care, and increase workforces through new funds for recruitment, retention, and training.
Enrollment of children in Medicaid is not dependent on the expansion of the Medicaid program. However, serious disparities in children’s enrollment can be greatly reduced if their parents become eligible for the program through the Medicaid expansion. The Medicaid program mandates services that include physician services, hospital services, laboratory and ex-ray services, family planning services and supplies, pregnancy-related services, pediatric and family nurse practitioner services, nurse midwife services, nursing facility services for individuals 21 and older, home health care for person eligible for nursing facility services, transportation services, and medical and surgical services of a dentist. The program also mandates Early and Periodic Screening and Diagnostic Testing (EPSDT) for individuals under 21 which include screening, preventive and early intervention services and diagnostic services and treatment determined to be necessary to correct or ameliorate children’s acute and chronic physical
and mental health conditions. The EPSDT is a significant resource for our children and tribal health care efforts to promote children’s healthy development.
Expansion of Medicaid presents an opportunity for tribal and off-reservation health care facilities to expand and strengthen services to our people. It is important that all of us understand these opportunities so that tribes and off-reservation communities can build upon the gains that have been made in recent years. We hope that you will convene with tribal officials and health care workers to examine this important opportunity. Registration form and agenda will be sent to you next week.
Kim Posich
Executive Director
New Mexico Center on Law and Poverty
505-255-2840
www.nmpovertylaw.org
Request for Documentation from Tribes to CMS
Head Councilman Joe Garcia of Ohkay Owhengeh, former Governor and current Southwest Representative to the National Congress of American Indians (NCAI) Has requested any and all documentation that your Tribe may have sent to the State of NM, IHS or CMS, regarding Tribal Consulation, Health care reform, Medicaid reform (pre 2010), and Centennial Care (Medicaid post 2010) be collected and cataloged.
He has offered to compose a resolution for AIPC and for NCAI to bring attention to CMS about NM Tribes opposition to Centennial Care and the State of NM lack of "collabotation and Consutlation"
Please send documents to the Blog website nahainformation@gmail.com
He has offered to compose a resolution for AIPC and for NCAI to bring attention to CMS about NM Tribes opposition to Centennial Care and the State of NM lack of "collabotation and Consutlation"
Please send documents to the Blog website nahainformation@gmail.com
News Article SF New Mexican "State still wrestling with Medicaid decision"
This article has the questions that the state has asked of CMS.
http://www.santafenewmexican.com/Local%20News/091412medicaid
State still wrestling with Medicaid decision
Kate Nash | The New Mexican
Posted: Thursday, September 13, 2012 - 9/13/12
The administration of Gov. Susana Martinez, who has yet to decide whether New Mexico will expand Medicaid coverage to more residents under the federal Affordable Care Act, is seeking answers to a list of questions before making the decision.
A letter sent by the state Human Services Department to federal health officials this week says the state has five key questions as it mulls whether to extend coverage to hundreds of thousands in the state.
“The decision on whether or not the state will expand its Medicaid program is one that is significant and that we do not take lightly,” Human Services Secretary Sidonie Squier wrote. “We must thoroughly assess the fiscal implications of Medicaid expansion, and consider them in terms of our ability to maintain current services for those New Mexicans most in need.”
For states that choose to expand Medicaid coverage to adults who live at up to 138 percent of the federal poverty level, the U.S. government would pay the entire bill, starting in 2014. By 2020, the federal share would drop down to 90 percent.
State officials estimate the number of newly eligible residents in New Mexico, where about one in five residents lacks health insurance coverage, is between 130,000 and 175,000.
As the state sorts through its options, it has these questions of U.S. Health and Human Services Secretary Kathleen Sebelius:
• Would New Mexico need to enroll everyone who is newly eligible at once, or could the state phase them in over time?
• For how long will the federal government guarantee the match it is expected to provide for states to help pay for the expansion of the program?
• If the feds provide a lower match, can states then adjust their eligibility requirements for the program?
• Could the state pay premiums for people who enroll in exchange programs instead of in the traditional Medicaid program and still receive federal matching funds? (Exchange programs are new health care plans that will be regulated by states and will be eligible for federal subsidies.)
• Could the state expand eligibility to a lesser level than 138 percent of the federal poverty level?
The department would like to hear back from federal officials in a “timely” manner, but the state hasn’t publicly set a deadline for deciding on Medicaid expansion.
Kennicott said department employees have spent countless hours on the issue. “It’s a constant topic of conversation for us,” he said. “It takes up a good deal of discussion time on any given day.”
The state for years has had among the highest rates of uninsured residents, although new census figures indicate that has eased a bit.
About 22 percent of New Mexicans were without health insurance in 2010, a figure that dropped to 19.6 percent in 2011. The uninsured rate is a problem that both Republican and Democratic officials in the past have worked to reduce.
The Martinez administration has kept its inclinations about whether to expand the program under wraps, although the first-term Republican governor has said she supports the provision that allows for children up to 26 to stay on a parent’s insurance plan and a requirement that pre-existing conditions be covered.
Without knowing more about which way Martinez is leaning, advocates of expansion are left waiting.
Veronica Garcia, executive director of New Mexico Voices for Children, in a statement this week called the expansion “an opportunity that the state simply can’t pass up in good conscience.”
So far, more than half the states have decided against expanding their Medicaid programs or are leaning against doing so, according to a report by MSNBC.com.
Contact Kate Nash at 986-3036 or knash@sfnewmexican.com. Follow her on Twitter at @katenashnm.
http://www.santafenewmexican.com/Local%20News/091412medicaid
State still wrestling with Medicaid decision
Kate Nash | The New Mexican
Posted: Thursday, September 13, 2012 - 9/13/12
The administration of Gov. Susana Martinez, who has yet to decide whether New Mexico will expand Medicaid coverage to more residents under the federal Affordable Care Act, is seeking answers to a list of questions before making the decision.
A letter sent by the state Human Services Department to federal health officials this week says the state has five key questions as it mulls whether to extend coverage to hundreds of thousands in the state.
“The decision on whether or not the state will expand its Medicaid program is one that is significant and that we do not take lightly,” Human Services Secretary Sidonie Squier wrote. “We must thoroughly assess the fiscal implications of Medicaid expansion, and consider them in terms of our ability to maintain current services for those New Mexicans most in need.”
For states that choose to expand Medicaid coverage to adults who live at up to 138 percent of the federal poverty level, the U.S. government would pay the entire bill, starting in 2014. By 2020, the federal share would drop down to 90 percent.
State officials estimate the number of newly eligible residents in New Mexico, where about one in five residents lacks health insurance coverage, is between 130,000 and 175,000.
As the state sorts through its options, it has these questions of U.S. Health and Human Services Secretary Kathleen Sebelius:
• Would New Mexico need to enroll everyone who is newly eligible at once, or could the state phase them in over time?
• For how long will the federal government guarantee the match it is expected to provide for states to help pay for the expansion of the program?
• If the feds provide a lower match, can states then adjust their eligibility requirements for the program?
• Could the state pay premiums for people who enroll in exchange programs instead of in the traditional Medicaid program and still receive federal matching funds? (Exchange programs are new health care plans that will be regulated by states and will be eligible for federal subsidies.)
• Could the state expand eligibility to a lesser level than 138 percent of the federal poverty level?
The department would like to hear back from federal officials in a “timely” manner, but the state hasn’t publicly set a deadline for deciding on Medicaid expansion.
Kennicott said department employees have spent countless hours on the issue. “It’s a constant topic of conversation for us,” he said. “It takes up a good deal of discussion time on any given day.”
The state for years has had among the highest rates of uninsured residents, although new census figures indicate that has eased a bit.
About 22 percent of New Mexicans were without health insurance in 2010, a figure that dropped to 19.6 percent in 2011. The uninsured rate is a problem that both Republican and Democratic officials in the past have worked to reduce.
The Martinez administration has kept its inclinations about whether to expand the program under wraps, although the first-term Republican governor has said she supports the provision that allows for children up to 26 to stay on a parent’s insurance plan and a requirement that pre-existing conditions be covered.
Without knowing more about which way Martinez is leaning, advocates of expansion are left waiting.
Veronica Garcia, executive director of New Mexico Voices for Children, in a statement this week called the expansion “an opportunity that the state simply can’t pass up in good conscience.”
So far, more than half the states have decided against expanding their Medicaid programs or are leaning against doing so, according to a report by MSNBC.com.
Contact Kate Nash at 986-3036 or knash@sfnewmexican.com. Follow her on Twitter at @katenashnm.
News Article ABQ Journal "Majority In N.M. Backs Medicaid Expansion"
http://www.abqjournal.com/main/2012/09/14/news/majority-in-nm-backs-medicaid-expansion.html?paperboy=loggedin
Majority In N.M. Backs Medicaid Expansion
By Dan Boyd / Journal Capitol Bureau on Fri, Sep 14, 2012
SANTA FE – A majority of New Mexico voters support expansion of the state’s Medicaid rolls to insure an additional 170,000 low-income residents, a Journal Poll found.
Republican Gov. Susana Martinez’s administration has not said whether it plans to participate and increase the Medicaid rolls in New Mexico, which has one of the nation’s highest uninsured rates for health care.
The program here already covers about 550,000 people – roughly one in every four state residents – and the expansion would be largely financed with federal dollars.
Fifty-three percent of likely voters surveyed statewide Sept. 3-6 in the Journal Poll said they supported expanding the federal-state program that provides health care coverage for low-income children, seniors, individuals with disabilities and pregnant women.
Thirty-three percent said they oppose the expansion, a key component of President Barack Obama’s federal health care overhaul. Eleven percent were undecided.
Medicaid spending makes up about 16 percent of the state’s $5.6 billion budget, a figure that does not include the federal matching funds the state receives to help pay for the program. The federal government currently pays about 70 percent of the state’s total Medicaid cost.
The debate over whether New Mexico should participate in the federal Medicaid expansion depends largely on one’s governmental philosophy, said Journal pollster Brian Sanderoff.
“Some people just resent additional government intervention and additional tax dollars being spent to enroll more people in a government health care program,” said Sanderoff, president of Research & Polling Inc. “Others think the government should spend more to expand Medicaid to more low-income people in the state or see it as an economic development issue.”
In one study, a University of New Mexico economist predicted that as many as 10,000 new jobs could be created a year in the state if the decision is made to expand Medicaid. However, some skeptics have voiced concerns about the escalating cost of Medicaid.
Breaking down results
Democratic voters strongly supported Medicaid expansion, with 74 percent saying they support it and just 15 percent expressing opposition.
Independent voters, or those who decline to state a party affiliation, also strongly supported Medicaid expansion – 53 percent to 27 percent opposed.
Among Republican voters surveyed, 59 percent were opposed and 25 percent were in support.
Voters who identified themselves as Hispanic were more likely than Anglo voters to support the expansion – 62 percent, compared with 49 percent.
Voters in all parts of the state were more likely to support than oppose Medicaid expansion, with residents of north-central New Mexico most likely to support it (64 percent) and residents of the northwestern part of the state most likely to express opposition (45 percent).
The Journal Poll asked voters: “The state of New Mexico needs to decide whether to participate in a federal program that will expand New Mexico’s Medicaid enrollment by providing health insurance to an additional 170,000 uninsured, low-income people. It is estimated that this expanded coverage will cost about $6.5 billion dollars over six years, with the federal government paying about 92 percent and the state paying about 8 percent. Do you support or oppose expanding the Medicaid program for New Mexico?”
The Journal Poll surveyed 402 likely voters statewide via telephone, both land lines and cellphones, Sept. 3-6. It has a margin of error of plus or minus 4.9 percentage points. The margin of error increases for subsamples, such as party affiliation, ethnicity and region.
The new law
Under the Affordable Care Act, which Obama signed into law in 2010, the federal government for three years beginning in 2014 would pay the cost of extending Medicaid benefits to adults earning up to 138 percent of the federal poverty level. States that agree to extend benefits would pay 10 percent of the cost thereafter.
The New Mexico Human Services Department has estimated that up to 170,000 additional individuals would receive Medicaid benefits over six years if the program is expanded. The department estimates the state would pay up to $500 million by 2020 and could receive more than $6 billion in federal funding.
Although the U.S. Supreme Court this year upheld the constitutionality of most of the federal health care law, it ruled the federal government cannot force states to expand their Medicaid rolls.
Though it has not yet advised the federal government whether New Mexico will participate in the Medicaid expansion, the Martinez administration is working on a plan to redesign Medicaid and reduce costs by administrative streamlining and charging certain co-payments to Medicaid recipients, among other things.
However, the redesign remains in limbo after the state requested in April that the federal government delay consideration of its proposal.
— This article appeared on page A1 of the Albuquerque Journal
News Article El Defensor "Medicaid debate: black, white, red"
News Article
http://www.dchieftain.com/2012/09/01/medicaid-debate-black-white-red
Medicaid debate: black, white, red
Last week, the state’s leading economist waded into the Medicaid debate.“I think we should seriously think of saying yes to Medicaid,” said Lee Reynis, director of UNM’s Bureau of Business and Economic Research. “It’s an opportunity to develop health-care infrastructure, especially in rural areas. The federal government is willing to pay the freight for much of it.”
BBER’s forecasting models indicate New Mexico would receive $3.9 billion from the federal government from 2014 to 2020, and the expansion would create thousands of new jobs. Reynis was speaking to Economic Forum, a nonpartisan business group. I was surprised at the comment, which came at the end of an otherwise gloomy look at the economy.
Medicaid expansion has become an election issue. The Supreme Court, in upholding the Affordable Care Act, removed the mandate to expand the program, giving states a choice. Expansion supporters and detractors have their boilerplate arguments, so true believers can take a position without thinking.
If you’re in the middle – I’m sorry – you’ll just have to think.
New Mexico, which has upwards of 400,000 uninsured people, could add 170,000 low-income, uninsured people at a cost to the state of up to $500 million between 2014 and 2020. The federal government pays everything for the first three years and 90 percent after that, or $6 billion.
Now look at the up side, the down side, and the unknowns.
Reynis and others see $6 billion as quite an investment in the state. If this were an economic development discussion about whether to spend $500 million to get $6 billion for, say, a military base, the labs, or a plant, I doubt that Economic Development Secretary Jon Barela would predict “a future of rising taxes and stagnating economic growth for the state.”
Is the sky beginning to crack?
An obvious up side is taking care of more people and the savings of treating them outside of emergency rooms before their conditions worsen, which means that the rest of us aren’t paying for their expensive ER visits. Although opponents are waving reports saying Medicaid patients have worse outcomes than insured patients, a recent Harvard study showed that expanded Medicaid in three states reduced the death rate by 6 percent – thousands of lives.
Those percentages have faces and names and loved ones. Suddenly, the waitress can pay her rent AND go to the doctor, not either-or.
Here’s the down side. Even if New Mexico doesn’t expand the program, the state Human Services Department expects 587,103 people will receive Medicaid benefits in 2014 at a cost to the state of $947 million. That number would grow by 2020 to 651,000 people – mostly children, low-income elderly and disabled adults, and pregnant women. The state is already spending nearly one-fifth of its general fund budget on Medicaid.
So when proponents say the federal government absorbs most of the cost, it’s like one of those sales – buy one and get one free. It doesn’t work if you can’t afford to buy one in the first place.
The iffier part is assuming Uncle Sam can hold up his end of the deal. In today’s fiscal climate, we’d be foolish to assume Uncle will be there as he always was.
Earlier this month the activist group Organizers in the Land of Enchantment (OLE) delivered a plate of waffles to the governor to urge her to stop waffling on Medicaid expansion, but she’s not waffling. The administration wants to weigh all the implications.
The battle will first be fought in the Legislature. Even though revenue is up, and there’s new money to spend, we have a lot of catching up to do and a great many other urgent needs. Even the most bleeding-hearted liberals will be torn. We’ll probably see some expansion but not what proponents want and more than opponents think we can bear.
Medicaid Coalition encourages Public comments on CMS Website
On the Centers For Medicare and Medicaid (CMS) s Website the public can Comment on NM's 1115 Waiver "Centennial Care" using the "Idea Factory". The Medicaid Coaltion, a group of health advocates meeting in ABQ, is encouraging the Public to visit the site and comment or "like" a comment that is already posted.
"CMS’ website here: https://cmsideas.uservoice.com/forums/175352-section-1115-demonstrations-nm-centennial-care-#/settings
In a nutshell, we all can post comments but they are limited to 5,000 characters (not words), which ends up being less than half a page or so. Other users can then show their support for your comment by “voting”, which is similar to “liking” a post on Facebook. Each user is limited to 10 votes. All of our comments must be submitted by October 5th.
So the downside is that there is not enough room to really hit issues in depth. National advocates have suggested that for Coalitions such as ours, each participating organization (optimally 10 or more) should take ownership of one issue and post their 5,000 character comment. The other Coalition members should then vote for each other’s comments. This way we can maximize attention on the most issues of concern in the waiver."
"CMS’ website here: https://cmsideas.uservoice.com/forums/175352-section-1115-demonstrations-nm-centennial-care-#/settings
In a nutshell, we all can post comments but they are limited to 5,000 characters (not words), which ends up being less than half a page or so. Other users can then show their support for your comment by “voting”, which is similar to “liking” a post on Facebook. Each user is limited to 10 votes. All of our comments must be submitted by October 5th.
So the downside is that there is not enough room to really hit issues in depth. National advocates have suggested that for Coalitions such as ours, each participating organization (optimally 10 or more) should take ownership of one issue and post their 5,000 character comment. The other Coalition members should then vote for each other’s comments. This way we can maximize attention on the most issues of concern in the waiver."
CMS TTAG Letter Tribal Consultation in State Exchange and Partnership Planning
Here is a letter from CMS Tribal Technical Advisory Group (TTAG) to Mr Gary Cohen, Deputy Administrator and Diretor of Center for Consumer Information and Insurance Oversight (CCIIO)
Letter from Secretary Kathleen Sebelius to State Governors Re: Tribes
US Health and Human Services Sectretary Katheleen Sebellius sent the following letter to States' Governors September 14, 2012, concerning Consultation between Tribes and States
KPHC letter to CMS asking for tribal/cms meeting
Kewa Pueblo Health Corporation has submitted the following letter to CMS.
Thursday, September 13, 2012
Community Health Assessment Workshop for Tribal Communities
Here is a workshop to help develop tribal health programs from Health Action NM
Community Health Assessment Workshop for Tribal Communities October 22 - 24
Registration is now open for the Community Health Assessment (CHA) Workshop for Tribal Communities Workshop – Part II. The Workshop takes place Monday, October 22 - Wednesday, October 24 at the Sandia Resort and Casino at Sandia Pueblo. Tribal individuals and groups are highly encouraged to attend. The workshop follows Part I, held in June, and will feature focused skills-building on database development, survey design, survey analysis, and designing and conducting interviews. There will also be focus on strategies for addressing challenges and sensitive topics in tribal CHA and strategies for maintaining leadership and community interest in CHA. The registration deadline is Friday, September 28. Travel scholarships are available. For more information and to register, contact Nathania Tsosie, Native Community Health Planner, at 505-925-4377 or by e-mail to NTsosie@salud.unm.edu.
--
Lori Ann Loera
Program Coordinator, Health Action NM
P.O. Box 460
Bernalillo, NM 87004
www.HealthActionNM.org
Office (505) 867-1095
Toll-free 1 (877) 867-1095
Cell (505) 377-3071
Fax (505) 867-1521
Community Health Assessment Workshop for Tribal Communities October 22 - 24
Registration is now open for the Community Health Assessment (CHA) Workshop for Tribal Communities Workshop – Part II. The Workshop takes place Monday, October 22 - Wednesday, October 24 at the Sandia Resort and Casino at Sandia Pueblo. Tribal individuals and groups are highly encouraged to attend. The workshop follows Part I, held in June, and will feature focused skills-building on database development, survey design, survey analysis, and designing and conducting interviews. There will also be focus on strategies for addressing challenges and sensitive topics in tribal CHA and strategies for maintaining leadership and community interest in CHA. The registration deadline is Friday, September 28. Travel scholarships are available. For more information and to register, contact Nathania Tsosie, Native Community Health Planner, at 505-925-4377 or by e-mail to NTsosie@salud.unm.edu.
--
Lori Ann Loera
Program Coordinator, Health Action NM
P.O. Box 460
Bernalillo, NM 87004
www.HealthActionNM.org
Office (505) 867-1095
Toll-free 1 (877) 867-1095
Cell (505) 377-3071
Fax (505) 867-1521
Wednesday, September 12, 2012
Health care law saved an estimated $2.1 billion for consumers
FOR IMMEDIATE RELEASE
Tuesday, September 11, 2012
Health care law saved an estimated $2.1 billion for consumers
The health care law – the Affordable Care Act – has saved consumers an estimated $2.1 billion on health insurance premiums according to a new report released today by the Department of Health and Human Services. For the first time ever, new rate review rules in the health care law prevent insurance companies in all states from raising rates with no accountability or transparency. To date, rate review has helped save an estimated $1 billion for Americans. Additionally, the law’s Medical Loss Ratio (or 80/20) rule is helping deliver rebates worth $1.1 billion to nearly 13 million consumers.
“The health care law is holding insurance companies accountable and saving billions of dollars for families across the country,” Secretary Sebelius said. “Thanks to the law, our health care system is more transparent and more competitive, and that’s saving Americans real money.”
Beginning Sept. 1, 2011, the health care law implemented federal rate review standards. These rules ensure that, in every state, insurance companies are required to publicly submit for review and justify their actions if they want to raise rates by 10 percent or more.
To assist states in this effort, the Affordable Care Act provides states with Health Insurance Rate Review Grants to enhance their rate review programs and bring greater transparency to the process. 42 states have used their rate review grant funds to make the rate review process stronger and more transparent.
These rules have brought more transparency and accountability to our health insurance marketplace and saved money for consumers. The report released today shows that because of rate review, consumers saved approximately $1 billion in premiums in the individual and small group markets.
This initiative is one of many in the health care law aimed at saving money for consumers and specifically works in conjunction with the 80/20 rule, which requires insurance companies to generally spend 80 percent of premiums on health care or provide rebates to their customers. Insurance companies that did not meet the 80/20 rule will provide nearly 13 million Americans with more than $1.1 billion in rebates this year. Americans receiving the rebate will benefit from an average rebate of $151 per household. The rate review report released today is available at: http://www.healthcare.gov/law/resources/reports/rate-review09112012a.html.
Information on how states are using their rate review grant funds is available at: http://www.healthcare.gov/law/resources/reports/rate-review09202011a.pdf
General information about rate review is available at: http://www.healthcare.gov/law/features/costs/rate-review/
Friday, September 7, 2012
Medicaid Expansion Questions
Does Governor Martinez have the authority to make the decision for Tribes regarding the Medicaid Expansion?
If the State of NM does not take the Medicaid Expansion can State law overide Federal Law, which Govern the Tribes?
Can Governor Martinez Make the Decision regarding the Medicaid Expansion without Tribal Consultation, according to State Law?
I submitted the following Statement, part of a document, to CMS representative.
"The US Supreme Court’s decision to up hold the PPACA except for the Medicaid Expansion is a concern for Tribes in NM. If Governor Martinez decides not expand Medicaid for NM’s low income individuals it will have a great effect on the Tribal Health Programs. NM Native Americans make up between 22%-26% of the Medicaid population with many more individuals eligible but not yet enrolled. That number will grow with expansion and help many individuals obtain needed healthcare. This is another instance where the State of NM will make a decision without Consultation with Tribes. Given the Government to Government relationship what will happen if Tribes want to Expand Medicaid and the State of NM chooses not to?"
This is a question that is the basis of an upcoming purposed Tribal Summit cosponsered by the Center for Law and Poverty, AIPC, NMICoA Health Committee Tenatively Scheduled for
October 16, 2012 9 AM to 12 PM
Place: TBA
Agenda to follow
There are a couple of opportunities for Tribes to ask this question coming up. the following statement will be asked at the HHS Secretary Tribal Advisory Committee (STAC)
"Regarding the Governor's authority to expand. An open question that tribes all over the country need clear guidance from CMS on is whether or not a Governor who decides to not expand Medicaid in their state can do so on behalf of Native Americans. Since the Affordable Care Act mandating expansion is a federal law, can a Governor decide to deprive Native Americans of this benefit in the face of the government to government relationship and supremacy? Tribal advocates will need a clear answer on this."
There is also a NCAI the last week of October, where this question can be posed to all Tribes.
If the State of NM does not take the Medicaid Expansion can State law overide Federal Law, which Govern the Tribes?
Can Governor Martinez Make the Decision regarding the Medicaid Expansion without Tribal Consultation, according to State Law?
I submitted the following Statement, part of a document, to CMS representative.
"The US Supreme Court’s decision to up hold the PPACA except for the Medicaid Expansion is a concern for Tribes in NM. If Governor Martinez decides not expand Medicaid for NM’s low income individuals it will have a great effect on the Tribal Health Programs. NM Native Americans make up between 22%-26% of the Medicaid population with many more individuals eligible but not yet enrolled. That number will grow with expansion and help many individuals obtain needed healthcare. This is another instance where the State of NM will make a decision without Consultation with Tribes. Given the Government to Government relationship what will happen if Tribes want to Expand Medicaid and the State of NM chooses not to?"
This is a question that is the basis of an upcoming purposed Tribal Summit cosponsered by the Center for Law and Poverty, AIPC, NMICoA Health Committee Tenatively Scheduled for
October 16, 2012 9 AM to 12 PM
Place: TBA
Agenda to follow
There are a couple of opportunities for Tribes to ask this question coming up. the following statement will be asked at the HHS Secretary Tribal Advisory Committee (STAC)
"Regarding the Governor's authority to expand. An open question that tribes all over the country need clear guidance from CMS on is whether or not a Governor who decides to not expand Medicaid in their state can do so on behalf of Native Americans. Since the Affordable Care Act mandating expansion is a federal law, can a Governor decide to deprive Native Americans of this benefit in the face of the government to government relationship and supremacy? Tribal advocates will need a clear answer on this."
There is also a NCAI the last week of October, where this question can be posed to all Tribes.
ABQ Journal "Some N.M. Tribes Fear Overhaul of Medicaid":
http://www.abqjournal.com/main/2012/09/05/news/nm-news/some-nm-tribes-fear-overhaul-of-medicaid.html
By Winthrop Quigley / Journal Staff Writeron Wed, Sep 5, 2012
JEMEZ PUEBLO — Some of New Mexico’s Indian tribes have been among the most vehement critics of a state proposal to overhaul Medicaid, the $3.9 billion program that finances health care for low-income children and disabled and elderly people. They argue the state would interfere with federal compacts the tribes have signed, would cost tribal health systems money, and would degrade care.
A visit to Jemez Pueblo in the red-rock canyons 55 miles northwest of Albuquerque is a good way to understand some of the tribes’ concerns.
In many ways, Jemez is running the kind of integrated, patient-centered program health policy experts envision when they talk about medical homes and accountable care, ideas that are enshrined in the federal Affordable Care Act and which are the philosophical basis of the state’s Medicaid overhaul plan known as Centennial Care. It is unclear whether health outcomes, as opposed to health care, are better because that data are still being collected.
The pueblo’s medical operation is housed in a new, well-equipped center staffed by physicians, dentists, physician assistants, nurses and other professionals. It offers everything from radiology to dental care. The center had almost 12,000 patient visits last year. Its pharmacy filled 41,000 prescriptions in 2011. Its dental clinic averages 300 patient visits per month.
The pueblo’s health program emphasizes prevention, fitness and care for the whole person. It’s the kind of program managed care organizations strive to provide.
Its fitness center hosts an average of 51 visits per day. Jemez has a 17-member Senior Olympics team. A network of exercise trails snakes through the valley. The pueblo organizes fun runs, bicycle clubs, weight-loss competitions and other fitness activities. The comprehensive behavioral health program integrates the care it provides with pueblo cultural, religious and judicial traditions and organizations.
Like most tribes, Jemez once relied almost entirely on the Indian Health Service to provide care to members, under the federal government’s treaty obligations. No one liked the system, including the feds. Money was always short, services were hard to deliver to rural areas, it could take decades for IHS to build the facilities tribes needed, and tribes could not create the systems that would work for their own people.
Jemez began building its own health care system starting in 2000, by obtaining grants and contracting with agencies, including the IHS, to deliver care on its behalf. A change in federal law ended the contractual relationship with IHS. Instead, Jemez signed a compact with the federal government in 2011 which authorized the pueblo to take over health care responsibility for the tribe’s members. In 1995, 1 percent of members’ health care was delivered at the pueblo. Today, it’s 98 percent of care.
Care has improved at Jemez. Mammography rates for women medically indicated for the test were at 30 percent, for example. This year, they should reach 55 percent.
Health care is free for members. To cover its costs, the Jemez system does what every other health care operation does. It bills third parties, including the commercial insurance that members get from their employers. About 70 percent of third-party reimbursement comes from Medicaid.
There are about 3,000 enrolled members, and total money spent on health care, including public health programs, youth services and the medical center, is about $22 million. The medical center by itself costs about $3 million a year.
The state Human Services Department wants all of New Mexico’s 500,000 or so Medicaid recipients, including all of the 89,000 Native American recipients, to enroll with a few managed care organizations. Today, about 15 percent of Indians receive benefits through an MCO. The rest visit providers of their choice who are then paid a fee for the services they provide.
It’s rather as if Texas had told New Mexico how to set property tax rates, in the view of some tribes. Jemez has an intergovernmental agreement with the feds giving it, not the state, the final word on how its members receive care.
Managed care organizations are supposed to contact Medicaid enrollees, assess their needs, assign them to medical practices, then monitor their health status to ensure their needs are being met. The MCOs can’t do it, Jemez health officials say. Many pueblo residents don’t have phones, some speak only Towa (only Jemez people speak it), and many of their homes are difficult to find. MCOs’ provider networks are concentrated in urban areas, far from the pueblo, so members would have trouble accessing the care they need.
This is what Jemez officials fear:
Jemez members will go to the health center, as usual. Their care will be coordinated by pueblo health providers, as usual. The health system will be asked to negotiate a provider contract with the MCOs that will pay a fraction of what the system receives today. Jemez will have to make up the difference by finding new sources of revenue from no one knows where.
Some N.M. Tribes Fear Overhaul of Medicaid
By Winthrop Quigley / Journal Staff Writeron Wed, Sep 5, 2012JEMEZ PUEBLO — Some of New Mexico’s Indian tribes have been among the most vehement critics of a state proposal to overhaul Medicaid, the $3.9 billion program that finances health care for low-income children and disabled and elderly people. They argue the state would interfere with federal compacts the tribes have signed, would cost tribal health systems money, and would degrade care.
A visit to Jemez Pueblo in the red-rock canyons 55 miles northwest of Albuquerque is a good way to understand some of the tribes’ concerns.
In many ways, Jemez is running the kind of integrated, patient-centered program health policy experts envision when they talk about medical homes and accountable care, ideas that are enshrined in the federal Affordable Care Act and which are the philosophical basis of the state’s Medicaid overhaul plan known as Centennial Care. It is unclear whether health outcomes, as opposed to health care, are better because that data are still being collected.
The pueblo’s medical operation is housed in a new, well-equipped center staffed by physicians, dentists, physician assistants, nurses and other professionals. It offers everything from radiology to dental care. The center had almost 12,000 patient visits last year. Its pharmacy filled 41,000 prescriptions in 2011. Its dental clinic averages 300 patient visits per month.
The pueblo’s health program emphasizes prevention, fitness and care for the whole person. It’s the kind of program managed care organizations strive to provide.
Its fitness center hosts an average of 51 visits per day. Jemez has a 17-member Senior Olympics team. A network of exercise trails snakes through the valley. The pueblo organizes fun runs, bicycle clubs, weight-loss competitions and other fitness activities. The comprehensive behavioral health program integrates the care it provides with pueblo cultural, religious and judicial traditions and organizations.
Like most tribes, Jemez once relied almost entirely on the Indian Health Service to provide care to members, under the federal government’s treaty obligations. No one liked the system, including the feds. Money was always short, services were hard to deliver to rural areas, it could take decades for IHS to build the facilities tribes needed, and tribes could not create the systems that would work for their own people.
Jemez began building its own health care system starting in 2000, by obtaining grants and contracting with agencies, including the IHS, to deliver care on its behalf. A change in federal law ended the contractual relationship with IHS. Instead, Jemez signed a compact with the federal government in 2011 which authorized the pueblo to take over health care responsibility for the tribe’s members. In 1995, 1 percent of members’ health care was delivered at the pueblo. Today, it’s 98 percent of care.
Care has improved at Jemez. Mammography rates for women medically indicated for the test were at 30 percent, for example. This year, they should reach 55 percent.
Health care is free for members. To cover its costs, the Jemez system does what every other health care operation does. It bills third parties, including the commercial insurance that members get from their employers. About 70 percent of third-party reimbursement comes from Medicaid.
There are about 3,000 enrolled members, and total money spent on health care, including public health programs, youth services and the medical center, is about $22 million. The medical center by itself costs about $3 million a year.
The state Human Services Department wants all of New Mexico’s 500,000 or so Medicaid recipients, including all of the 89,000 Native American recipients, to enroll with a few managed care organizations. Today, about 15 percent of Indians receive benefits through an MCO. The rest visit providers of their choice who are then paid a fee for the services they provide.
It’s rather as if Texas had told New Mexico how to set property tax rates, in the view of some tribes. Jemez has an intergovernmental agreement with the feds giving it, not the state, the final word on how its members receive care.
Managed care organizations are supposed to contact Medicaid enrollees, assess their needs, assign them to medical practices, then monitor their health status to ensure their needs are being met. The MCOs can’t do it, Jemez health officials say. Many pueblo residents don’t have phones, some speak only Towa (only Jemez people speak it), and many of their homes are difficult to find. MCOs’ provider networks are concentrated in urban areas, far from the pueblo, so members would have trouble accessing the care they need.
This is what Jemez officials fear:
Jemez members will go to the health center, as usual. Their care will be coordinated by pueblo health providers, as usual. The health system will be asked to negotiate a provider contract with the MCOs that will pay a fraction of what the system receives today. Jemez will have to make up the difference by finding new sources of revenue from no one knows where.
NM Centennial Care RFP
The Request for Proposal (RFP) for the Centennial Care program has been released. You can find a the complete RFP on the HSD website at
http://www.hsd.state.nm.us
Scroll down to the bottom of the Page and click on the
Centennial Care RFP
This is the Native American Portion
6.7 Native Americans
1. Describe the strategies and resources that the Offeror will use to operationalize the delivery of culturally competent care to Native Americans, both on and off the reservation, and the process that the Offeror will use to ensure that culturally appropriate materials are available to Native Americans.
2. Describe how the Offeror will monitor the adequacy of medical transportation for Native Americans residing in Rural, Frontier, and Tribal areas and the strategies the Offeror will implement to minimize access issues.
3. Describe how you will contract with IHS and Tribal 638 organizations for: a. nonemergency medical transportation services; b. care coordination and case management services;
c. behavioral health services, including the treatment of substance abuse; and
d. any other Medicaid-covered services provided outside of a clinic or hospital.
The Offeror’s description should also include any special issues that the Offeror foresees in building and sustaining these contractual relationships, and the Offeror’s strategies to overcome these issues.
4. Describe the process the Offeror will implement in order to facilitate the availability of a sufficient number of appropriately credentialed providers in IHS, Tribal 638 facilities, and/or urban Indian health clinics as PCPs.
5. Describe the processes that the Offeror will follow in order to: a. ensure that I/T/Us are reimbursed at a minimum of one hundred percent (100%) of the rate currently established for the IHS facilities or Tribal 638 facilities by the Office of Management and Budget (OMB) in accordance with the provisions of Section 4.10.2.2 of Appendix I of this RFP;
b. allow Native American Members to seek care from any I/T/U, whether or not the provider is a Contract Provider; and
c. exempt all services provided by I/T/Us from prior authorization.
6. Describe the Offeror’s methods to communicate effectively with Native American Members in Rural, Frontier, and Tribal areas (both on and off the reservation), including but not limited to how the Offeror will ensure the following:
a. all materials are culturally appropriate;
b. translation services are available;
c. local media (radio and television) are used; and
d. outreach is provided through Tribal, fraternal, or religious organizations
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