My thoughts on State Tribal Consultation at Dancing Eagle hosted by Laguna Pueblo

Frist of all I would like to Thank Governor Luarkie for hosting the consultation, and the Governors/ Representative for attending and speaking clearly on behalf of Pueblos and Tribes.  I also would like to thank all of the other attendees for showing that we, Native American Indians, are not just going to smile and whatever the State chooses to give us.

the following is the comment paper written on behalf of the New Mexico Indian Council on Aging's Health Committee by Dr. Ron Lujan:

State Tribal Consultation and Collaboration

Dancing Eagle Casino

Pueblo of Laguna

July 30, 2012

The Health Committee of the New Mexico Indian Council on Aging (NMICoA) has followed NM Human Services Department (HSD)’s Centennial Care waiver proposal to the Centers for Medicare and Medicaid (CMS) since it’s unveiling earlier this year.  The Health Committee has these following concerns and issues with HSD’s attempts to have its 1115 waiver accepted by CMS.

·         HSD has not been transparent in properly informing and involving Tribes and Pueblos to input grassroots solutions and networking to inform HSD about possible problems incurred with developing strategic health planning from a unilateral perspective. The government to government process is still not evident in meetings attended by members.  Discordant information was presented at the NM Primary Care Association meeting and UNM Cancer Center meeting sponsored by the Navajo Nation.

·         HSD does not understand the sovereign status of Tribes and Pueblos of NM and the Federal responsibility

o   HSD needs to review Federal-Tribal policy and understand Tribes and Pueblos should be funded directly for their members who are enrolled in Medicaid

o   This allows a 100% Federal Medical Assistance Percentage (FMAP) funding for natives to obtain medical services at Indian Health Services (IHS), 638 facilities but more importantly, network providers who provide services not available at IHS/638 facilities.

o   Carve out of Medicaid funding to Tribes/Pueblos should be considered such that local facilities and service providers can benefit patients with case management, care coordination, transportation, personal care, respite care in a more intergraded fashion.

o   The health committee believes that the opt-out category should still be intact and the choice to enroll in Managed Care should remain with the individual Medicaid enrollee.

o   In the past, with the institution of the Salud program, Native Americans were mandatorily enrolled in Managed care.  This experience resulted in a loss of revenue to IHS and 638 facilities and confused the Native population. Currently approximately 80 % of Native Americans enrolled in Salud still opt-out of managed care in the face of enrollment efforts by the state and MCO’s

·         Managed care organizations need to involve Tribes/Pueblos early in the proposal process to allow Native programs and providers the opportunity to be included in strategic planning

·         The Health Committee also stands by its support of Tribal leadership and does not accept the State mandate for enrolling Natives into managed care.

·         Tribes and Pueblos should be allowed to develop their own system of care management which includes all on and off reservation providers which provide primary and secondary services. The State should allow Tribal/Pueblo programs and providers to be in these case managed systems with HSD collaboration to provide technical assistance such as getting billing, coding and reimbursement services, integrative systems need to be developed to track clinical, behavioral health and long term care services needs and documentation of non-duplication by service providers, and patients are not inappropriately utilizing Medicaid services.

In conclusion the Health Committee still believes the opt-out category should remain intact and if patients choose to enroll in managed care, it should be a personal choice.  The State needs to understand Tribal Protocol from the Tribal/Pueblo perspective and honor these protocols when meeting on reservation lands.  The Health Committee also believes that All Indian Pueblo Council (AIPC) resolution allows them to represent Pueblo elders and disabled members on matters of elder healthcare.

Respectfully,

Dr. Ron Lujan

For the NMICoA Health Committee

Now, having attended this and other consultations regarding this topic (Centennial Care) by the NM HSD, I have the following Statements, comments, questions:

How can these sessions be considered meaning full when Tribes have no advanced viewing of the material?  After searching HSD Web Site I have not found a current copy of the waiver or a copy of the Slide presentation that was given on on June 30, 2012.  How are Tribes who did not attend suppose to make informed decisions on Centennial Care without viewing these two Documents?

The waiver information that is posted on the HSD web site is the one that was submitted (and later resented) to CMS in February 2012.  The slide presentation that was given to Tribal leaders had a lot of new material  that is not part of the February version of the Waiver. 

I share Governor Madalena's sentiment regarding the state referencing data, that does not include Tribal data, that shows we have the worse health disparities and outcomes. 

All Tribes are still opposed to the Mandatory inclusion into Managed Care, the opt out category being taken away, charging co pays for any Medicaid Service regardless of where medicine is obtained, and getting rid of the prior quarter coverage.  The State believes that Enrolling Native American Indians in Managed care will elevate their health, but even though we have asked many times for the Data supporting the claims, NM HSD has not provided this information.  That is a claim being use across the country to advocate for managed care but there is no evidence that being enrolled in and MCO improves the individuals health, it does decrease state spending and increases MCO profits.

Even though the State HSD has come up with several new ideas to help entice Tribes into accepting Centennial Care, they still have not done their homework,  many of the incentives like, mini block grants, and paying a PM/PM for services provided by IHS and 638 facilities, would require Federal approval, IHS direct services Tribes would not be able to take advantage of them. 

These are just  a few of the concerns I have that we all should be taking into count.

I will be posting more comments and questions regarding Centennial Care as I analyze the current documents.