Medicaid Expansion question

 

The following letter was emailed to me from Cynthia Lacounte, I met her at the NICOA conference here in Albuquerque NM, she sat in on my presentation.  After the presentation she offered to ask the following of her supervisors and CMS TTAG Reps.

 

Cynthia LaCounte

Director

Office for American Indian, Alaska Natives and Native Hawaiian Programs

Administration for Community Living

Administration on Aging

 

"Dear Erik,

Cyndi Gillespie has responded to the Medicaid Expansion questions from NICOA below. Please note that she has asked for clarification on your second question.

Does the Expansion of Medicaid first require the Governor’s office to consult Tribes before any action is taken?

The Medicaid and CHIP programs require States to solicit advice from Indian health providers and urban Indian organizations on any changes that have a direct effect on Indians, Indian health programs or urban Indian organizations. In order to comply with this requirement, NM submitted a State Plan amendment outlining a process for seeking advice from I/T/Us. In New Mexico’s State Plan, they also include consulting the federally-recognized tribal governments, as well as the health providers. When the NM tribes and I/T/Us worked with the State on the process, they defined direct effect as those items reducing eligibility, coverage or payment to the I/T/Us. Since the Medicaid expansion would increase eligibility, they would not have to consult or solicit advice for the expansion, although they certainly could choose to do so or tribes could request they do so.

Does the Governor’s office have the authority to make the decision on behalf of NM Sovereign Tribes?

I am not sure what you mean about this question. Medicaid is administered by States because of the Statutory requirements that a single state agency administer the program. Can you clarify the question?

I will be out of my office until October 9, but Cyndi’s contact information is given below. I will be working remotely, however, so I will be available.

Cyndi Gillespie, Technical Director"

 

 

After receiving this response I am unsure where "they" are getting thier information from because it is clear that some tribes where consulted with but not all, and the comments, position, views, of the Tribes weren't really reflected in the "State Plan Amendment"

 

the next portion is from CMS TTAG reps.

 

 

Subject: Questions regarding Medicaid Expansion

Dear John, Richard and Cindy,

I hope this finds you all doing well.

I attended the National Indian Conference on Aging last week in Albuquerque, which is always such an exciting event. I attended a session on Medicaid in New Mexico that was presented by Mr. Erik Lujan who works at the Native American Healthcare Alliance in New Mexico. It was an excellent session, and I was very impressed with Mr. Lujan’s working knowledge of the Medicaid Program.

With the decision that Governor Martinez is facing on whether or not to expand Medicaid statewide, two of the concerns noted for Tribes in New Mexico were:

· Does the Expansion of Medicaid first require the Governor’s office to consult Tribes before any action is taken?
· Does the Governor’s office have the authority to make the decision on behalf of NM Sovereign Tribes?

Please include Mr. Lujan in your response and contact him with any additional questions or for additional information.

Thank you so much for your assistance.

Cynthia

Cynthia LaCounte

Director

Office for American Indian, Alaska Natives and Native Hawaiian Programs

Administration for Community Living

Administration on Aging

 

I have not recieved a response from CMS TTAG to make a comment on.

I have also not received any response from CMS Dallas Region on the first document submitted in August 2012.