NMICoA Health Committee Comments for Consutlation

January 23, 2013

NMICoA Health Committee

Comments for CMS/Tribal/HSD Consultation

The Health Committee of the New Mexico Indian Council on Aging (NMICOA) was founded in response to the institution of Coordination of Long Term Services (CoLTS) by the state of New Mexico’s Human Services Department (HSD).  In late 2008, Health Committee members met with representatives of HSD, Aging and Long Term Services (ALTS) and Indian Affairs Department (IAD) officials to discuss issues and concerns regarding the CoLTS program and mandatory enrollment of eligible seniors in to managed care programs contracted by HSD to provide Medicaid services to native seniors.  The Health Committee at present sees the Centennial Care Plan as increasing the confusion of Pueblo seniors in understanding a greater array of managed care organizations (MCO) from which to enroll in.  The two current MCO’s have not been fully understood by this population and expansion to a greater number of MCO’s will certainly become more problematic.

Members of the Health Committee have identified the following specific concerns:

●     Through various treaties, acts and executive orders, the federal government has an obligation to provide health care to Native American people;

●     The government-to-government relationship has not recognized the federal –tribal relationship in these discussions where state government has had no meaningful consultation with tribes in NM;

●     The Health Committee views the mandatory enrollment of ALL Medicaid eligible Native Americans as contrary to the protections of Patient Protection and Affordable Care Act (PPACA) and Indian Health Care Improvement Act (IHCIA) which exempts Indian people from these state requirements.  The Committee sees this as erosion of the Federal-Tribal sovereign relationship;

●     Possible change in the OMB reimbursement to IHS/Tribal “638” facilities and sub-capitated reimbursement to the Indian Health delivery system by MCO’s; and

●     Loss of presumptive (retroactive) eligibility for Medicaid eligible individuals which may adversely affect access to appropriate health services not available to Indian patients at IHS/Tribal “638” facilities.

In summary, the NMICOA Health Committee has serious concerns about managed care being mandated to our people.  We understand the Medicaid funding is also meant to provide health care services to Indian people from a government-to-government relationship and request that CMS consider more appropriate Tribal input and consultation in order to maximally benefit Medicaid eligible Indian people to meet their healthcare needs.

 

Respectfully Submitted,

 

Florence Chavez                                                        Ron Lujan, MD

Vice President NMICOA                                           Pueblo of Taos/Pueblo of Ohkay Owingeh

Pueblo of Sandia                                                       

 

Manuel Cristobal                                                       Joe Cherino

Councilman                                                                Pueblo of Taos/Sandia                     

Pueblo of Santa Ana (Tamaya)

 

Eloise Smith                                                               Kay Ray

Pueblo of Laguna                                                      President Elders Association

                                                                                      Pueblo of Laguna

 

Leonard Armijo                                                         Joe Ray

Councilman, Former Governor                               Executive Director

Chairman Veterans Affairs AIPC                            Native American Independent Living NAIL

Pueblo of Santa Ana                                                  Pueblo of Laguna

 

Erik Lujan

Volunteer Advocate/policy analysis

Pueblo of Taos/ Pueblo of Ohkay Owingeh