Ohkay Owingeh
Position Paper
For CMS
State of New Mexico Centennial Plan
Ohkay Owingeh opposes the New Mexico Medicaid plan detailed in the Centennial Care Concept paper.
Centennial Care is presented by the State of New Mexico as a means to ensure Health Care for New Mexicans for the next century. The consequences of these plans will reduce costs by limiting medical services and care coordination to all New Mexican residents.
Native Americans specifically will be imposed the same limitations’ which would include a direct threat to tribal sovernty and authority by the state.
I. THE DIRECT THREAT OF AUTHORITY AND SOVEREIGNTY FOR OHKAY OWINGEH IS POSED BY THE CENTENNIAL CARE PLAN.
Ohkay Owingeh tribal member’s choice of health service has always been the Indian Health Service. PL 93-638 law authorizes Ohkay Owingeh (individual Tribal Nations) to contract our shares of health care funds that would have been spent by the IHS on our individual tribal members. This law authorizes Ohkay Owingeh (individual Tribal Nations) to determine and design the best health care system for our tribal population. Ohkay Owingeh uses surveys, health data, expendable analysis, prevalence data, and a number of other health measures provided by IHS to determine the shape and scope of our health system (IHS). Ohkay Owingeh then assists in formal financial planning of IHS. Part of the planning includes 3rd party revenue collecting inclusive of Medicaid reimbursements.
A. STATE TRIBAL GOVERNMENT TO GOVERNMENT
RELATIONSHIP
Senate Bill 196 (State Tribal Collaboration Act) requires that the state hold consultations with tribes in respect to all issues concerning or affecting Native Americans in New Mexico. Since the elimination of the Office of American Indian Health and its Directors, the state has failed to live up to its responsibilities. The State of New Mexico has failed to have consultations with New Mexico Tribes when the options of improved Medicaid services and cost savings became available. Listening sessions with the tribes were not consultations. New Mexico Medicaid plan had been finalized prior to these so called consultations. Comments, concerns or objections of the Centennial Care Plan were not documented and submitted in the application. If meaningful consultations had been conducted by the state with the tribes there would have been comments on the proposed Centennial Care Plan. The documents would have been submitted in the application. The information and the documents would have provided CMS with an understanding of the concerns of New Mexico tribes. The changes would then have been addressed and engaged with the tribes directly and submitted in the application. It is with this the Ohkay Owingeh and other tribal leaders request to have CMS hear our objections and our following requests:
OPT IN EXEMPTION CENTENNIAL CARE
Ohkay Owingeh (tribal leaders) request an exemption from New Mexico’s proposed mandate to include tribal Medicaid enrollees in the Centennial Care Plan’s managed care program. We ask that individual tribal members have the choice to either opt in or out of Centennial Care Plan.
Given the relationship among the tribes, the Indian health system, and the federal government, Ohkay Owingeh and tribal leaders ask by what authority can The State of New Mexico mandate fundamental changes in the delivery of health care to our people and Native Americans residing in New Mexico. Even though the Centennial Care Plan requires MCO’s to contract with I/T/U’s. The I/T/U’s are under legal obligations to contract with MCO’s and federal law still requires New Mexico to pay for any services rendered to Native individuals in any Indian health system facility. Even if New Mexico were able to compel the participation of Ohkay Owingeh tribal members in managed care the waiver does not effectively address the issues of our members who receive services from IHS clinics, 638 compact health facilities, and contract health services (CHS). Congress, through legislation enacted over decades, has created a multifaced health care system for tribal communities, a system that includes IHS and tribal health facilities.
Ohkay Owingeh has never received data on how the New Mexico State’s plan for managed care of our tribal members in Ohkay Owingeh will produce better health care outcomes. Concerns with PCP’s will reside in urban communities which may be as far as 200 miles away. Ohkay Owingeh tribal members are comfortable with IHS, they will not be able to accommodate an MCO to obtain their health care. Our experience with Salud and other providers was that once they were enrolled you never heard from them or the services they provided were limited. There were always delays in obtaining permission for services. What was sad was how services were denied by PCP’s who they had never seen. The ability for Ohkay Owingeh tribal members to opt in if the feel that their health care needs will be met is paramount.
B. MAINTENANCE OF THE FEE FOR SERVICE OPTION
Ohkay Owingeh requests that the Centennial Care Plan retain the traditional FFS option to compensate IHS clinics and other Indian health systems facilities for the services they render. About 85 percent of the Ohkay Owingeh Medicaid population is FFS. The proposed managed care system will shift the financial burden from the state to the tribes and CHS. As much as 70 percent of revenue will leave the Indian health system as a result of the Centennial Care Plan. Will the MCO be receiving payment when providers in the Indian Health System deliver service?. The state at this present time allows FFS for undocumented aliens and refugees but not for American Indian individuals. It is very difficult and time consuming when payment is being secured by middlemen.
C. END RETROACTIVE ELIGIBILITY
Ohkay Owingeh (tribal leaders) request that the Centennial Care Plan exempt Ohkay Owingeh tribal members (Native Americans) from the proposed termination of retroactive eligibility. If the State of New Mexico eliminates retroactive eligibility, a huge burden for individuals may result. If individuals are not CHS eligible they may face huge debt which will go to collections. Paying for the cost of denial of retroactive eligibility will shift the financial burden from the state to the tribes or CHS.
In concluding, if the State of New Mexico can not accommodate Ohkay Owingeh (tribal leaders) with these three requests, then on behalf of Ohkay Owingeh we recommend that the New Mexico 1115 waiver proposal be rejected in its entirety.
Ohkay Owingeh believes that tribes should be afforded the opportunity to select Native Americans to represent them in the Native Advisory Board and the Native American Technical Advisory Sub Committee.
Ohkay Owingeh leadership concur with all our native brothers and their concerns and objections and issues with the proposed New Mexico Centennial Care Plan.
Ohkay Owingeh also supports the comments, issues, and suggestions of the panel of the tribal advisement. April Wilkinson, Eric Lujan, Anthony Yepa, Quela Robinson
Sincerely
Governor Marcelino Aquino
Ohkay Owingeh
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