House Bill 376 and supporting documents

American Reinvestment and Recovery Act Section 5006
42 U.S.C. §1396u-2(a)(2)(C)
http://www.law.cornell.edu/uscode/text/42/1396u-2
(C) Indian enrollment
A State may not require under paragraph (1) the enrollment in a managed care entity of an individual who is an Indian (as defined in section 4(c)  [1] of the Indian Health Care Improvement Act of 1976 (25 U.S.C. 1603 (c)) unless the entity is one of the following (and only if such entity is participating under the plan):
(i) The Indian Health Service.
(ii) An Indian health program operated by an Indian tribe or tribal organization pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination Act [25 U.S.C. 450f et seq.].
(iii) An urban Indian health program operated by an urban Indian organization pursuant to a grant or contract with the Indian Health Service pursuant to title V of the Indian Health Care Improvement Act [25 U.S.C. 1651 et seq.].

• There is uniform opposition from New Mexico’s 20 pueblos, the Mescalero and Jicarilla Apache tribes, and the Navajo Nation due in part to the state’s failure to adhere to New Mexico’s 2009 State Tribal Collaboration Act requiring the state to collaborate with Indian nations, tribes and pueblos in the development and implementation of any policies that directly affect these populations.
• The American Reinvestment and Recovery Act Section 5006(e) (“ARRA”) and federal guidance mandates that state plans for Medicaid must involve extensive and regular consultation with tribal Indian Health programs and Urban Indian Organizations and must “include solicitation of advice prior to submission of any plan amendments, waiver requests, and proposals for demonstration projects likely to have a direct effect on Indians, Indian Health Programs, or Urban Indian Organizations”.

• IHS and Tribal clinics had provided information demonstrating that outsourcing Medicaid services to national managed care corporations will deprive tribal health care providers of millions of dollars of revenue and will not result in better health care for these communities. (see letter from Pueblo of Jemez)
• In 1997, Native Americans were auto-assigned to Salud! Managed Care organizations that didn't have facilities in tribal communities.  Albuquerque I.H.S. lost an estimated $2 million and the Navajo I.H.S. lost $10 million in reimbursements in 1998 due to this policy, but continued to provide services to patients.
• The state’s behavioral health contracts with MCO’s Value Options and OptumHealth in 2008-2009 resulted in lapsed payments of over $900,000 to I/T/U’s.
• Under the mandatory managed care CoLTS program implemented in 2009, the financial systems of CoLTS contractors did not have the ability to track payments owed to providers. I/T/U’s waited for payments in excess of $300,000 due for over a year.
• In FY12, over $85 million was generated by I.H.S. from serving more than 360,000 people. These funds and the infrastructure they support are directly threatened when MCO’s stand between tribal providers and the communities they serve.
• The state can provide no data showing that mandatory managed care has resulted in better health outcomes for Native Americans
• The state also has not provided any information about how Native Americans will be identified or enrolled in managed care, how the provision of services will be tracked, or how these individuals will be provided with information about dis-enrollment or how to “opt out” of their MCO.
• 15% of the Native Americans eligible for Medicaid statewide have enrolled with an MCO.

• Under managed care, for Native American, who is enrolled with an MCO, the state will pay the MCO upwards of $1700/patient/month. This amount is called a per-patient per-month (“PMPM”) or “capitated” rate, and is paid monthly regardless of whether or not the patient utilizes or has access to the MCO’s services. In fact, the state’s contracts with the MCO’s indicate that the state will share half of any profit generated by the MCO’s in excess of 3%. Profits that only increase when the PMPM rate is not spent on providing services.