NMICOA contribution to HB376 support documents

Native American Long Term Care Services (LTCS) Home and Community Based Services (HCBS) vs. Managed Care Organization (MCO)

The New Mexico Human Services Department (HSD) has made the claim that their Coordination of Long Term Services Program (CoLTS) has improved the Health disparities of New Mexicans across the State.  While this may be true for Urban Areas, where individuals enrolled in a Managed Care Organization (MCO) have readily available access to Doctors, Specialists, hospitals, and Laboratory facilities and other LTCS, the rest of the state in considered “rural” or “frontier”.  In these regions of the State there is a severe shortage of medical professionals and facilities that are part of or contracted by these MCOs.  On reservations there is no MCO presence in the case of Doctors’ offices or medical Facilities, only Indian Health Services (IHS) and Tribal operated health facilities (Tribal 638).  Often times an individual Native American who is enrolled in an MCO doesn’t utilize services through the MCO because they rely on IHS or Tribal 638 facilities.  MCOs do not track Health data for Specific Native American consumers.  We have seen no Health outcomes/disparities data Specific to a certain Tribe or Native Americans in general.  The NM HSD has made no attempt to obtain/include any Health outcomes/disparities data to include in the development of the Waiver or to compare or support their claim that the CoLTS Program has improved or elevated the Health outcomes/disparities for NM Native American Population. 

HSD has also state that  a “Fee For Service” model will not improve Health outcomes for Native Americans because there is no ability for care coordination, no access to LTCS or access to value added benefits provided by MCOs.  Case management and care coordination does happen at the IHS tribal 638 facilities, through established Indian Health Services/Tribal 638/Urban Indian Healthcare Providers (I/T/Us) Benefits coordinators, social services and Community Health Representatives (CHRs). Services provided by these programs are culturally sensitive, relevant and parallels traditional modes of elder care in previous generations.  I/T/U benefits coordinators refer enrolled individuals as needed for specialty care off reservation, using Medicaid funding.  This system utilized by the Tribes and IHS is similar to a “Money Follows the Person” model.  A health care provider is reimbursed on an encounter basis for approved health care services provided.  Through the “2013 Money Follow the Person Tribal Initiative” release by the Centers for Medicare and Medicaid (CMS) Tribes could have, with CMS approval and meaningful collaboration with the state, initiated, developed and implemented their own Medicaid program which could include a Tribal specific health benefits package including LTCS and care coordination.    The IHCIA mandates the IHS to begin providing LTCS.

 Utilizing a “Fee for Service” or “Money Follows the Person” model would allow Tribes to develop and provide much needed healthcare services on reservation and in Rural Areas. More importantly the I/T/U could take advantage of the 100% Federal Medical Assistance Percentage (FMAP) on behalf of an individual Native American Medicaid enrollee.  This would relieve the State on paying 25-30% of the FMAP on behalf of the individual Native American Medicaid enrollee for health care services obtained through a Medicaid provider.

Approximately:

FMAP for NM 28-32% State 72-68%  Federal

$4,000,000,000 total Medicaid program cost

$1,000,000,000-$1,200,000,000 State of NM Share of Medicaid Program cost

15-20% Medicaid population is NA

$150,000,000-$240,000,000 potential state savings if NA self-directed Medicaid program