NM HIX Native American Work Group recommendation

From Roxane Bly Co-chair of the NM HIX Workgroup:

Based on the current situation, we believe our best strategy is to ask tribal leaders to invoke the consultation policy and meet with CMS directly.  I will be drafting a template that we can use for these letters.  The State has not formally consulted with the tribes regarding the Health Insurance Exchange since 2011.

Exchange Legislation:

• SB 221 is Senator Shendo's bill to establish the NM Health Insurance Exchange.  It passed the Senate on 3/11 with a 36-5 vote.  It's been assigned to the House Health, Government & Indian Affairs Committee and is expected to pass through the House.  There are significant problems/flaws with this bill, but at this point, we each need to consider what is best for our consumers - a federally facilitated Exchange or a flawed State Exchange
• One good thing about SB 221 is it includes language to establish the Native American Service Center.

The Following document is a Template that Tribal leaders can use to invoke Tribal Consultation.  Supporting documents can be found in previous posts on this Blog.


Marilyn Tavenner
Acting Administrator
Center for Medicare & Medicaid Services
7500 Security Blvd
Baltimore, MD  21244

RE:  New Mexico Tribal Consultation

Dear Ms. Tavenner:

In November 2011, the State of New Mexico was awarded a Level I Establishment Grant to develop the New Mexico Health Insurance Exchange (NM HIX).  Included in the grant was an initiative designed to create a Native American Service Center (NASC) to ensure that the NM HIX is accessible, complies with American Indian components of the Affordable Care Act (ACA) and Indian Health Care Improvement Act (IHCIA), and facilitates meaningful, ongoing tribal consultation.   Approximately $1.3 million was allocated for tribal consultation, Native American outreach, education, and assistance activities, and staffing for the NASC.

Since 2010, the State of New Mexico Human Services has not formally consulted with tribal leaders regarding plans to establish the NM HIX and NASC.  Further, they have not spent any of the Establishment Grant funding to complete any of the activities for which the $1.3 million was allocated.   As part of the New Mexico Health Insurance Exchange Advisory Task Force, the State convened an informal Native American Work Group , but recently cancelled its meetings and suspended its activities.

Despite the lack of formal consultation, the State has proceeded to make pivotal decisions and miss key deadlines related to the establishment of an Exchange.  Specifically, they have chosen to suspend all activities related to the Establishment grant until there is an entity established with the legal authority to operate as the NM HIX.   While efforts have been made to pass legislation necessary to allow the New Mexico Health Insurance Alliance to operate as the NMHIX, it is not clear that Governor Martinez will enact it.

This letter serves as a formal request to consult with the Center for Medicare & Medicaid Services and the Center for Consumer Information and Insurance Oversight regarding the New Mexico Health Insurance Exchange and Level I Establishment Grant funding.  It is not acceptable for the State of New Mexico to proceed with (or suspend) key policy and funding decisions without formally consulting with the New Mexico Indian Pueblos, Tribes, and Nations.

Sincerely,