Good day, Everyone:
The Kewa workgroup met on April 17 to address a number of issues related to healthcare reform, including the newly established state health insurance exchange. For those of you unfamiliar with the Kewa group, it originated several years ago in response to the state’s announcement of its Centennial Care plan to manage the Medicaid program. The group has been influential in educating the tribes regarding the problems related to Centennial Care and its work formed the foundation for the eventual ruling by the Center on Medicare and Medicaid Services (CMS) to prohibit state mandatory enrollment of Native American Medicaid beneficiaries in managed care organizations (MCOs). At the most recent meeting, Kewa Health Corporation board members and staff questioned the wisdom of maintaining the name, Kewa workgroup, because the workgroup is not a function of the Kewa Health Corporation and only has the name because initial meetings of the group were held at Kewa Pueblo. Since the Medicaid Convening last October, the concept of the Kewa workgroup which originally included only Pueblo members has been expanded to include healthcare staff from all the tribes and off-reservation facilities. Anthony Yepa, Acting Director of Kewa Health Department, told the attendees at last weeks’ meeting that he and members of the Kewa Health Corporation Board of Directors believe it is time to recognize the growth and intertribal mixture of the group and that it should be renamed to reflect not only the growth of the group but should take on the definition of an intertribal effort. Since then the name for the expanded group has become “Intertribal Health Workgroup” which encompasses tribal people on and off-reservation.
Issues discussed:
1. Kelsey Heilman, Center on Law and Poverty healthcare team attorney, commented on work being done at the Center regarding the health reform law that will be made available to tribal officials and workers within the next two weeks which will focus on specific features pertaining to Native Americans. There will be two documents: one will be a pamphlet which can be distributed in clinic offices and other places and the second will be a small manual for use by healthcare workers to give them full information about the Health Reform Law and to assist them in advising and informing consumers in their facilities. She also highlighted various features of the health reform law that need our attention, such as money in the Health Insurance Exchange for in-person assistants, the Native American Advisory Committee and the Native American Service Center. The Native American Subcommittee of the Medicaid Advisory Committee also needs attention. Attached to this email is a list of upcoming Exchange deadlines prepared by the Center’s healthcare attorneys. 2. Iris Reano, Kewa CHR Director, told the group about the work the CHRs are doing at Kewa Pueblo and said that home visits are proving to be the most efficient means to educate the people about the benefits of enrollment in Medicaid and the upcoming Health Insurance Exchange. At the inaugural meeting of the New Mexico Health Insurance Exchange on Monday Apr. 29 and Tuesday Apr. 30, funding is issue no. 8 on the agenda. The Health Reform Law of which the Exchange is a function provides for monies to support a program of in-person assistants. It will be important to make sure that the needs of the people are reflected in a grant application submitted by the Exchange. A request for funds to support the work of in-person assistants in all the Pueblos and Native communities in the state should be part of the Exchanges grant application.
3. Representative Roger Madalena (Jemez) told the attendees at the meeting that he hopes that the group will establish a strong identity and that there will be a representative from each of the tribes. He sees the Intertribal Health Workgroup as the locomotive that can be used to inform all the tribes of issues that require attention and effort. He stressed the importance of the people speaking with the same voice. He recognized that there will be differences of opinion but that those differences be handled within the group and that the participants strive to compromise so that in public we are seen as one. He is concerned that the navigator program which can provide essential assistance to the people is unfunded and offered to talk with the gaming tribes regarding their state contributions and the possibility that some of those funds could be designated to support a navigator program for the tribes. He stressed the importance of organization of healthcare staff and officials and the need for a public structure so that leadership is well=-recognized.
4. Michael Hely who is on the staff of the Legislative Counsel Service and was the lead drafter on HB 376. stressed the importance of contact with the Legislature and its committees so that the members are well aware of tribal priorities. He recommended that healthcare staff and officials provide information to the Legislative Health and Human Services Committee at interim hearings throughout the state. The Center on Law and Poverty is again partnering with Regis Pecos’ Leadership Institute to produce another convening that will address both the Health Reform Law and Medicaid. The Center’s healthcare team attorneys are working on a Health Reform Law checklist which will form the basis of their presentation at the convening. It is constructed in such a way that attendees will be able to identify those issues that are most pressing and on which the Intertribal Health Workgroup and the officials can work. The convening is tentatively planned for the latter part of June. This will give time to put together the information that can be presented to the Legislative Health and Human Services Committee and other committees during the interim period before the Legislature meets again. One of the issues that we might address at the convening is whether or not to ask Rep. Madalena to reintroduce HB 376.
He explained that the Health Insurance Exchange is a non-profit corporation not a state agency but it is governed by state law. It was established on March 28th and within 60 days of that date it is charged with the appointment of a Chairperson and development of a preliminary plan of operation. By September 28 the Exchange must have a final plan of operation that will include decisions regarding the navigator and in-person assistant programs, policy regarding communication and collaboration with Indian tribes which will include issues of cultural competency. A Native American liaison will be appointed to assist the Health Insurance Exchange Board to ensure implementation of the exchange program in tribal and off-reservation communities. The law that governs the Exchange does not require that the Native American liaison be a Native person. This matter will be discussed at the inaugural meeting on Monday and Tuesday of next week. It is in our best interest that the liaison be Native and it is difficult for me to understand how the Exchange can fully comply with the requirement for cultural competence if a Native person is not appointed to this very important position. As you will note the agenda for the Exchange meeting also includes decision-making about the Native American Service Center, consumer outreach and assistance and the Native American Advisory Committee. These issues are crucial and need serious attention. Participation in the inaugural meeting provides the opportunity for tribal and off-rez people to be involved in the design of resources made available through the Exchange. Teresa Gomez (Isleta) has been appointed to the Exchange Board and she has pledged to advocate for tribal and off-rez healthcare issues and needs.
5. Anthony Yepa called attention to the need for tribes to work to help restore the IHS budget which was cut more severely than other agencies by the sequestration. If you need more information about what you and your tribe can do, please contact Anthony at ayepa@kp-hc.org. It may be that tribal officials and the Intertribal Health Workgroup would want to launch an effort regarding the IHS budget like that conducted to convince the Center on Medicare and Medicare Services to issue a ruling prohibiting a requirement that Native American Medicaid beneficiaries enroll in managed care.
New Mexico Workforce Training Center – Room 207
5600 Eagle Rock Ave. NE
Albuquerque, NM 87113
Monday, April 29th: 10:00am to 5:00pm
Tuesday, April 30th: 9:00am to 5:00pm
A map is attached.
Best regards, Evelyn
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