MCOs contacting Tribal leaders and programs while disregarding CMS ruling

From the Pueblo of Jemez Health and Human Services Director:

Evelyn – please distribute to the listserv.  Thanks

 

Please be aware that Molina ,and possibly others will follow, are coming on to the Pueblo’s unannounced and asking to meet with Tribal leadership to push its managed care product.  What they are basically telling your tribal members and tribal leaders is that our managed care is better than your tribe’s managed care – be it provided by the tribe or IHS.  Molina was out here three times unannounced and even set up a booth on feast day (somehow).  I don’t know if they signed any our tribal members up for Molina but this is upsetting. 

Maria K. Clark
Director, Jemez Health & Human Services

 

From the Center on Law and Poverty:

 

 

Good afternoon, Everyone,

HSD and the MCO salespeople are making the rounds attempting to contract with tribal programs and enroll tribal members.  These salespeople are telling the officials and people that the healthcare services which will be provided by the MCOs are superior to those provided by IHS, tribal and off-rez facilities.  Despite the fact the tribes and advocates won the CMS ruling that removes the MCO enrollment mandate, HSD tribal liaison Theresa Ballenger and MCO representatives are disregarding the ruling.  Regrettably these disregarding behaviors are not unusual.  The violators are comfortable in their belief that they cannot be stopped.  At this juncture it is clear that the state does not accept the CMS ruling in fact and will only give lip service to it.   I have suggested to tribal officials that the MCOs receive a letter informing them of proper procedure and protocol when doing business with their tribe.  The CMS ruling that removes the requirement that Native Medicaid beneficiaries enroll in an MCO must be honored.  This behavior points up the importance of state legislation such as HB 376 which Representative Madalena will reintroduce in the next legislative session.  We worked to get it passed the first time and were sabotaged by the complicity of the HSD and Senator John Arthur Smith’s office.  We learned a lot from our first try and will put it to use in this second effort and will succeed.  There is no question now that a state law is needed to protect the rights of Native people to make their own decisions about healthcare and its delivery.  The implications of MCO takeover of healthcare services are serious and have the capacity to threaten the growth and development of indigenous healthcare systems.

Best regards, Evelyn