I wrote this commentary paper for the Legislative Health and Human Services Committee panel on the NM Health Insurance Exchange that was suppose to take place on Oct 4th in Hobbs NM. Unfortunately this panel was cancelled so I have decided post this commentary here instead. When I started to write this commentary the first draft was very inclusive and was around ten pages long. I condensed it to two for the legislature and this is the result. I will post the ten page version when I complete it.
Comments for the Legislative Health and Human Services
NM Health Insurance Exchange and Native Americans
I’d like to thank the Committee chair for giving me the
opportunity to provide commentary on this important issue. My name is Erik Lujan, I am a consumer
advocate for the New Mexico Indian council on Aging, and for the last four
years I have been following and participating in Health care reform and PPACA
Implementation here in NM.
For the purpose of
this commentary I would point out that in NM we have the State Tribal
consultation collaboration and Communication Act that is the basis for how
State agencies interact with the many Tribes, Nations and Pueblos. Included in
the Act are the requirement for each state agency to develop a tribal
consultation policy, hire a Native American Liaison. The Act also requires that
State Agencies must consult tribal leaders when the agency is making a change
in funding that will affect Native American communities, and individuals. The
Act also elevated the Indian Affairs Department to a cabinet level state
agency.
Additionally, within the Legislation which established
the Health Insurance Exchange, Senate bill 221, passed in 2013 there were
several provision that were specific to Native Americans. The NM Health Insurance Exchange (NM HIX) is
required by law, to hire a Native American Liaison to assist the Executive board
in outreach education and consultation with NM Tribes, Nations, and
Pueblos. Also required by law is the
establishment of a Native American Advisory Committee composed of Native
Americans representing communities on and off reservations. The NM HIX also has the option to create a
Native American Service Center, which is intended to provide a call center
function for Native consumers, as well as technical assistance with eligibility
and tribal enrollment verification.
There has not been any formal consultation between the
state and Tribes regarding the NM HIX, the last scheduled consultation was set
for April of 2011, this session was cancelled and never rescheduled. Since then
the NM HIX has included Native Americans in none informal workgroups and committees
and taskforces:
Native American Workgroup, the office of Health Care
Reform (OHCR) established a task force to begin developing policy and
guidelines in anticipation of the passage of legislation creating a state based
health insurance exchange. The Native American Workgroup (NAWG) was created to
provide guidance and insight into how the NM HIX would interact with NM’s
tribes Nations and Pueblos. The NAWG worked topic such as: Job description/role
of a Native American Liaison, consultation policies, creating a Native American
Service Center and its functions, Tribal exemptions in the ACA, verification of
Tribal enrollment eligibility for the HIX. The NAWG was composed of Advocates,
healthcare providers, IHS and leaders. At each meeting it was clearly stated
that the workgroup did not constitute tribal consultation and that the state
needed to formally consult with tribes on the activities of the Human Services
Department Office of Health Care Reform and the HIX
Native American Listening Session, the NM HIX Native
American Standing committee, in order to address NA concerns instructed Mike
Nunez, the Interim CEO, of the HIX to hold a listening session in order to
solicit comments on what the needs of tribes were when it came to development
and implementation of the HIX. Over 70 NA representatives participated in this
session and the message was loud and clear. First Consultation with Tribes
needs to happen as soon as possible, second the HIX needed to hire multiple
Tribal liaisons, and third the Native American Advisory committee must be
convened as soon as possible.
Interim Native American Advisory Committee- following up
on a suggestion that came out of the listening session an interim advisory
committee made up of members of the previous Native American Work group was
convened to develop a communication policy for the HIX, this effort was
replaced with the hiring of a Native American Consultant.
At an emergency session of the HIX board it was announced
that Poston and Associates was hired to help the board and staff to create a
tribal communication collaboration policy and facilitate outreach and education
with Tribes. Also Scot Atole (Jicarilla
Apache) was hired as a Native American Coordinator. When I asked what the selection process was
to hire Poston and Associates, Mike Nunez relied that there was no RFP and that
selection was made by Staff of the HIX.
Native American communication collaboration session, on
October 2, 2013 another listening/communication session was held with the intent
to solicit guidance on developing consultation policy, development of a Native
American service Center, Marketing best practices.
Throughout the development of the NM HIX there have been
many instance where Tribes have unanimously state the same issues that needed
to be addressed by the HIX: Meaningful Tribal Consultation, hiring of a Tribal
Liaison or multiple Liaisons, and establishing a Native American Advisory
committee, all of which are mandated by the law governing the HIX. These Three task have yet to be completed.
It has been established that the NM HIX is a Quazi
Governmental non-profit organization and therefore is not subject to the State
Tribal Consultation Collaboration and Communication Act. This may be the case
but the Act clearly states that any time and Agency applies for or changes
funding that will directly affect Tribal individual’s communities and Tribes,
there agency is obligated to hold formal consultation with NM Tribes Nations and Pueblos in order to inform
them of the changes. While the NM HIX is
a quazi- governmental organization the NM Human Services Department, the
umbrella organization to the NM HIX, was the cabinet level state agency that
applied for the original Level one establishment grant of $34 million and the
secondary grant of $8 million. Since applying for and receiving the grant
funding HSD has held on to that funding.
The HSD Secretary Squire should be aware of the obligation to consult
with Tribes given the recent consultation sessions with the Medicaid program.
From my point of view the NM HIX has had many opportunities
to address Native American issues, and has at times delayed, and not fully
taken advantage of the work and resources available.
Respectfully,
NMICoA Health Committee
(505) 280-2811
elujan78@gmail.com
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