Friday, August 31, 2012
"KanCare" Kansas 1115 Waiver with the NA portion still "opted Out"
I got Kansas's 1115 Waiver "Kancare" off the Center for Medicare and Medicaid (CMS.gov) yesterday, and reading the Native American Specific portion of the Waiver (the last 10 pages or so) I found that Kansas really understands Tribes, the Federal obligation and the Government to Government relationship. The 4 Tribes in Kansas cited several laws that proved that States DO NOT HAVE the RIGHT to MANDATE Native Americans into MANAGED CARE. The way the waiver is worded the Tribes allowed their members to be automatically "OPTED INTO" Managed care with the Ability to then choose to be "OPTED OUT'. This is the point that we here in NM need to make other Tribes still have the an "OPT OUT" catagory.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ks/ks-kancare-pa.pdf
Center on Law and Poverty Comments on Resubmitted Centennial Care 1115 Waiver
A Few Quick Comments on the Resubmitted Centennial Care 1115 Waiver
by Quela Robinson From The Center on Law and Poverty
The final 228-page proposal submitted today contains changes which represent important victories for the 550,000 New Mexicans currently enrolled in the program. The state is no longer planning to reduce eligibility for the Working Disabled and Pregnancy Medicaid programs to the bare minimum required by federal law. Instead, the final proposal preserves current eligibility levels so that working disabled individuals under 250% of the federal poverty level (FPL) and pregnant women under 185% FPL can continue to get coverage. However, eligibility for the Medicaid category that provides Family Planning services will be reduced for people with incomes under 185% FPL to 138% FPL and eligibility for the Breast and Cervical Cancer program will be reduced from 250% FPL to 138% FPL.
HSD will also delay implementation of a proposal to stop paying for the medical bills of individuals who have received healthcare services in the three months prior to becoming officially enrolled in Medicaid. The current policy, known as “retroactive coverage” ensures that healthcare providers are paid for services and it alleviates financial hardship and expensive debt for low-income families. The Department has chosen to eliminate this coverage in July 2014, rather than in January of that year, explaining that Medicaid enrollees will be given an extra six months to seek coverage after healthcare reform takes full effect on January 1, 2014. However, the proposal will still burden many low-income New Mexicans. The Department has no plans to do outreach or address existing barriers in the application process to ensure that every person who qualifies for Medicaid is enrolled in the program. As a result, many individuals will not know they are eligible and will not apply until they need healthcare services and have unpaid medical bills.
Significantly, the state has also included a new proposal to extend twelve month “continuous eligibility” to adults enrolled in Medicaid. This ensures that individuals won’t lose Medicaid if their employment or income changes over the course of one year. This is a major new benefit that will create stable and continuous coverage for hourly, temporary or seasonal workers whose income often fluctuates, or for those who are temporarily unemployed.
Despite these important changes, one of the most controversial proposals from the original waiver application remains. The state intends to move forward with imposing co-pays on Medicaid patients when they visit emergency rooms but turn out not to have had actual emergencies, despite almost uniform opposition from Medicaid recipients, providers and hospitals. These fees will heavily impact patients who cannot get care due to New Mexico’s severe provider shortage. As a result, the proposal will likely fall short of the federal law's requirement that states ensure that there are actually accessible and available alternatives for care before these fees can be charged.
In sum, the final Centennial Care application contains promising new changes that protect Medicaid beneficiaries. However, there continue to be cuts to retroactive coverage and new fees for emergency room use that will impact low-income New Mexicans. It also appears that the state is moving forward with mandating enrollment of Native Americans into managed care, despite firm rejection of this proposal at every tribal consultation. Lastly, the final waiver application makes no mention of whether the state will be taking up the opportunity under healthcare reform to extend Medicaid to every low-income adult under 138% FPL.
The final Medicaid application is available on HSD’s website:http://www.hsd.state.nm.us/Medicaid%20Modernization/index.html
by Quela Robinson From The Center on Law and Poverty
The final 228-page proposal submitted today contains changes which represent important victories for the 550,000 New Mexicans currently enrolled in the program. The state is no longer planning to reduce eligibility for the Working Disabled and Pregnancy Medicaid programs to the bare minimum required by federal law. Instead, the final proposal preserves current eligibility levels so that working disabled individuals under 250% of the federal poverty level (FPL) and pregnant women under 185% FPL can continue to get coverage. However, eligibility for the Medicaid category that provides Family Planning services will be reduced for people with incomes under 185% FPL to 138% FPL and eligibility for the Breast and Cervical Cancer program will be reduced from 250% FPL to 138% FPL.
HSD will also delay implementation of a proposal to stop paying for the medical bills of individuals who have received healthcare services in the three months prior to becoming officially enrolled in Medicaid. The current policy, known as “retroactive coverage” ensures that healthcare providers are paid for services and it alleviates financial hardship and expensive debt for low-income families. The Department has chosen to eliminate this coverage in July 2014, rather than in January of that year, explaining that Medicaid enrollees will be given an extra six months to seek coverage after healthcare reform takes full effect on January 1, 2014. However, the proposal will still burden many low-income New Mexicans. The Department has no plans to do outreach or address existing barriers in the application process to ensure that every person who qualifies for Medicaid is enrolled in the program. As a result, many individuals will not know they are eligible and will not apply until they need healthcare services and have unpaid medical bills.
Significantly, the state has also included a new proposal to extend twelve month “continuous eligibility” to adults enrolled in Medicaid. This ensures that individuals won’t lose Medicaid if their employment or income changes over the course of one year. This is a major new benefit that will create stable and continuous coverage for hourly, temporary or seasonal workers whose income often fluctuates, or for those who are temporarily unemployed.
Despite these important changes, one of the most controversial proposals from the original waiver application remains. The state intends to move forward with imposing co-pays on Medicaid patients when they visit emergency rooms but turn out not to have had actual emergencies, despite almost uniform opposition from Medicaid recipients, providers and hospitals. These fees will heavily impact patients who cannot get care due to New Mexico’s severe provider shortage. As a result, the proposal will likely fall short of the federal law's requirement that states ensure that there are actually accessible and available alternatives for care before these fees can be charged.
In sum, the final Centennial Care application contains promising new changes that protect Medicaid beneficiaries. However, there continue to be cuts to retroactive coverage and new fees for emergency room use that will impact low-income New Mexicans. It also appears that the state is moving forward with mandating enrollment of Native Americans into managed care, despite firm rejection of this proposal at every tribal consultation. Lastly, the final waiver application makes no mention of whether the state will be taking up the opportunity under healthcare reform to extend Medicaid to every low-income adult under 138% FPL.
The final Medicaid application is available on HSD’s website:http://www.hsd.state.nm.us/Medicaid%20Modernization/index.html
ABQ Journal Article "Medicaid Reforms Proposed"
http://www.abqjournal.com/main/2012/08/18/news/medicaid-reforms-proposed.html
Medicaid Reforms Proposed
By Barry Massey / The Associated Presson Sat, Aug 18, 2012
SANTA FE – Gov. Susana Martinez’s administration asked the federal government Friday to approve a revised plan to overhaul a program providing health care for a fourth of New Mexico’s population.
The Human Services Department’s latest Medicaid proposal comes nearly six months after the administration initially unveiled a blueprint to improve health care for needy New Mexicans while slowing the growth of a program costing nearly $4 billion a year. About a fourth of the money comes from the state budget, with the federal government paying the remainder.
The administration hopes to implement the Medicaid overhaul in January 2014.
Human Services Secretary Sidonie Squier said the broad outlines of the administration’s original Medicaid overhaul remain unchanged. No enrollment cuts are proposed, and there’s no planned reduction in rates paid to health care providers.
After the department received additional comments from the public and providers, changes were made to ensure Medicaid coverage for more low-income pregnant women and disabled New Mexicans who are working. Previous eligibility proposals would have required some of those people to pay for coverage through a state-run health insurance exchange planned under a federal health care law. The working disabled on Medicare also would have been precluded from getting supplemental health coverage through the exchange.
The department is sticking with a proposal to require Native Americans to obtain Medicaid services through managed care organizations.
Tribal leaders have expressed concerns that a switch to managed care could limit access to health care providers for Native Americans living in remote areas.
But Squier said the department is confident that won’t happen, because the overhaul proposal makes clear that Medicaid-eligible Native Americans can continue to use their current primary care providers through the federal Indian Health Service or other tribal health systems. That will happen regardless of whether a doctor or clinic is part of a managed care network or has a contract with the managed care company. The department also has committed to ensuring prompt reimbursement for Medicaid services by tribal health care providers.
Medicaid Reforms Proposed
By Barry Massey / The Associated Presson Sat, Aug 18, 2012
SANTA FE – Gov. Susana Martinez’s administration asked the federal government Friday to approve a revised plan to overhaul a program providing health care for a fourth of New Mexico’s population.
The Human Services Department’s latest Medicaid proposal comes nearly six months after the administration initially unveiled a blueprint to improve health care for needy New Mexicans while slowing the growth of a program costing nearly $4 billion a year. About a fourth of the money comes from the state budget, with the federal government paying the remainder.
The administration hopes to implement the Medicaid overhaul in January 2014.
Human Services Secretary Sidonie Squier said the broad outlines of the administration’s original Medicaid overhaul remain unchanged. No enrollment cuts are proposed, and there’s no planned reduction in rates paid to health care providers.
After the department received additional comments from the public and providers, changes were made to ensure Medicaid coverage for more low-income pregnant women and disabled New Mexicans who are working. Previous eligibility proposals would have required some of those people to pay for coverage through a state-run health insurance exchange planned under a federal health care law. The working disabled on Medicare also would have been precluded from getting supplemental health coverage through the exchange.
The department is sticking with a proposal to require Native Americans to obtain Medicaid services through managed care organizations.
Tribal leaders have expressed concerns that a switch to managed care could limit access to health care providers for Native Americans living in remote areas.
But Squier said the department is confident that won’t happen, because the overhaul proposal makes clear that Medicaid-eligible Native Americans can continue to use their current primary care providers through the federal Indian Health Service or other tribal health systems. That will happen regardless of whether a doctor or clinic is part of a managed care network or has a contract with the managed care company. The department also has committed to ensuring prompt reimbursement for Medicaid services by tribal health care providers.
ABQ Journal Article "GOP Wasting Time on ACA Repeal"
http://www.abqjournal.com/main/2012/08/19/opinion/gop-wasting-time-on-aca-repeal.html
GOP Wasting Time on ACA Repeal
By Sen. Jeff Bingaman / Democrat, New Mexico on Sun, Aug 19, 2012
In June the Supreme Court upheld the vast majority of the Affordable Care Act. Still, Republicans in the House of Representatives continue to press for the law’s repeal.
This is a waste of time. Instead, we need to get to work on fixing our broken health care system. The time has come to stop fighting over ACA and instead focus on implementing it.
Across the country, the law is already working. Under ACA, millions of Americans benefited from free preventive health services last year, and women now have access to the full range of recommended preventive health services they need at no cost. ACA also requires that at least 80 percent of health care premiums be spent providing high-quality health care, not boosting the bottom line of insurance companies. Implementation of the fraud, waste and abuse protections in the law recovered $4.1 billion in taxpayer dollars in 2011 alone.
I am a strong supporter of ACA because New Mexico will benefit tremendously.
New Mexico has one of the highest rates of uninsured people in the country – nearly one in five residents lack health insurance. Uninsured New Mexicans still get lifesaving health services when they need it, but only because insured New Mexicans subsidize these costs through higher premiums. ACA expands health care coverage to more uninsured residents, saving all families money. According to one study, New Mexican households will have an additional $1,756 in their pockets in 2019 due to this law.
Here in New Mexico, we’re seeing other important benefits as well. Twenty-six thousand young New Mexicans have gained coverage because the ACA requires their parents’ health insurance plans to cover them until they turn 26.
Another 122,000 children in our state are no longer being denied coverage because of their pre-existing conditions. In 2014, no one with a pre-existing condition will be denied coverage; that’s at least 420,000 New Mexicans. And seniors and people with disabilities in New Mexico saved more than $17 million on prescription drug costs since the law was enacted.
And there is more to come. We won’t feel the full effects of the law until 2014, when some 30 million more Americans will get health care coverage either because they will qualify for Medicaid or can purchase health insurance through the new health insurance exchanges. These are marketplaces that will be set up in every state so Americans can comparison shop to find the most affordable health care plan.
According to the Bureau of Labor Statistics, by improving our nation’s health care safety net we will be creating millions of new jobs. New Mexico Voices for Children projects that 30,000 to 38,000 health sector positions will be created in our state. Our health care sector will be bolstered with an influx of $8 billion to $10 billion, according to one study.
These dollars will help pay New Mexico doctors, nurses and other providers, and cover the cost of laboratory tests, medications and visits to health clinics.
On the other hand, according to the nonpartisan Congressional Budget Office, repealing the law would add $109 billion to our deficit over the next decade, and dig us an even deeper hole in the following 10 years. Repeal would include rolling back controls on the unsustainable rise in Medicare costs and reducing intake of revenues further straining our economy.
What will we have to do in order to fully benefit from the ACA?
First, our state needs to continue developing its health insurance exchange. Nearly half of working New Mexicans do not have access to health insurance through their employers. Through the exchange, individuals and small businesses will both be able to shop for insurance and determine whether they qualify for federal subsidies or tax credits to help pay premium costs.
Second, we should fully participate in the Medicaid expansion. As many as 170,000 low-income New Mexicans would become eligible for Medicaid; the federal government will cover 100 percent of the cost of expansion for the first three years and more than 90 percent of the cost after that.
Implementing health care reform will not only help make us a healthier nation, but it will also strengthen our economy and put money in our pockets. Let’s stop bickering over ACA and instead prepare to fully reap its benefits.
GOP Wasting Time on ACA Repeal
By Sen. Jeff Bingaman / Democrat, New Mexico on Sun, Aug 19, 2012
In June the Supreme Court upheld the vast majority of the Affordable Care Act. Still, Republicans in the House of Representatives continue to press for the law’s repeal.
This is a waste of time. Instead, we need to get to work on fixing our broken health care system. The time has come to stop fighting over ACA and instead focus on implementing it.
Across the country, the law is already working. Under ACA, millions of Americans benefited from free preventive health services last year, and women now have access to the full range of recommended preventive health services they need at no cost. ACA also requires that at least 80 percent of health care premiums be spent providing high-quality health care, not boosting the bottom line of insurance companies. Implementation of the fraud, waste and abuse protections in the law recovered $4.1 billion in taxpayer dollars in 2011 alone.
I am a strong supporter of ACA because New Mexico will benefit tremendously.
New Mexico has one of the highest rates of uninsured people in the country – nearly one in five residents lack health insurance. Uninsured New Mexicans still get lifesaving health services when they need it, but only because insured New Mexicans subsidize these costs through higher premiums. ACA expands health care coverage to more uninsured residents, saving all families money. According to one study, New Mexican households will have an additional $1,756 in their pockets in 2019 due to this law.
Here in New Mexico, we’re seeing other important benefits as well. Twenty-six thousand young New Mexicans have gained coverage because the ACA requires their parents’ health insurance plans to cover them until they turn 26.
Another 122,000 children in our state are no longer being denied coverage because of their pre-existing conditions. In 2014, no one with a pre-existing condition will be denied coverage; that’s at least 420,000 New Mexicans. And seniors and people with disabilities in New Mexico saved more than $17 million on prescription drug costs since the law was enacted.
And there is more to come. We won’t feel the full effects of the law until 2014, when some 30 million more Americans will get health care coverage either because they will qualify for Medicaid or can purchase health insurance through the new health insurance exchanges. These are marketplaces that will be set up in every state so Americans can comparison shop to find the most affordable health care plan.
According to the Bureau of Labor Statistics, by improving our nation’s health care safety net we will be creating millions of new jobs. New Mexico Voices for Children projects that 30,000 to 38,000 health sector positions will be created in our state. Our health care sector will be bolstered with an influx of $8 billion to $10 billion, according to one study.
These dollars will help pay New Mexico doctors, nurses and other providers, and cover the cost of laboratory tests, medications and visits to health clinics.
On the other hand, according to the nonpartisan Congressional Budget Office, repealing the law would add $109 billion to our deficit over the next decade, and dig us an even deeper hole in the following 10 years. Repeal would include rolling back controls on the unsustainable rise in Medicare costs and reducing intake of revenues further straining our economy.
What will we have to do in order to fully benefit from the ACA?
First, our state needs to continue developing its health insurance exchange. Nearly half of working New Mexicans do not have access to health insurance through their employers. Through the exchange, individuals and small businesses will both be able to shop for insurance and determine whether they qualify for federal subsidies or tax credits to help pay premium costs.
Second, we should fully participate in the Medicaid expansion. As many as 170,000 low-income New Mexicans would become eligible for Medicaid; the federal government will cover 100 percent of the cost of expansion for the first three years and more than 90 percent of the cost after that.
Implementing health care reform will not only help make us a healthier nation, but it will also strengthen our economy and put money in our pockets. Let’s stop bickering over ACA and instead prepare to fully reap its benefits.
BIz journals New Article "Medicaid expansion wouldn't hit NM general fund"
http://www.bizjournals.com/albuquerque/news/2012/08/16/report-medicaid-expansion-wouldnt.html
Report: Medicaid expansion wouldn't hit NM general fund
New Mexico Business Weekly by Dennis Domrzalski, Reporter
Date: Thursday, August 16, 2012, 10:59am MDT
New Mexico Voices for Children says the state could expand Medicaid with no net expense to the general fund.
New Mexico could expand its Medicaid program to cover low-income adults with no net expense to the state’s general fund, says a new report by New Mexico Voices for Children.
The state’s Human Services Department has estimated that expanding Medicaid to cover adults who earn up to 138 percent of the federal poverty level would require as much as $496 million in new general fund revenue. However, that total would be covered by state taxes on the new federal Medicaid money that would come into the state. That federal money would be subject to the state’s 4 percent insurance premium tax and to the gross receipts tax when Medicaid benefits are paid by insurers to health care providers, said the study by the children’s health care advocacy organization.
It’s estimated that up to 150,000 New Mexicans would be eligible for Medicaid under the proposed expansion.
The June 28 U.S. Supreme Court decision that upheld the federal Affordable Care Act gave states the option to not participate in Medicaid expansion. Gov. Susana Martinez has not decided whether New Mexico would participate in the expanded program.
Under the ACA, the federal government would pick up 100 percent of the cost of new Medicaid enrollees for the first three years of the expansion. After the seventh year, the federal share would drop to 90 percent.
More than 530,000 New Mexicans currently receive Medicaid services.
Report: Medicaid expansion wouldn't hit NM general fund
New Mexico Business Weekly by Dennis Domrzalski, Reporter
Date: Thursday, August 16, 2012, 10:59am MDT
New Mexico Voices for Children says the state could expand Medicaid with no net expense to the general fund.
New Mexico could expand its Medicaid program to cover low-income adults with no net expense to the state’s general fund, says a new report by New Mexico Voices for Children.
The state’s Human Services Department has estimated that expanding Medicaid to cover adults who earn up to 138 percent of the federal poverty level would require as much as $496 million in new general fund revenue. However, that total would be covered by state taxes on the new federal Medicaid money that would come into the state. That federal money would be subject to the state’s 4 percent insurance premium tax and to the gross receipts tax when Medicaid benefits are paid by insurers to health care providers, said the study by the children’s health care advocacy organization.
It’s estimated that up to 150,000 New Mexicans would be eligible for Medicaid under the proposed expansion.
The June 28 U.S. Supreme Court decision that upheld the federal Affordable Care Act gave states the option to not participate in Medicaid expansion. Gov. Susana Martinez has not decided whether New Mexico would participate in the expanded program.
Under the ACA, the federal government would pick up 100 percent of the cost of new Medicaid enrollees for the first three years of the expansion. After the seventh year, the federal share would drop to 90 percent.
More than 530,000 New Mexicans currently receive Medicaid services.
News article Las Crusus Sun "Leaders hash out future of Medicaid for Navajos"
http://www.lcsun-news.com/new_mexico-news/ci_21324012/leaders-hash-out-future-medicaid-navajos
Leaders hash out future of Medicaid for Navajos
By Jenny Kane jkane@daily-times.com
Posted: 08/16/2012 01:00:00 AM MDT
SHIPROCK &mdash: Stanford Washburn, 53, was ready to tell the story of his deteriorating heart to the Legislative Health and Human Services Committee on Wednesday.
He was going to tell the committee about how his condition, cardiomyopathy, leaves him vulnerable to a heart attack at any time.
He was going to tell them about how he has no transportation from his home, a storage shed, to the hospital and how he walks six miles to town for every appointment.
He was going to tell them about how he once had to hitchhike to the hospital in Farmington to get a pacemaker, and then how he had to hitchhike back after the procedure.
He was going to tell them, but then he had a heart attack just before the meeting.
"We think he's going to be okay," said Sovereign Hager, Washburn's attorney from the DNA People's Legal Services in Shiprock.
Washburn's story led assembled leaders into a day-long discussion Wednesday about how the state might better provide comprehensive health care to American Indians.
The conversation focused on the potential to expand the state's Medicaid program, a possibility since the Supreme Court upheld the Affordable Care Act in June.
Gov. Susana Martinez, who was in Farmington on Wednesday, and the Legislature both are under pressure from organizations statewide to expand or not expand Medicaid to about 200,000 low-income New Mexicans. Neither has led on to what decision might be in the works.
"There's a fine line in the sand that says, "We're not going to go there,'" said Rep. Miguel Garcia (D-Albuquerque).
Studies already are in the works to determine how Medicaid expansion beginning in 2014 would affect the state and the Navajo Nation.
Studies shared Wednesday were positive, though not always believable, committee members said.
A study by New Mexico Voices for Children found that the state would generate more than $1 billion in new tax revenue by 2020. It also would generate between 32,000 and 38,000 jobs by the same time, the study said.
"We're selling this as an economic boost, but there's a lot of issues here," said Rep. Dennis Kintigh (R-Roswell).
Kintigh also questioned how the Navajo Nation intended on figuring out Medicaid expansion for the tribe when it is stretched across three states, New Mexico, Arizona and Utah.
All could pass different policies.
"The Navajo Nation already is assessing the expansion of health care," said Gayle Din Chacon, surgeon general for the Navajo Nation.
Currently, about 30,000 Navajo in New Mexico are enrolled in the state's Medicaid program. About 50,000 are enrolled in Arizona's program, and 1,000 in Utah's.
Many more, however, are eligible and are not taking advantage of the services offered.
"A lot of these people don't know these services are available to them," said Quela Robinson, an attorney for the New Mexico Center on Law and Poverty.
The committee considered increasing outreach to low-income New Mexicans, particularly those living in rural areas. Many of them do not have access to mainstream media and technology.
"If the state chooses to do this, I want to make sure that everyone that qualifies gets it," said Sen. Sander Rue (R-Albuquerque).
The state has much research to do on the outcome of expanding its Medicaid program, as does the Navajo Nation, but it was clear Wednesday parties statewide are interested in collaborating to better the system.
"If we don't do a lot of planning, there's going to be a lot of collateral damage," said David Foster, chairman of the Health Care Committee for the Association of Commerce and Industry of New Mexico
Tuesday, August 14, 2012
NMICoA HC Medicaid Coaltion informal discussion comments
NMICoA Health Committee
Medicaid Coalition Discussion with
Centers for Medicaid and Medicare
August 14, 2012
The Health Committee of the New Mexico Indian Council on Aging (NMICoA) has followed NM Human Services Department (HSD)’s Centennial Care waiver proposal to the Centers for Medicare and Medicaid (CMS) since it’s unveiling earlier this year. The Health Committee has these following concerns and issues with HSD’s attempts to have its 1115 waiver accepted by CMS.
- HSD has not been transparent in properly informing and involving Tribes and Pueblos to input grassroots solutions and networking to inform HSD about possible problems incurred with developing strategic health planning from a unilateral perspective. The government to government process is still not evident in meetings attended by members. Discordant information was presented at the NM Primary Care Association meeting and UNM Cancer Center meeting sponsored by the Navajo Nation.
- HSD does not understand the sovereign status of Tribes and Pueblos of NM and the Federal responsibility
- HSD needs to review Federal-Tribal policy and understand Tribes and Pueblos should be funded directly for their members who are enrolled in Medicaid
- This allows a 100% Federal Medical Assistance Percentage (FMAP) funding for natives to obtain medical services at Indian Health Services (IHS), 638 facilities but more importantly, Non-Tribal network providers who provide services not available at IHS/638 facilities.
- Carve out of Medicaid funding to Tribes/Pueblos should be considered such that local facilities and service providers can benefit patients with in –house; case management, care coordination, transportation, personal care, respite care in a more intergraded fashion.
- The health committee believes that the opt-out category should still be intact and the choice to enroll in Managed Care should remain with the individual Medicaid enrollee.
- In the past, with the institution of the Salud program, Native Americans were mandatorily enrolled in Managed care. This experience resulted in a loss of revenue to IHS and 638 facilities and confused the Native population. Currently approximately 80 % of Native Americans enrolled in Salud still opt-out of managed care in the face of enrollment efforts by the state and MCO’s
- The State of NM needs to present information to be consulted on to Governors/Tribal Leaders, at least ten days (10) prior to consultation sessions and submission of plans, amendments, proposals, waivers in order to give tribes proper time to analyze State documents to give informed input and comments in consultation sessions.
- Managed care organizations need to involve Tribes/Pueblos early in the proposal process to allow Native programs and providers the opportunity to be included in strategic planning
- The Health Committee also stands by its support of Tribal leadership and does not accept the State mandate for enrolling Natives into managed care.
- Tribes and Pueblos should be allowed to develop their own system of care management which includes all on and off reservation providers which provide primary and secondary services. The State should allow Tribal/Pueblo programs and providers to be in these case managed systems with HSD collaboration to provide technical assistance such as getting billing, coding and reimbursement services, integrative systems need to be developed to track clinical, behavioral health and long term care services needs and documentation of non-duplication by service providers, and patients are not inappropriately utilizing Medicaid services.
- After the last Tribal Consultation session between the State and NM Tribes, Tribes asked that HSD exclude them from mandatory inclusion in to Managed Care for one year. This will allow the State of NM to develop, implement and streamline Centennial Plan for the rest of the population. This will also give Tribes additional time to analyze their’ own options for health care delivery. If after one years’ time, the Tribes decide, based on Health outcomes data, to be incorporated into Centennial Care they may choose to.
- The US Supreme Court’s decision to up hold the PPACA except for the Medicaid Expansion is a concern for Tribes in NM. If Governor Martinez decides not expand Medicaid for NM’s low income individuals it will have a great effect on the Tribal Health Programs. NM Native Americans make up between 22%-26% of the Medicaid population with many individuals eligible but not yet enrolled. That number will grow with expansion and help many individuals obtain needed healthcare. This is another instance where the State of NM will make a decision without Consultation with Tribes. Given the Government to Government relationship what will happen if Tribes want to Expand Medicaid and the State of NM chooses not to?
Respectfully Submitted by
Erik Lujan
Volunteer Advocate
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