family dental funding bill (hb 2768)
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Washington Health Benefit Exchange
Washington Coalition on Medicaid Outreach Deb Sosa, Tribal Liaison
March 11, 2016
Role of Tribal Liaison
▪ The Tribal Liaison works with federally recognized Tribes, Urban Indian Health Programs (UIHP), and the American Indian Health Commission (AIHC), other Tribal regional organizations, state agencies, government and community organizations, and private businesses to address Exchange issues that impact all American Indians and Alaska Natives(AI/ANs).
▪ Provide technical assistance to WAHBE staff on government-to-government relations, cultural competency and impact of policy and implementation to AI/ AN’s
▪ Communicate regularly with Tribes through tribal assisters and tribal and urban organizations
▪ Respond to tribal – AI/AN-related questions and issues
▪ Facilitate meetings between WAHBE and Tribal representatives through the Tribal Advisory Workgroup (TAW)
▪ Perform triage of individual tribal issues and concerns
Federal Trust Responsibility
▪ Article 1, Section 8 of the Constitution establishes the government-to-government relationship.
▪ Treaties negotiated by the U.S. in return for 400 million acres of Indian lands created the trust obligation for health, education and social services.
WA State American Indian Demographics
▪ Total AI/AN population for 2014 was 192,114 (2.9% ), of the total state population. the smallest racial/ethnic group in the state
▪ Washington has the sixth largest AI/AN population - 3.9 % of the total 4.9 million AI/AN population in the United States.
▪ Over one-half of the AI/AN population reside in urban areas.
http://www.aihc-wa.com/files/2014/05/Overview-of-the-Indian-Health-Care-System.pdf
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Portland Area Indian Health Service
▪ Portland Area IHS provides access to care for approximately 150,000 AI/AN residents of 42 tribes in ID, OR, WA
▪ 65,000 receive care from WA Tribal and IHS clinics
▪ Remaining 85,000 AIANs are without access to IHS and Tribal
programs.
Urban Indian Population
▪ 96,000 AIANs live in Seattle Tacoma metro area.
▪ 35,000 in Spokane, Bellingham and Vancouver.
▪ 130,000 of 215,000 or ≈ 50% live in metro areas.
Washington’s AI/AN Tribal Services
▪ Not a Tribal Health “System”
▪ Each tribe is an independent – Sovereign Nation
▪ No IHS Hospital or Specialty Care in the region.
Tribal Programs ▪ There are 34 tribal medical clinics providing primary care
▪ 22 of the medical clinics also provide dental care
▪ 12 provide pharmacy services,
▪ 19 provide mental health treatment and
▪ 15 provide chemical dependency services.
▪ Only 3 sites are run directly by the IHS
▪ Tribes are essential community providers for Washington’s AI/AN Tribal population
▪ Rural Tribes are often primary care in many areas for non-Natives
Washington’s AI/AN Urban Indians ▪ A WA tribal member living away from their tribe ( moved from home
state to obtain jobs, school, other opportunities
▪ Tribal members away from their home tribe and out of their tribal Contract Health Service Delivery Area.
▪ Federal job training relocation programs – 60’s and 70’s
▪ Numerous military installations across WA
▪ Alaskan Native’s relocating due to climate change- permafrost thaw and sinking villages
▪ Seattle is a Tertiary Care/Specialty Care area for the Alaskan Native Tribal Health Consortium (ANTHC)
Special Provisions in the ACA for AI/AN’s
▪ Enrolled members of Federally recognized tribes can purchase health insurance through the Marketplace and have access to the special provisions.
▪ Zero cost sharing plan, and do not have to pay co-pays or other cost-sharing if their income is between 100 and 300 % of the FPL
▪ Income below 100 % and above 300 % of FPL can enroll in a limited cost sharing plan
▪ pay no out-of-pocket costs to receive services from an ITU or
▪ no out-of-pocket costs from another provider if referred from an ITU
▪ Even with a $0 cost share plan, may receive advance premium tax credits if eligible.
▪ Monthly enrollment period.
▪ Exempt from the shared responsibility payment if they do not maintain minimum essential coverage-includes descendants using IHS facilities.
▪ Can file an Indian exemption on federal income tax return.
QHP Enrollees by Race/Ethnicity
MAGI Medicaid by Race/ Ethnicity
EXCHANGE PROGRESS IN 2015
▪Successful Premium Aggregation Removal
▪ Improvements to Healthplanfinder
▪ Improvements to Renewal Process
▪Health Literacy Campaign
▪ Improved Issue/Complaint Resolution
Moving Forward- 2016
▪ HealthPlanFinder
▪ Working with the AIHC to support Tribal Sponsorship
▪ AIHC will focus on tribes with under-enrollment of members with health coverage.
▪ Focus of outreach this year will be on Urban Indians
▪ Providing Support through the Call Center – May 2016
Tribal Sponsorship
Of the 29 tribes currently 8 are participating in the sponsorship program:
▪ Jamestown S’Klallam Tribe Kalispel Tribe
▪ Lower Elwha Klallam Tribe Makah Tribe
▪ Port Gamble S’Klallam Tribe Muckleshoot Tribe
▪ Shoalwater Bay Suquamish Tribe
▪ Swinomish Bay.
Additional Resources
WA HBE- Tribal Members website;
http://www.wahbexchange.org/new-customers/who-can-sign-up/tribal-members/
Federal site-Health coverage for American Indians & Alaska Natives website;
▪ https://www.healthcare.gov/american-indians-alaska-natives/
CMS How to Order Tribal Products
▪ https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/CMS-Tribal-Products.html