Tribal Consultation Medicaid Modernization Albuquerque, New Mexico August 3, 2011 y y y y y Look at Tribal Workgroup work from last

year Message read Pueblo of Zia Pueblo of Laguna Read statement Pueblo of Santa Ana o IHS wait for 2 months to see providers Taos Pueblo will submit formal statement o Need to look at all of the work done through the Tribal workgroup and the work of Tribal members. o Have worked very hard at getting Taos providers approved Medicaid providers and now concerned about a redesign o Everyone is responsible for each other s health care. o Need to consolidate Medicaid physical health and behavioral health. As they are separate it created a confusion o Tribes and Indian health services have worked hard to create a provider network. Would like to see the state recognize and allow the providers become part of the system. o State lacks in providers. o New Mexico is a poor state. Re-design needs to be based on what our people s need are. Pueblo of Laguna o Laguna established 5 priorities for health care for the Pueblo (will get statement) Pueblo of San Felipe o Read a prepared statement from the Governor o Increasing premiums of co-pays make it impossible for community members to afford o Admin. Simplicity agrees needs to be more user friendly and reduce burden on service providers o The multitude of waivers is a hindrance and best served to reduce all o Lack of adequate funding to IHS is a problem and should be fully funded. IHS should not be considered a fall back option o Coordination of Services Agrees with concept. o Increasing Personal Responsibility federal rules preclude some of it. o Any Medicaid redesign needs research with models for Native Americans Pueblo of Isleta o Worked hard to establish the opt-out. Native Americans should not have to navigate the managed care system o No Co-pays o Maintain tribal facilities

y y

y y y

o More tribal-state consultations needed Pueblo of Jemez o Cause no harm to Native American issues o Possible solutions Educate tribal members about input options o Coordinate with legislators to gauge their support o Improve health outcomes for Indian People o Indian facilities need to be available when needed o Establish Tribal Work group for legislation o Care coordination is good intention, often time plays out as referrals. Not positive managed care increases care coordination o More layers = more confusion o Adding another layer causes confusion for billing o Preserve the opt-out choice o Express lane agencies needed for enrollment o How do you hold providers responsible for patient outcomes? o What would the reward system look like? o Add an opt-out option for CoLTS Pueblo of Zuni o Medicaid reduction would create a negative impact at the Pueblo o Need affordable health care o Would like to manage their own funding for health care Support the continuation of the Medicaid Tribal State Workgroup Does not support any type of Block Grant program Pueblo of Acoma o Need further consultation as the plan is created o Personal responsibility Look at a senate bill regarding this particular issue o Admin. Simplicity agrees if indeed looking at bringing all of the 13 federal authorities of Medicaid function and make it more simplistic o Opt-out issue. Should not even be brought up as a discussion. o 638 programs continue to obligate, enforce, implement responsibilities of the federal government Public comment o Establish enrolling in outreach o Medicaid accessible o Exempt Native Americans from co-payments o Establishment payment methodology o Plan increased health care services o Federal Medicaid assistance percentage (FMAP) - Extend 100% of FMAP to all contracted long-term care, home health and other health care services offered outside tribal facilities

o o o o o o o o

Taos/Picuris Opt-in/Opt-out. Many Native Americans rely on IHS care. Suggesting they do look into some managed care system. No follow-up in homes. Those who remain opted out (especially pregnancy) their delivery may not be fully covered at IHS facilities (?) Takes a lot of educating to explain what health care opportunities are available to Native Americans If state goes to managed care only a lot of outreach and education is needed Need to establish a system/relationship with the county offices. Wants a system evaluation of the global waiver idea. Caution on personal responsibility do not go the way of no child left behind CoLTS was never an opt-out option nor consulted with Native Americans Don t see the money that goes to managed care shared with the community on services (CoLTs) Managed Care Organization for Tribes