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State-Tribal Leadership ConsultationCentennial CareMarch 20, 2012All Indian Pueblo Cultural Center in Albuquerque _____________________________________________________________________________________NotesGovernor of Pueblo of Picuris
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Serious problem with alcoholism in their community. Need to focus onthis issue, not only for Native people for all who have these social problems.Pueblo of Zuni
 –
 
Full opposition to elimination of the “
opt out
”
for their community basically because of their location. It is hard to get health care providers outside their reservation. Also, the emergencyfacilities have lost a lot of tribal members. Substance abuse is also a very critical area. Currently theyhave difficulty with transportation issues with contracting with the providers. Need more localproviders. They d
on’t have quality of road care and transportation services
and cannot locate them inan appropriate amount of time. Cultural healers, there is a misunderstanding from tribe to tribe.Licensed or non-licensed we need that implemented for tribal members. Want better care for theircommunities. Pueblo of Zuni needs a more understanding for the Tribal members that have theMedicaid benefits because they misunderstand what they really have.Pueblo of Santa Clara -
We don’t have all of our members registered with Medicaid. Will there be
enough medical facilities to handle an increased enrollment? Also they have an adult day care centerthat was approved. It is crucial to have third-party billing with Medicaid and the state. There are a lot of substance abuse issues and their Systems of Care are providing assistance. In regards to Emergency Use
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many people use ERs because there are not enough providers that people can see otherwise.Pueblo of Santo Domingo
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In response to the concept paper, health care for Native Americans (NA) hashistorically been through the federal government (gave a brief history). There are federal protectionsfor NAs in federal laws. Under the Indian Health Care Improvement Act there is no mandatoryparticipation for NA to enroll in managed care nor is there a requirement for those to buy healthinsurance. No premium on cost sharing for services. There are special rules for Indian enrollees. IHSand Tribal 638s get reimbursed at the highest reimbursement rates. No cost sharing should be requiredat Indian facilities or outside facilities. Healthcare is a federal responsibility for NAs. Need to followfederal laws before Centennial Care is implemented in this state. Patient center medical homes are agood idea. Fee for Service (FFS) has to remain. FFS shows that other states in the past that rural andfrontier area have limited MCO facilities. MCOs have had their own challenges in rural and frontierareas. Pueblo of Santo Domingo (Kewa Pueblo) has a written statement that they will be leaving withthe state.
 
Joe Garcia
 –
Ohkay Owingeh Head Tribal Councilman
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It is important for State of NM recognizes therelationship that tribes have with the federal government, which is to provide adequate health care. Inthis case, NM does not understand that relationship. Example: several different organizational levelsthat the tribes here in NM have. 1) Direct Service Tribes (majority). 2) 638 contracting. 3) self-governance
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side where IHS contracts and takes care of the health care for the tribe. The federal lawthat is in place, and NM goes forward with Centennial Care, the state will be in violation of federal law.They should have the option to go to tribal facilities. Reduce costs
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not about cost reduction, but ratherabout providing quality services. (Mr. Garcia misunderstood the point about education
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thought thestate was talking about actually educating health care in the schools). Workgroups did not represent allof NM tribes. In reference to
the “opt out” issue, is this an op
portunity to discuss or is the state justmoving forward. If moving forward, there will be problems. Does HSD have a written policy for statetribal consultation? (HSD provided the written document later in the meeting.) Ohkay Owingeh Pueblowill be providing a written document.Pueblo of Laguna
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A statement from Pueblo of Laguna was read
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Opposes mandatory participation inManaged Care Organizations (MCOs.) In the past there have been access issues. Tribal members havethe right to choose their own providers. Medicaid program should meet the needs of our Tribalmembers. The Pueblo opposes cost sharing on NA beneficiaries. NA Medicaid beneficiaries should notincur out of pocket expenses. The Pueblo of Laguna would be interested in a partially capitated model.Pueblo of Jemez Lt. Governor
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Supports the reduction of the state budget, however, not by this plan.Support Medicaid Modernization. They worked hard for the Public law 638. The Pueblo 638 relies onthe third-party billing to operate. 70% of their third party revenue is from Medicaid. The Pueblobelieves they will see a negative effect through this plan. Pueblo of Jemez has quality and quantity of health care. Supports statements made about under the affordable care act, not mandated toparticipate in managed care. In reference to co-pays, m
any elders live on a budget, and can’t afford a
co-pay, especially for the emergency room. Urgent Care facilities are not available 24/7. IHS facilitiesare not available 24/7. Co-
pays are pretty high and can’t afford that.
Pueblo of Jemez is comfortablewith what they have. Strongly oppose Medicaid Modernization. Urges Secretary Allison to go back toGovernor Martinez and have her re-consider and have Tribal Communities op out.Julie Weinberg, HSD Medicaid Director
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Clarified some issues/misunderstandings. The state will berequiring the MCOs to contract with IHS
and Tribal 638’s and get the OMB rat
e. Also we are going topursue exempting NA from the two co-payments that we have proposed (prescriptions/ER), outside of the NA facilities to exempt tribal members from those co-payments. The state agrees that ourcontractors must do better with tribal health facilities are reimbursed promptly. The state understandsthat has been a problem and getting corrected now and hope not to have that problem in CentennialCare. In regards to Senate Bill 196
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Julie clarified we are HSD and we do have a policy.Acoma Pueblo
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Opt out for NA must remain intact. The State mandate for all NAs into MCOs directlychanges the tribal sovereignty. NAs are also exempt from proposed cost-sharing. NAs should havehealth plans. Acoma Pueblo has developed networks at both regional and local. State should givepreference to develop training instead of contracting with MCOs. Consultation processes needs to be
 
more than one informational session. State needs to go to each tribe individually. In regards to theHealth Insurance Excahange (HIX), federal mandate to provide cradle to grave health care for NAs takesprecedence over the State of NM HIX. Tribes should negotiate with Federal Govt. directly. Fedgovernment should create an exchange for NAs. Urges all leaders to take this back to their councils andgive real feedback to the state.Vice-President of Navajo Nation (NN)
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NN believes that Navajo members who reside in NM the federalgovernment is required to provide quality health care. Concern is related to costs. With additional layerof bureaucracy takes more administrative costs. Beneficiaries need to be explained the changesproposed. This need to be done in Navajo, and explained clearly. In reference to the status of workingdocument, the NN is concerned that NM is indicating that they are moving forward without trueconsultation without technical assistance to NA communities. Revise plans to exempt tribal membersfrom cost sharing. MCOs should not make a profit off of the NA enrollees. Bundles and profits.Comprehensive Holistic package. NN recommends the NN as a pilot project for a Medicaid feasibilitystate. Tribal representation is not adequate for consultation in the concept paper. NN did not haverepresentation on policy making/decision making. NN recommends at least one NN on the policycommittee. NN recommends the Medical Assistance Division (MAD) includes Tribal members in thedevelopment of the RFP. Stakeholder involvement
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information has been limited. NN recommendsimplement with all stakeholders to ensure the development enhances the NN position.Gilbert Suazo Sr., Lt. Governor Taos Pueblo
 –
Taos pueblo has health issues/problems just like any othercommunity. The responsibility of the federal government and what it is supposed to do for NA people.Taos has had Tribal 638 for years and now going into self governance. Lacking facilities, like nursinghomes for elders, treatment centers for substance abuse, more active preventive care programs.
Always goes back to the federal government’s responsib
ility, providing free healthcare for Indianpeople, along with education and protection of Tribal lands. Whole process has been misunderstood.Now the state is getting involved and it is being mandated that all people go into an MCO. This is not theright approach for sovereign tribes who practice self determination and self governance. Questions howmuch discussion there has been with IHS and Tribal Governments in trying to put into place a healthcare process. IHS needs to be a prominent figure in trying to figure out health care for NA people.Unless there is a more thought out plan for Tribal governments this will lead to a more misunderstoodand complex process. Federal government may move further away from its trust responsibility inproviding
health care for its NA people. Not sure what the state’s motives are
. Where they are comingfrom? More government to government discussion needs to take place and with the IHS at the table.Taos Pueblo will provide a written statement. Some of the tribal efforts being made are underway to tryto improve the treatment of their Indian people who need health care and for social problems.Manuel Cristobal
 –
Pueblo of Santa Ana
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Opposition to the Medicare/Medicaid reformat. Appeal to allIndian pueblo council for a tribal resolution. This is medical genocide.Picuris Pueblo
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At this point they are working on a facility to incorporate with the pueblo of Taos.Facility with 8 northern pueblo leadership. In the future would like to see these insurance policiesincorporated into this facility, to promote and make it grow. Insurance policies should be honored to
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