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American Indian Health Commission for Washington State AIHC Delegates officially appointed by Tribal Councils to represent each individual Tribe with UIHO representatives serve as members-at-large; Forum for achieving unity and guiding the collective needs of tribal governments and UIHO providing high-quality, comprehensive health care to AI/ANs in Washington; Goal behind promoting increased tribal-state collaboration is to improve the health status of AI/AN by influencing state and tribal health policy and resource allocation. A trusted Indian organization and is considered a best practice model in State-Tribal relations by Tribal and State leaders
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Lessons Learned and Promising Practices in AI/AN Outreach and
EngagementPresented to the
Washington Coalition on Medicaid OutreachDecember 18,2015
American Indian Health Commission for Washington State
Presented byVicki Lowe
Executive Director
American Indian Health Commission for Washington State
• Created in 1994 by Washington State federally recognized tribes, Urban Indian Health Organizations (UIHO), and other Indian organizations;
• Provides a forum for addressing tribal-state health issues;
• Mission is to improve the health of American Indians and Alaska Natives (AI/AN) through tribal-state collaboration on health policies and programs that will help decrease disparities;
• Works on behalf of the 29 federally-recognized Tribes and 2 UIHO in the state.
American Indian Health Commission for Washington State
• AIHC Delegates officially appointed by Tribal Councils to represent each individual Tribe with UIHO representatives serve as members-at-large;
• Forum for achieving unity and guiding the collective needs of tribal governments and UIHO providing high-quality, comprehensive health care to AI/ANs in Washington;
• Goal behind promoting increased tribal-state collaboration is to improve the health status of AI/AN by influencing state and tribal health policy and resource allocation.
• A trusted Indian organization and is considered a best practice model in State-Tribal relations by Tribal and State leaders
Key Activities of the AIHC
• Identifying health policy issues and advocating strategies to address Tribal concerns;
• Coordinating policy analysis;• Soliciting and collecting information from the state for
Tribal review and response;• Disseminating information to Tribal health programs and
leaders; • Promoting the government-to government relationship
between tribes and state health agencies;• Advances best and promising practices; • Supports activities that prevent and reduce adverse health
conditions and health disparities
AIHC Contract Work
AIHC contracts with the following Washington State Agencies:
• Department of Health
• Health Care Authority
• Washington Health Benefit Exchange
• Office of the Insurance Commissioner
Lessons Learned and Promising Practices in AI/AN Outreach and
Engagement
Passage of the Affordable Care Act in 2010, permanently reauthorized the Indian Health Care Improvement Act.The combination of these two laws brought the opportunity of utilizing health insurance coverage to help fill in the healthcare gaps caused by the underfunding of Indian Health Services (I.H.S.)
Lessons Learned and Promising Practices in AI/AN Outreach and
Engagement
I.H.S. is the federal program that was intended to meet the Federal government’s obligation to provide health care to Indian people in the United States. Although health disparity rates among Native American and Alaska Indian (AI/AN) populations are high, this lack of funding equals poor access to care for most Indian people.
Lessons Learned and Promising Practices in AI/AN Outreach and
EngagementBoth the ACA and IHCIA provide benefits that are specific to AI/ANs. They include: Exemption from tax penalty; Ability to enroll in QHPs and change
plans each month; No cost sharing for Essential Health
Benefits (EHB); Establishment of Tribal Premium
Sponsorship
Outreach and Education Efforts Encompass Many Issues
Education and Understanding Staff Communities Leadership
Staffing -Tribal Assisters Technology- Friend and Foe What was learned?
Outreach efforts differ from non- Native population:
Exemption from mandate- no tax penalty for not signing up for coverage.
Used to getting coverage through the “tribal program”
Federal government has an obligation to provide care;
Open enrollment all year long, no timeframe for big push
Education and UnderstandingI/T/U Staff
Usually the first to recognize how coverage can help: Referrals for specialty care Saving the CHS funds Third Party Revenue for Clinics
Easiest to educate, there are many opportunities for staff
They will do most of the work
Education and UnderstandingLeadership
Support of leadership is very important
Access to care and CHS program savings plus revenue all important concepts to convey
How does this coverage affect the Federal Governments obligation to provider healthcare to AI/ANs?
Education and UnderstandingCommunities
Within each community there are informal leaders who can be your allies: Respected Elders Members of large families.
Community Events Can work but you must know the
issues ahead of time and have answers.
Staffing -Tribal Assisters A Tribal Assister is specific to the WAHBE
Navigator Program. Tribal Assisters go through the same
certification process as any other Navigator in Washington State.
They have an increased level of access in the HPF allowing them to verify an applicants enrollment in a federally recognized Tribe.
It is this verification that gives access to the AI/AN specific benefits Zero or limited cost sharing the ability to in a QHP enroll all year long and to
change plans throughout the year.
Staffing -Tribal Assisters Knowledge of the AI/AN specific benefits and
how to correctly enter AI/AN information into the application
AND Computer skill are important;
However, the following are just as important: Understanding of the positive impacts of QHP
and Medicaid coverage Must be trusted members of communities Have the ability to work together with clients Not easily upset by negative comments
Staffing- Tribal Assisters The workload of the Tribal Assister is much
more broad and complicated than was expected Training required all year long to keep up with
technology issues surrounding the AI/AN applications and other issues
Tribal Assisters need to coordinate with each other, and with many other tribal employees (e.g., Enrollment, Billing, ICW, etc.) to get the job done
Understanding of premium tax credits and IRS filing
How do we help Tribal members living away from their tribe?
Technology-Friend and FoeElectronic Application – Friend Eligibility known as soon as application
successfully submitted Listed of any needed follow up given right
away Can alleviate the need to bring in paperwork Application can actually be done over the
phoneBetter participation if the application process is as painless as possible.
Technology-Friend and Foe
Electronic Application - Foe Technology was a greater barrier than expected
Issues with the identity verification Separate applications for mixed households in
order for zero or limited cost sharing to work Complications with the AI/AN identification in the
HPF Lack of knowledge of AI/AN specific issues and
benefits by WAHBE customer service staff Involvement of the IRS and tax returns with
premiums that are paid by someone else
What Was Learned?
Much work needs to be done just to get to begin to do Outreach and Education with our Tribal Members
The best resources are trusted members of your community- educate them as much as you can
Ongoing education of the “front line” staff is necessary.
What Was Learned?
Have to be willing to invest the time needed in order to build a program and get people to agree to apply Earn trust Show knowledge Working together.
Don’t let technology issues keep people from getting on coverage
Other Things to Consider:
Learn to recognize when you are dealing with Tribal politics, and don’t take things personally
Need to ask the “right” questions to get the information needed for an application, for example– Are you “legally” married? – Will your income continue, or change in the next few
months?You need a process to keep track of homeless
people or “couch surfers”, and complete their applications correctly
Resources In Washington State:
AIHC Indian Health Care Reform Manual:http://www.aihc-wa.com/aihc-health-policy-issues/indian-health-care-reform-manual-for-wa-state/
Washington Health Benefit Exchange Partner Resources:
http://www.wahbexchange.org/partners/
Questions?
vicki.lowe.AIHC@outlook.comor
AIHC.General.Delivery@outlook.com Website: www.aihc-wa.com
Phone: 360-477-4522
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