Legislative Health Care Working Group focuses on tribal health care system

Posted on: 9/27/19


The bi-partisan Health Care Working Group of the Oklahoma Legislature focused on Oklahoma’s tribal health care system at their meeting Wednesday morning and the possible impact Medicaid expansion could have on it. If enacted, SQ 802 would provide access to medical care for Oklahomans who qualify.  The qualifying income levels would include an individual making less than $17,000 annually or a family of three making less than $29,000 annually. According to the speakers, Medicaid expansion would be of great benefit to tribal members.

Melanie Fourkiller, policy advisor of the Chickasaw Nation’s Division of Health, and Melissa Gower, director of the Cherokee Nation’s Health Services, made the presentation to legislators covering three elements, (1) background of the system; (2) how the system interfaces with the federal and state government; and, (3) what tribal health care looks like.

Fourkiller explained that although there were 375,000 patients seen at least once by one of the tribal providers in the last three years, it does not equate to health insurance coverage. Indian health care facilities provide services to more than 375,000 tribal members with over 3.2 million outpatient visits annually. An estimated 1.3 million Oklahomans were uninsured in 2017, with Native Americans representing less than 10 percent of that total amount.

Gower spoke on the exact scope of services, noting Oklahoma ranks last in federal funding among the 12 areas served by the Indian Health Service, which in turn limits the amount of funds the state can dedicate to services. Because Oklahoma ranks last in federal funding among 12 areas served by Indian Health Services, funding from the state is limited so the ability to purchase care is also limited. Referrals are prioritized and basically limited conditions threatening life and limb. Further, for tribal members, anything outside of that was not likely to be covered by the Indian health care system. Gower stated, “You’re going to be on your own,” adding the state’s system had about 75,000 referrals in 2017 that were either denied or deferred.

Gower said she is often asked why Native Americans need health insurance, given their access to primary care. “Just because they have some access to primary health care does not mean they don’t need health insurance,” she said, reiterating tribal health facilities are located in concentrated areas and distance prevents access to care.

The system is funded at 39 percent, including federal Indian Health Service appropriations, plus all third-party reimbursements from private insurance providers, Medicare and Medicaid. Of those three reimbursements, Fourkiller said Medicaid was by far the largest at 13 percent on average. Despite its resources, she continued, Oklahoma has the largest native population in the country without a third-payer health care resource.

By expanding Medicaid, tribal members falling into the income categories would be eligible to receive insurance coverage. Medicaid expansion covers the 10 essential health benefits required under the ACA: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services, including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care. (Lynne White)

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