By Kristen Bitsuie, Tribal Health Care Outreach and Education Policy Coordinator, National Indian Health Board
Understanding health insurance coverage can be complicated – especially during the current COVID-19 pandemic. Thankfully, every Indian Health Service (IHS) facility or Tribal health clinic has a Patient Benefits Coordinator or Enrollment Assister to help American Indian and Alaska Native (AI/AN) individuals and families explore their health coverage options, whether through a federal program like Medicaid, Medicare or the Children’s Health Insurance Program (CHIP), or a private insurance plan from the Health Insurance Marketplace. For AI/ANs, having health coverage can bring security but it also supports the community by bringing in funding from third-party sources.
It is important for AI/ANs to know that IHS is not health insurance. So, when a patient needs specialty care for heart and kidney health, they must get a referral to see a provider outside of the Indian health system. If the patient doesn’t have health coverage, then IHS pays for the care out of its Purchased/Referred Care (PRC) (formerly called contract health) funds, which are known to deplete quickly. But, if the patient has health coverage through Medicaid, Medicare or CHIP then that program will cover the cost and reimburse IHS, adding to the facility’s third-party revenue. Those reimbursement dollars help to offset healthcare costs and allow IHS and Tribal facilities to offer more services to more Tribal members, thus supporting the community.
For example, a 13-year-old girl enrolled in the Omaha Tribe of Nebraska, living in the Great Plains Area, hadn’t been feeling well and began to develop itchy red spots all over her legs. She was hospitalized and diagnosed with a disease associated with vasculitis that affects the blood vessels, skin, kidneys and lungs. She received the crucial treatment she needed and as a result of Medicaid, her treatment, stay in the hospital and ongoing doctor appointments were completely covered.
Medicaid allowed this young girl to have a streamlined healthcare experience between her Tribal health facility and the children’s hospital. In this case, Medicaid saved valuable care dollars for the PRC program at this girl’s Tribal health facility – dollars that could be saved for other AI/AN individuals who are in dire health need. Third party payments, including those from Medicaid, often contribute more than 50% of Tribal healthcare operating budgets.
Patient Benefits Coordinators and Enrollment Assisters are knowledgeable about the special protections for eligible AI/ANs through Medicaid, CHIP and the Marketplace, such as no premiums or out-of-pocket costs for Medicaid, free dental plans for children through Medicaid and CHIP and zero cost sharing for a private insurance plan. Members of federally recognized Tribes can also enroll in health insurance coverage any time of the year, not only during open enrollment periods.
A 35-year-old Native mother in the Portland, Ore. area was pushed out of the income bracket to qualify for the state Medicaid program due to an increase in her husband’s income. Her family relied heavily on public insurance and, thankfully, her children were eligible for coverage through CHIP. But, her husband’s employer-sponsored health insurance was considered unaffordable, so she enrolled in a Health Insurance Marketplace plan, obtaining coverage that helped the family financially while she was able to receive quality health services.
Flexible legislative and policy changes to Medicare, Medicaid, CHIP and the Health Insurance Marketplace in response to the COVID-19 pandemic have streamlined coverage for eligible AI/ANs. Some examples include Medicaid applications are expedited, the weekly unemployment supplement of $600 is not counted as income for Medicaid applicants, and federal rules prevent state Medicaid programs from disenrolling anyone by automatically renewing their benefits.
Healthcare coverage saves lives and contributes to a healthy community, even when a virus is disproportionately affecting Tribal Nations, families, and communities across Indian Country.
Learn more about the special protections for AI/AN at https://www.healthcare.gov/american-indians-alaska-natives/coverage/. For more information about the National Indian Health Board’s outreach and education efforts, please contact Kristen Bitsuie at [email protected].