Centers for Medicaid &
Medicare Services
(CMS)/Ho-Chunk Nation:
Outreach and Education
Activities
1
CMS Organizational Overview
CMS
(Centers for Medicare & Medicaid Services)
• Department of Health and Human Services (DHHS)
• Administers Medicare, Medicaid, Children’s Health
Insurance Program (CHIP) and Exchanges
– Serving over 98 million beneficiaries
• Annual Budget of approximately $800 billion
• CMS plays a key role in the overall direction of the
U.S. health care system
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CMS Organizational Overview
10 CMS Regional Offices
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CMS Provides Assistance to I/T/Us
• CMS is committed to maximizing AI/AN access
to Medicare, Medicaid and CHIP.
• The Tribal Affairs Group serves as a liaison
between the Agency and Tribal communities
regarding Indian health and CMS programs.
• At each CMS Regional office, there is a Native
American Contact (NAC) who is available to
provide technical assistance to Tribal programs
• Contact your NAC if your tribal program has
questions about Medicare, Medicaid and CHIP
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CMS AI/AN Beneficiaries
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AI/AN populations served by IHS – 1.8 million
AI/AN populations enrolled in:
Medicare:
180,000
Medicaid:
800,000
SSA authority for IHS to bill Medicare & Medicaid
FY 2011, IHS estimates Medicare & Medicaid
reimbursements exceed $800 million
• The revenues collected at each service unit varies
and helps supplement the service unit’s hospital and
clinics operating budgets
My Health, My Community
• My Health – when an AI/AN enrolls in
CMS programs, they benefit as an
individual through access to health
services; and they benefit …
• Their Community – through Medicare and
Medicaid reimbursements to IHS facilities
and the revenues supplement resources
available for others in the community.
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Ho-Chunk Nation
• Comprised of 7,194 Tribal Members
• 5,046 Tribal Members reside in Wisconsin
• 2,148 Tribal Members are considered AtLarge
• Majority of our tribal members reside in
CMS Regional Office V
• Ho-Chunk is part of the Bemidji Area for
Indian Health Service
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Ho-Chunk Nation CHSDA
• Comprised of 15 counties in Wisconsin
• Includes Houston County of Minnesota
• Operations Include two Flagship Clinics
located in Jackson and Sauk Counties
• 4 Satellite Offices located in Monroe,
Wood, Shawano and La Crosse Counties
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Ho-Chunk Nation Eligibility and
Outreach Program
• Ho-Chunk Nation secured a grant from the
Wisconsin Department of Human Services
to support the cost of 4 Benefit Specialists
• Benefit Specialists primary role was to
identify eligible tribal members and enroll
them in Medicaid/CHIP programs
• The goal was to increase third party
revenue through Medicaid and CHIP
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Community Outreach and
Education
• Ho-Chunk Nation begins a media
campaign to educate tribal member on the
importance of enrolling for these benefits
to increase access to care, especially for
member who do not reside closely to IHS
facilities
• Tribal members educated on the
importance of cost savings to the Nation
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CMS Barriers to Enrollment
• Do not have incentive to apply because
can receive care at no cost from IHS
• Federal government’s responsibility to
provide health care based on treaties shouldn’t have “to apply” for programs
• Mistrust that information provided will be
used for other purpose (estate recovery)
• Concerned about quality care they might
receive from non-Indian providers
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Ho-Chunk Nation Barriers
• Poor tribal to county relations
• Transportation
• Continued mistrust in regards to giving
personal information
• No incentive to enroll since tribal members
continued to receive services at no cost
• No linkage to Contract Health Service
payments for services rendered outside
IHS clinics
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CMS Training for Tribal Programs
• In 2011 and 2012, the TAG, working with
NACs and the IHS, will hold Area
Trainings on Medicare, Medicaid, and
CHIP issues.
• To register for the trainings and see the
schedule of upcoming trainings, go to:
www.blsmeetings.net/cmsitutrainings/locat
ions.cfm
Ho-Chunk Nation Strategies to
increase enrollment
• Utilization of multiple forms of media
• Increased education of Benefit specialists
• Increased presence in the community at
monthly area meetings, health fairs, and
coordination with other services such as
WIC clinics, food distribution and Head
Start
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Additional CMS Resources
• CMS produces the Medicine Dish: a series of
broadcasts for health professionals and AI/AN
beneficiaries on CMS programs
• Broadcasts can be found on You Tube – search
for “Medicine Dish”
• In 2012, we plan to film the Medicine Dish
Broadcasts out in Indian Country – in a
documentary or magazine format – to showcase
promising practices in Indian Country
Ho-Chunk Nation Utilization of
CMS Resources
• Increased technology in waiting room
areas allows for tribal friendly CMS videos
to be played
• Increased education of providers
• Protocols set in place to identify uninsured
qualified adults and children
• Linkage to Contract Health Service Dollars
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Ho-Chunk Nation Enrollment
into Medicaid and CHIP
Series 1
Series 1
297
214
205
173
129
2008
2009
2010
2011
2012
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Ho-Chunk Nation Medicaid
Revenue Increase
Medicaid Revenue
500000
450000
400000
350000
300000
250000
200000
150000
100000
50000
0
Medicaid
2009
77193
2010
219570
2011
458227
2012
341378
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Ho-Chunk Nation Reduction in
Beneficiary Expenses
Beneficiary Expense
4500000
4000000
3500000
3000000
2500000
2000000
1500000
1000000
500000
0
Beneficiary
2009
4046934
2010
2320383
2011
2510377
2012
400861
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Ho-Chunk Billing Strategy
• Conduct community health assessment
• Anticipating increased workload to the
billing staff and accounts receivable team
• Anticipating increased educational
campaign towards childless adult
population, tribal council, tribal members,
county, state and private insurance
companies to ensure appropriate payment
for services
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CMS Tribal Consultation Policy
• Tribal Consultation Policy – effective
November 17, 2011
• Agency specific policy that CMS is in the
process of implementing SOP’s
• Agency is committed to consultation and
will conduct an annual review of the policy
• Can be found at cms.gov/AIAN
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Tribal Technical Advisory Group
• CMS Tribal Technical Advisory Group (TTAG)
provides advice and input to CMS on issues
affecting Indian health programs and AI/AN
beneficiaries.
• TTAG is comprised of 17 representatives, one
from each of the 12 IHS Areas and a
representative from NIHB, NCAI, TSGAC,
NCUIH, and IHS.
• TTAG meets three times a year in Washington,
DC and holds monthly conference calls and
subcommittee calls.
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Ho-Chunk Participation: Pro-Active
• Tribes have been given a great
opportunity to be pro-active in regards to
CMS policy rather than reactive
• Created a team of elected officials and
health officers to tackle health issues
affecting Ho-Chunk Nation
• Advocacy efforts may even extend beyond
tribal healthcare and ensure access to all
people
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TTAG Outreach & Education Subcommittee
• O& E subcommittee meets regularly to
– Review outreach materials
– Review PSA and DVD scripts
– Provides input and comments
– CMS incorporates advice and feedback from
subcommittee into its work
– Chaired by: Dr. Alec Thundercloud, HoChunk Nation and Bemidji Area TTAG rep
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Our Health, Our Community
• Our Health, Our Community Video
• Developed in 2007 – with Gale Marshall,
NIHB, and CMS TTAG
• To encourage Indian families to enroll in
CMS programs
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CHIPRA, Recovery Act, & ACA
• Children’s Health Insurance Program
Reauthorization Act (CHIPRA) reauthorizes the
CHIP program for FY 2009 through FY 2015
• American Recovery and Reinvestment Act
(Recovery Act) – Section 5006: Protections for
Indians Under Medicaid & CHIP
• Affordable Care Act: Includes provisions specific
to Indians for State Health Exchange Plans
• Special Enrollment Periods for Indians
• Cost Sharing Exemptions for Indians up to 300% FPL
• Members of Indian Tribes exempted from individual mandate
CHIPRA and Indian Health
• Section 201: outreach and enrollment
– Provides for $100 million for all enrollment
and outreach activities –
• $80 million for outreach and enrollment grants to
States and other eligible entities
• $10 million for national enrollment campaign,
including outreach materials for Native Americans
• $10 million set aside for outreach to Indian children
through grants to Indian Health providers and
urban Indian organizations
AI/AN CHIPRA Grantees
• April 16, 2010 – HHS announced $10
million to 41 grantee -- IHS, tribal and
urban Indian programs
• Purpose of grants is to improve outreach
and enrollment of Indian families in
Medicaid and CHIP
• October 31, 2011 an AI/AN CHIPRA
grantee training held to build a community
and share outreach and enrollment ideas
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CHIPRA Outreach Efforts
• Billy Mills PSA – 1964 Olympic gold
medalist, Veteran, Oglala tribal member
• CHIPRA DVD – won ECHOE award at 2nd
Annual CHIP Summit, 2011
• “Building a community” of CHIPRA
grantees – sharing O & E practices
• Lessons learned from CHIPRA grantees
will assist in implementation of ACA
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Affordable Insurance Exchanges
• Starting in 2014, Exchanges will be one-stop
marketplaces that allow consumers and small
businesses to choose a private health insurance
plan.
• ACA Includes provisions specific to Indians for
Exchange Plans
• Special Enrollment Periods for Indians
• Cost Sharing Exemptions for Indians up to 300% FPL
• Members of Indian Tribes exempted from individual mandate
• Final rules were published on March 12, 2012
and additional guidance is forthcoming.
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Medicaid Expansion
• Starting in 2014, Medicaid will be available to
individuals between ages 19 and 64 with
incomes up to 133 percent of the federal poverty
level – currently $14,856 for an individual and
$30,656 for a family of four.
• These changes will become effective in 2014
• Section 5006 – Protections for Indians under
Medicaid are retained
• Additional guidance is forthcoming.
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Ho-Chunk Nation Strategies
• Engage the state early to develop the
exchanges, even if your state has returned
the federal monies to set up the state
exchanges
• Anticipate barriers to state exchanges
such as enforcement of the special
provisions for AI/AN, lack of internet
access by tribal members
• Work towards improving county, state and
tribal relations
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Ho- Chunk Strategies (cont’d)
• Need to know your State’s Tribal
consultation SPA and consultation policies
• Invite State Officials to your clinic
• Educate State Officials on Tribal issues
and protections afforded to AI/ANs
• It is not too early to begin working with
States
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Thank you for the opportunity to
present information.
Questions?
Tribalaffairs@cms.hhs.gov