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 2 CMS Organizational Overview 10 CMS Regional Offices 3 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 4 CMS AI/AN Beneficiaries • • • • • • 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. 6 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 7 8 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 9 10 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 11 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 12 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 13 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 14 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 16 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 18 Ho-Chunk Nation Enrollment into Medicaid and CHIP Series 1 Series 1 297 214 205 173 129 2008 2009 2010 2011 2012 19 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 20 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 21 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 22 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 23 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. 24 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 25 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 26 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 27 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 30 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 31 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. 32 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. 33 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 34 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 35 Thank you for the opportunity to present information. Questions? Tribalaffairs@cms.hhs.gov