Northwest Portland Area Indian Health Board
Quarterly Meeting
Skagit Valley Resort & Casino
October 17, 2012
Establishment of the Lummi Nation
Health & Wellness Reform
Task Force
Purpose of the Task Force
• Secure the maximum benefit available from the
National Health Reform Initiative consistent with
Lummi members health care needs.
• To Seek Benefits including:
– Expansion of health care services to all Tribal members
Elimination of the barrier of income to accessing health care
consistent with identified need.
– Establishment of Disease Prevention and Health Promotion
Programs & Services.
Development of the
Strategic Plan
• Evaluate Costs
• Determine population by collecting data from Clinic &
Behavioral Health Systems
• Work with State to determine number and level of
service provided to Lummi children, pregnant women,
parents, seniors and individuals with disabilities.
• Identify and Estimate the cost of the uninsured Tribal
Members
• Review and analyze all aspects of health care provided
by the Lummi Government
• Pursue Formal Accreditation including Public Health
Community Involvement
• Coordinate Lummi Community Listening Sessions
• Identify Lummi Nation’s Health Reform Public
Education needs.
• Gather public comments about Lummi Nation Health
Care Systems
• Plan for community review of the draft strategic plan as
developed.
• Identify the need for community involvement in annual
performance evaluation.
Task Force Membership
• Two (2) Members of the Lummi Indian Business
Council (LIBC)
• Three (3) Members of the Health and Family
Services Commission
• Tribal Health and Family Services Administration,
Managers and Staff
• Support Staff – From Lummi Nation Treasurer’s
Division
Lummi Nation Health
System Overview
Lummi Nation Health Systems Service Entities
• Ambulatory Health Clinic – Physical and Dental Health
Services
• Contract Health Care – Referred Care – Hospitalization,
Hospice, Physical, Occupational and Speech Therapy, Oral
Surgeon, Orthodontics, optometrists.
• Specialty Clinics, Geriatrics, Diabetic, STD Awareness
• Behavioral Heath Division – Mental Health, Substance
Abuse
• Lummi Nation Self-Funded Employee Health Insurance Plan
Lummi Nation Health
Outreach Services
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Lummi Nation Schools
Head Start and Day Care Center
Little Bear Creek Senior Living Center
Youth Academy Residential Services
Se-Ye-Chen Youth Home
Self-Funded Employee Health Insurance Plan -1200
employees of Tribal government, College and
Enterprises.
Tribal Members & Health Care
Insurance Coverage
Patient
Descriptions
Percentage
Status
Number
*Eligible Patients
100%
All Eligible
Patients
6,016
**CHS Eligible
53%
100% of CHS
3,217
CHS Eligible
88%
Lummi Nation
2,820
Lummi & Non-Lummi
40%
No Insurance
2,427
Lummi & Non-Lummi
34%
Medicaid
2,040
Lummi & Non-Lummi
29%
Private Insurance 1,739
Total CHS
*Members of Federally Recognized Tribes who have had Health Services
appointments at LNTHC in the last three years
**CHS Eligible – Patients whose assessment determined that no other sources of
payment for medically necessary health care is available.
Lummi Nation Health System
Cultural &Traditional
Knowledge and Practices
Current Clinical,
Behavioral Health,
Rehab & Recovery
Services
Disease Prevention and
Health Promotion
Lummi
Nation
Health
Care
System
Development of Lummi Nation Health
Services and Care System Strategic Plan
LIBC
LNHC
HealthCare
Service
Needs
Health Care
Resources
Lummi Nation
Comprehensive
Health Care
System
LNHRTF
Strategic Plan
Development
Strategic Plan
Completion
Strategic Plan
Implementation
Lummi Planning Assumptions
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Critical planning assumptions
Most Lummi Tribal members will be eligible for subsidized
health care insurance through the Federally Mandated/State
operated Health Insurance Benefit.
Most Lummi Tribal members will not see the need to secure
additional health care insurance at their own expense.
Most Lummi Tribal members would not be able to compare
plan services and costs and select one.
Most Lummi Tribal members will not be aware of their rights
provided by the ACA, which incudes the following:
 Limits individual tax penalties, co-pays to persons over
300% of FPL,
 Prohibits managed care plans, more than monthly
enrollment periods
 Allows the I/T/U system billing of Qualified Health Plans
for services provided to Tribal participants.
Identifying/Tracking Income
•
Lummi Nation will need to add income as a major component
in their health planning activities.
• Lummi needs to track tribal member income ranges in order to
successfully mange their health care cost recovery activities.
• Tribal Enrollment status is still critical but other categorical
qualifications have been eliminated.
•
Lummi will need to develop the capability to move tribal
members from Medicaid (0 to 133% of FPL) to subsidized
insurance (134% of FPL to 300% of FPL) without interrupting
Health Services - based on their income as a percentage of
the Federal Poverty Levels.
Tribal/State/Federal
Development Coordination
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Lummi Nation is involved, at the federal level, through CMS TTAG
and at the state level, through the Washington State American
Indian Health Commission.
H.B. 2319 Washington State law authorizing the development of the
State Health Benefit Exchange requires Tribal consultation.
Lummi Nation is concerned that State Exchanges will not support
waivers & prohibitions provided to Indians in the ACA
Tribal Leaders know the Federal government will create the Health
exchange plans in several states.
Unanswered questions – Affordability of Employer Plans & Spouse
& Dependents Coverage
Coverage of incarcerated individuals.
Requiring Qualified Health Plans to contract with Tribal Health
Systems as Providers.
Qualified Health Plans (QHP’s)
• Lummi Nation is interested in participating in Qualified
Health Plans as a provider of Health Care Services.
• All Tribes must be able to participate as providers in
approved qualified health plans.
• Tribal leaders have tried to get federal regulators to
identify Federally funded health care services as
essential community service providers but have not
been successful.
• Federal regulators have stated that they will review
closely how the plans incorporate members of the
I/T/U services systems.
Lummi Strategic Plan
Component Assumptions
 Tribes must have the option of sponsoring Tribal members as
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insurance customers of Qualified Health Plans.
Coordinate Develop and Implement a Plan of how to utilize
benefits coordinators to get people enrolled or determine
eligibility for a plan
Special provisions and rights of tribal members will not be
part of Navigator programs designed to assist the general
public.
Tribal members will expect Tribe to provide this level of
assistance.
Lummi Nation will have to collect and protect income
information from it’s membership.
Questions or Comments?
CONTACT INFORMATION:
Cheryl Sanders – CherylLS@lummi-nsn.gov
Maureen R. Kinley – MaureenK@lummi-nsn.gov
Jerry Folsom – JerryF@lummi-nsn.gov