for Medicaid amp Medicare Services CMS HoChunk Nation Outreach and Education Activities 1 CMS Centers for Medicare amp Medicaid Services Department of Health and Human Services DHHS ID: 185789
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Centers for Medicaid & Medicare Services (CMS)/Ho-Chunk Nation:Outreach and Education Activities
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CMS(Centers for Medicare & Medicaid Services)Department of Health and Human Services (DHHS) Administers Medicare, Medicaid, Children’s Health Insurance Program (CHIP) and ExchangesServing over 98 million beneficiariesAnnual Budget of approximately $800 billionCMS plays a key role in the overall direction of the U.S. health care system CMS Organizational Overview
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10 CMS Regional OfficesCMS Organizational Overview3Slide4
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 programsContact your NAC if your tribal program has questions about Medicare, Medicaid and CHIP CMS Provides Assistance to I/T/Us4Slide5
CMS AI/AN BeneficiariesAI/AN populations served by IHS – 1.8 millionAI/AN populations enrolled in:Medicare: 180,000Medicaid: 800,000SSA authority for IHS to bill Medicare & MedicaidFY 2011, IHS estimates Medicare & Medicaid reimbursements exceed $800 millionThe revenues collected at each service unit varies and helps supplement the service unit’s hospital and clinics operating budgetsSlide6
My Health, My CommunityMy 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.6Slide7
Ho-Chunk Nation7Comprised of 7,194 Tribal Members5,046 Tribal Members reside in Wisconsin2,148 Tribal Members are considered At-LargeMajority of our tribal members reside in CMS Regional Office VHo-Chunk is part of the Bemidji Area for Indian Health ServiceSlide8
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Ho-Chunk Nation CHSDAComprised of 15 counties in WisconsinIncludes Houston County of MinnesotaOperations Include two Flagship Clinics located in Jackson and Sauk Counties4 Satellite Offices located in Monroe, Wood, Shawano and La Crosse Counties9Slide10
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Ho-Chunk Nation Eligibility and Outreach ProgramHo-Chunk Nation secured a grant from the Wisconsin Department of Human Services to support the cost of 4 Benefit SpecialistsBenefit Specialists primary role was to identify eligible tribal members and enroll them in Medicaid/CHIP programsThe goal was to increase third party revenue through Medicaid and CHIP 11Slide12
Community Outreach and EducationHo-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 facilitiesTribal members educated on the importance of cost savings to the Nation12Slide13
CMS Barriers to EnrollmentDo not have incentive to apply because can receive care at no cost from IHSFederal government’s responsibility to provide health care based on treaties -shouldn’t have “to apply” for programsMistrust that information provided will be used for other purpose (estate recovery)Concerned about quality care they might receive from non-Indian providers13Slide14
Ho-Chunk Nation BarriersPoor tribal to county relationsTransportationContinued mistrust in regards to giving personal informationNo incentive to enroll since tribal members continued to receive services at no costNo linkage to Contract Health Service payments for services rendered outside IHS clinics14Slide15
CMS Training for Tribal ProgramsIn 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/locations.cfmSlide16
Ho-Chunk Nation Strategies to increase enrollmentUtilization of multiple forms of mediaIncreased education of Benefit specialistsIncreased presence in the community at monthly area meetings, health fairs, and coordination with other services such as WIC clinics, food distribution and Head Start 16Slide17
Additional CMS ResourcesCMS produces the Medicine Dish: a series of broadcasts for health professionals and AI/AN beneficiaries on CMS programsBroadcasts 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 CountrySlide18
Ho-Chunk Nation Utilization of CMS ResourcesIncreased technology in waiting room areas allows for tribal friendly CMS videos to be playedIncreased education of providersProtocols set in place to identify uninsured qualified adults and childrenLinkage to Contract Health Service Dollars18Slide19
Ho-Chunk Nation Enrollment into Medicaid and CHIP19Slide20
Ho-Chunk Nation Medicaid Revenue Increase20Slide21
Ho-Chunk Nation Reduction in Beneficiary Expenses21Slide22
Ho-Chunk Billing StrategyConduct community health assessmentAnticipating increased workload to the billing staff and accounts receivable teamAnticipating increased educational campaign towards childless adult population, tribal council, tribal members, county, state and private insurance companies to ensure appropriate payment for services22Slide23
CMS Tribal Consultation PolicyTribal Consultation Policy – effective November 17, 2011Agency 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 policyCan be found at cms.gov/AIAN23Slide24
Tribal Technical Advisory GroupCMS 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.24Slide25
Ho-Chunk Participation: Pro-ActiveTribes have been given a great opportunity to be pro-active in regards to CMS policy rather than reactiveCreated a team of elected officials and health officers to tackle health issues affecting Ho-Chunk NationAdvocacy efforts may even extend beyond tribal healthcare and ensure access to all people 25Slide26
TTAG Outreach & Education Subcommittee O& E subcommittee meets regularly toReview outreach materialsReview PSA and DVD scriptsProvides input and commentsCMS incorporates advice and feedback from subcommittee into its workChaired by: Dr. Alec Thundercloud, Ho-Chunk Nation and Bemidji Area TTAG rep26Slide27
Our Health, Our CommunityOur Health, Our Community VideoDeveloped in 2007 – with Gale Marshall, NIHB, and CMS TTAGTo encourage Indian families to enroll in CMS programs27Slide28
CHIPRA, Recovery Act, & ACAChildren’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 & CHIPAffordable Care Act: Includes provisions specific to Indians for State Health Exchange PlansSpecial Enrollment Periods for IndiansCost Sharing Exemptions for Indians up to 300% FPLMembers of Indian Tribes exempted from individual mandateSlide29
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 organizationsSlide30
AI/AN CHIPRA GranteesApril 16, 2010 – HHS announced $10 million to 41 grantee -- IHS, tribal and urban Indian programsPurpose of grants is to improve outreach and enrollment of Indian families in Medicaid and CHIPOctober 31, 2011 an AI/AN CHIPRA grantee training held to build a community and share outreach and enrollment ideas30Slide31
CHIPRA Outreach EffortsBilly 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 practicesLessons learned from CHIPRA grantees will assist in implementation of ACA31Slide32
Affordable Insurance ExchangesStarting 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 PlansSpecial Enrollment Periods for IndiansCost Sharing Exemptions for Indians up to 300% FPLMembers of Indian Tribes exempted from individual mandateFinal rules were published on March 12, 2012 and additional guidance is forthcoming.32Slide33
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. 33Slide34
Ho-Chunk Nation StrategiesEngage the state early to develop the exchanges, even if your state has returned the federal monies to set up the state exchangesAnticipate barriers to state exchanges such as enforcement of the special provisions for AI/AN, lack of internet access by tribal membersWork towards improving county, state and tribal relations34Slide35
Ho- Chunk Strategies (cont’d)Need to know your State’s Tribal consultation SPA and consultation policiesInvite State Officials to your clinicEducate State Officials on Tribal issues and protections afforded to AI/ANs It is not too early to begin working with States35Slide36
Thank you for the opportunity to present information.Questions? Tribalaffairs@cms.hhs.gov