Document

Report
Washington Health Benefit Exchange
Serving American Indians/Alaska Natives
Summer 2013
Purpose and Objectives
Purpose
This training module is to provide an overview of
serving American Indians and Alaska Natives (AI/ANs)
in Washington’s Healthplanfinder
Objectives
Upon completion of this training you will:
▪ Understand the Federal responsibility to AI/AN for health care
▪ Have a general understanding of the Indian health system and why it
is important in the Exchange
▪ Understand the special benefits afforded to AI/AN in the ACA and
Exchange
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Training Module Contents
▪ Federal Responsibility for Indian Health Care
▪ State-Exchange Responsibilities to Tribes and Urban
Indian health organizations
▪ Indian Health Care Delivery System
▪ Indian Health Disparities
▪ Special Provisions/Protections for AI/AN
▪ Benefits to AI/AN
▪ Eligibility
▪ Issues important to AI/AN
▪ Let’s review
▪ Knowledge Check
Federal Trust Responsibility for Indian Health
TRIBAL SOVEREIGNTY
"The definition of
sovereignty is to have
control over your own
lands, and resources,
and assets, and to have
control over your own
vision for the future,
and to be able to
absolutely determine
your own destiny.”
- - - the late Wilma Mankiller,
United States has a
responsibility to provide
for the health care needs
of Native people
Executive
Orders
Statute
Cherokee Nation President
Treaty
Key Point
Court Cases
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Treaties Established Health Care Services
“And the United States finally agree to
employ a physician to reside at the said
central agency, who shall furnish
medicine and advice to their sick, and
shall vaccinate them; the expenses of
…medical attendance to be defrayed by
the United States, and not deducted
from the annuities.”
• Treaty of Point Elliot, 1855, Article 14
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Tribal-State Government-to-Government
WHBE Tribal Consultation Policy
Key Point
Exchange is required to develop a process for Tribal
Consultation
Establishes a clear and concise consultation and collaboration
process between the WHBE and federally-recognized tribal
Governments as required by Affordable Care Act
Tribal Advisory Workgroup: collaboration and
identification of issues with Tribal implications
Tribal Liaison: works with Tribes, Urban Indian health
programs, Exchange staff and In-Person Assisters to
facilitate positive relationships and assure uninsured
AI/AN can enroll in Healthplanfinder
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Indian Health Care Delivery System
▪ Federal Indian Health Service
▪ U.S. Department of Health & Human Services
▪ Serves approximately 1.5 million AI/AN
▪ IHS is NOT considered insurance; entitlement based on federal
Indian policy and law
▪ Goal - improve AI/AN health status, uphold federal government
obligations
▪ Area Offices
▪ Portland Area Office - WA, Oregon, Idaho
▪ Washington State Indian Health System
▪ 29 federally recognized Tribes, 2 Urban Indian Health Programs
▪ 34 health care facilities - operated by the federal IHS, Tribes or
urban Indian health programs; services free of charge to AI/AN
▪ Contract Health Services – Tribes/Urban Programs pay for
healthcare services outside of their clinics
Key Point
So Why Do AI/AN Need to Enroll in Washington
Healthplanfinder?
▪ Indian Health Service Funding Inadequacies
▪ 60% of level of need
Key Point
▪ Indian Health Care Disparities
▪ Worst health outcomes overall than any other population in
Washington
▪ In WA State, 1 out of 3 AI/AN experience high blood pressure
▪ 18% of AI/AN suffer from asthma compared to 9% of general
population
▪ 11% of AI/AN have diabetes compared to 7% of general pop
▪ 10% of AI/AN suffer from heart disease and stroke compared to
6% of general population
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Why AI/AN Benefit from Healthplanfinder con’t.
▪ AI/AN Uninsured in WA
▪ 23.1% compared to
overall WA at 13.4%
▪ 45,000 AI/AN
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Myths as Barriers to Indian Health
▪ “All Indians get all their health care
through a separate government
system”
▪ “Indians do not need regular health
care coverage”
▪ “Indians are not eligible for Medicaid
or Medicare or other public benefits”
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AI/AN Special Benefits and Protections in ACA
▪ AI/AN living in Washington State will be eligible for
additional benefits when Washington
Healthplanfinder opens in October 2013
▪ The Affordable Care Act includes a number of
provisions that outline special rules for American
Indian and Alaska Native enrollment in Washington
Healthplanfinder
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Special Protections for Enrolled AI/AN
AI/AN with
Income below
300% of
Federal Poverty
Level (FPL)
• NO DEDUCTIBLES
• NO CO-PAYMENTS
• NO CO-INSURANCE COSTS
Key Point
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Special Provisions for Enrolled AI/AN con’t. . .
Key Point
• No Federal Mandate – AI/AN are not subject to
tax penalty for not enrolling in minimum health care
coverage
• No Costs for Using Indian Health Services no co-pays or other costs for AI/AN who receive health
care services or receive a referral from Indian Health
Service, a Tribe, a Tribal organization or Urban Indian
Health program
• Special Enrollment Options – limited enrollment
periods do not apply to AI/AN; An AI/AN can enroll in or
change a health plan on a monthly basis
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Special Provisions for AI/AN con’t. . .
Income
Exemptions for
AI/AN
• Alaska Native Corporations and Settlement
Trusts;
• distributions from property held in trust;
Key Point
• distributions and payments from fishing,
natural resource extraction and harvests;
• distributions from ownership of natural
resources and improvements;
• payments from ownership of items that have
unique religious, spiritual, traditional, or
cultural significance according to Tribal Law
or custom; and,
• student financial assistance from Bureau of
Indian Affairs education programs).
“Plain Language” reference document being developed for IPA use
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New Protection for AI/AN Descendants
▪ New Federal Rule: No penalty for not enrolling in a
QHP or having Minimum Essential Coverage (MEC)
for Tribal descendants
▪ Checking the Box: “Tribal descendant” or “User of
IHS services”
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Verifying AI/AN Enrollment Status
▪ Process within WA Healthplanfinder
▪ Only Tribal Assisters can manually verify
▪ Other In-Person Assisters can facilitate verification
documentation download
▪ Exchange will generate reports to WA State Tribes for
verification
▪ Without documentation, AI/AN has 90 days to provide
▪ Eligible in 90 day period for special benefits
▪ “Good faith effort” clause may extend period
Eligibility for health coverage in a QHP is NOT tied to
AI/AN status. If no AI/AN documentation is
available, the AI/AN can still receive coverage
through the Exchange with no special benefits!
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AI/AN Verification Reference
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Tribal Assisters – Role & Responsibilities
Provide outreach and awareness
activities
• Inform AI/ANs about special provisions
afforded them under the ACA
• Maintain expertise in eligibility,
enrollment and program specifications
• Facilitate an individual’s selection of a
qualified health plan
• Assist individuals in applying for
premium subsidies
• Enter information related to an
individual’s application and enrollment
in the Washington Healthplanfinder
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Knowledge Check
Federally-recognized Tribes and Alaska Native
corporations have a government-to-government
relationship with the U.S. government. They are
considered sovereign nations. This means:
A. They govern their own lands and people
B. They have one leader
C. They impose no rules
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Knowledge Check
The Exchange Tribal Advisory Workgroup helps with:
A. Determining the Federal rules imposed upon
AI/AN.
B. Determining which individuals are AI/AN.
C. Helps in on-going communication and
collaboration with the Exchange on issues that
impact AI/AN.
D. Establishing Tribal policy regarding the ACA.
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Knowledge Check
High poverty rates and limited access to high-quality
health care are the main causes of:
A. Poor health in the AI/AN populations.
B. Low tax rates.
C. Limited access to housing.
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Knowledge Check
The federal Indian Health Services is:
A. The Association that determines the amount of
money a AI/AN pays for their health care
coverage.
B. The principal federal health care provider and
health advocate for Indian people.
C. The agency that determines the taxes imposed
on AI/AN.
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Knowledge Check
American Indians and Alaska Natives who are
enrolled in federally-recognized Tribes or registered
with Alaska Native corporations do not have to pay
deductibles, co-payment or co-insurance under a
Qualified Health Plan in the Exchange if they are…
A. Paying very high premiums.
B. Related to someone that works with the
Exchange.
C. Making an income below 300% of the Federal
Poverty Level.
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Knowledge Check
The only cost to AI/AN that have an income of less than 300%
of the FPL is premium payments. When comparing QHPs in
the Washington Healthplanfinder, an AI/AN individual or
family who meet these income criteria, would want to look for
a QHP that best fits his/her healthcare needs with…
A. The lowest premium because co-pays and deductibles do
not apply.
B. The highest premium because that is fair to everyone.
C. A Gold level plan because the premiums are lowest.
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Knowledge Check
If an AI/AN does not secure health care coverage they will
be…
A. Subject to the individual mandate and a tax penalty will
be imposed on them.
B. Put in jail.
C. AI/AN are not subject to the individual mandate.
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Knowledge Check
An AI/AN can enroll in a qualified health plan or change
plans…
A. On a monthly basis rather than waiting for the standard
Open Enrollment period (by the 23rd of the current month
to be eligible for the 1st of the following month)
B. Must enroll during the open enrollment period like
everyone else.
C. Can enroll at any time during the month for coverage
effective on the first of the month they enroll in.
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Knowledge Check
AI/AN are exempt from reporting all of the following forms of
Income except…
A. Distributions from property held in trust
B. Income from Tribal distributions of casino revenues
C. Distributions and payments from fishing, natural resource
extraction and harvests
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Knowledge Check
An AI/AN completes an application and pays their first month’s
premium for a QHP by the 23rd day of the month. During the 90
day waiting period for AI/AN to verify their Tribal enrollment
status, she or he…
A. Has benefits beginning on the first day of the following month
with special provisions
B. Has benefits beginning on the first day of the following month
without special provisions
C. Has no benefits until the required documentation has been
provided and uploaded in to the Healthplanfinder.
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Questions
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Congratulations! You have completed
Serving American Indians/Alaska Natives course!
Thank you!
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