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Northwest Portland Area Indian Health Board Quarterly Meeting Skagit Valley Resort & Casino October 17, 2012. Lummi Nation Welcomes Health Reform. Establishment of the Lummi Nation Health & Wellness Reform Task Force. Purpose of the Task Force.

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Presentation Transcript

Northwest Portland Area Indian Health Board

Quarterly Meeting

Skagit Valley Resort & Casino

October 17, 2012

Lummi Nation Welcomes Health Reform



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

  • 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

  • *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 planning assumptions
Lummi Planning Assumptions Strategic Plan

  • 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
Identifying/Tracking Income Strategic Plan

  • 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
Tribal/State/Federal Development Coordination Strategic Plan

  • 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) Strategic Plan

  • 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
Lummi Strategic Plan Strategic PlanComponent Assumptions

  • Tribes must have the option of sponsoring Tribal members as 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
Questions or Comments? Strategic Plan


CONTACT INFORMATION: Strategic Plan

Cheryl Sanders – [email protected]

Maureen R. Kinley – [email protected]

Jerry Folsom – [email protected]


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