CMS Division of Tribal Affairs

1. CMS Division of Tribal Affairs Centers for Medicare & Medicaid Services Training for Indian Health Service Tribes and Tribal Organizations Urban Indian Organizations

2. Role of CMS Tribal Affairs • CMS Division of Tribal Affairs (DTA) is located in Baltimore within the Intergovernmental & External Affairs Group, under the Center for Medicaid & CHIP Services. • DTA serves as the point of contact on Indian health issues for the agency and tribal and federal partners. • At each CMS Regional office, there is a Native American Contact (NAC) who is available to provide technical assistance on CMS programs to I/T/Us. • For the list of DTA and NAC staff, please visit: https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/NACTAGlistJanuary2018.pdf

3. The Role of CMS in Indian Health Care CMS developed a video that highlights the history of Indian Health Care, CMS Tribal Consultation and the significant impact that CMS programs have in Indian Country.  https://www.youtube.com/watch?v=I2EnR88gIZM

4. IHCIA provided the necessary funds and authorities to improve AI/AN access • In 1976, Congress enacted Title IV of the IHCIA amending the Social Security Act to provide authority to IHS hospitals and clinics to receive reimbursement for services rendered to Medicare and Medicaid patients. • Congress recognized that many AI/ANs were eligible for Medicare and Medicaid services but had no access to services and providers, unless they traveled off reservation to private/public providers hundreds of miles away. • The authority to bill Medicare and Medicaid is unique to any other federal health program (i.e., VA and DoD do not have similar authority). • IHS publishes its reimbursement rates in the Federal Register on an annual basis, often called the OMB rates. • In addition to Medicaid and Medicare, I/T/Us also bill the Children’s Health Insurance Program (CHIP) and private insurance, including those purchased on the Health Insurance Marketplace.

5. AI/AN Beneficiaries served by Indian Health Service, Tribes and Urban Indian programs • 2.2 million American Indians and Alaska Natives (AI/ANs) receive health care (at no cost to them personally) from hospitals and health centers operated by the Indian Health Service (IHS), Tribal health programs or urban Indian health programs in 36 states. • For FY 2017, Medicare & Medicaid reimbursements to IHS exceed $1 billion. • The revenues collected at each service unit varies from 15% to 65% of the local hospital or clinic operating budgets • Revenues are used to meet accreditation standards, hire new staff, and provide greater resources to the uninsured.

6. CMS National Campaign CMS held focus groups to test AI/AN knowledge of the ACA and to obtain feedback on outreach materials, and found: • Low to moderate knowledge of the ACA • Strong identification of AI/AN symbols, colors, and designs • Images of individuals or families should be AI/ANs • Messages must be clear and to the point

7. 2017 Open Enrollment

8. Monthly drop-in “news ads” and Radio Clips • 30 second radio clips using the same topic selected for drop-in “news shorts.” • Recorded in five Native languages: • English • Navajo • Lakota • Ojibwe • Yupik • Zuni February 2018 Available on YouTube

9. AI AN Specific Training Materials

10. Numbers reached through outreach In addition to PSAs and newspaper drop ins, CMS secures exhibit space to perform outreach and disseminate CMS outreach materials at 9 AI/AN National Conferences annually, for a total of 200,000 in distribution of materials to over 8,000 conference participants. The total outreach including the monthly “news adds”, radio clips, Twitter and LinkedIn posts exceeded 14 million impressions.

11. Customizable Flyers Man Family Boy on Bike Mom Kissing Girl Email tribalaffairs@cms.hhs.gov to order

12. CMS AIAN Websitego.cms.gov/AIAN

13. Long Term Services and Supports Newsletter You can sign up for the LTSS newsletter here: https://public-dc2.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_11962

14. Outreach and Education Newsletter You can sign up for the O&E newsletter by visiting this website: http://cms.us9.list-manage.com/subscribe?u=c0033d065eadb44cbd20725a3&id=c16000fc19

15. Outreach and Enrollment CIB • On November 28, 2016, CMS released an Informational Bulletin that provides strategies and helpful information for states, Tribes, Tribal organizations, Indian health care providers, and application assisters to increase enrollment of American Indians and Alaska Natives into programs administered by CMS. • Strategies for states: • Tribal Access to State Medicaid Eligibility Portals, out stationing of eligibility workers at Tribal FQHCs, Tribal Medicaid Administrative Match, express lane eligibility for children, presumptive eligibility, and continuous eligibility to increase enrollment of American Indians and Alaska Natives. • Strategies for Tribes: • Making personal contact and building trust, holding enrollment events at Tribal powwows or other cultural events, and using social media and radio stations to improve outreach and education efforts. https://www.medicaid.gov/federal-policy-guidance/downloads/cib112816.pdf

16. How to Order Tribal Products If this is your first time ordering, visit:http://productordering.cms.hhs.gov

17. GoodHealth TV

18. CMS ITU Trainings • CMS provides 12 face to face trainings in or near Indian Country for IHS/Tribal/Urban Indian patient benefits coordinators on Medicare, Medicaid, CHIP and the Health Insurance Marketplace, as well as Social Security and Veterans’ benefits. • CMS also holds webinars throughout the year on particular CMS programs and initiatives. • For more information, please visit: https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Trainings.html

19. Collaboration with Federal Agencies CMS partners with the Administration for Children and Families (ACF) to increase knowledge and awareness of CMS programs federal and tribal grantees in the following ACF tribal programs: Head Start Child Care LIHEAP TANF Child Welfare Administration for Native Americans

20. CMS Division of Tribal Affairs For additional information: DTA Website: https://go.cms.gov/AIAN Trainings and webinars:www.cmsitutrainings.com Questions: tribalaffairs@cms.hhs.gov