Lummi Nation Welcomes Health Reform - Northwest Portland Area by pptfiles



     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
• 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
• 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
           Lummi Nation Health
             System Overview
Lummi Nation Health Systems Service Entities
• Ambulatory Health Clinic – Physical and Dental Health
• 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
• 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
      Patient              Percentage             Status             Number
*Eligible Patients         100%             All Eligible           6,016
**CHS Eligible             53%              100% of CHS            3,217
CHS Eligible               88%              Lummi Nation           2,820
Total CHS
Lummi & Non-Lummi          40%              No Insurance           2,427
Lummi & Non-Lummi          34%              Medicaid               2,040
Lummi & Non-Lummi          29%              Private Insurance      1,739
     *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                  Nation
 Disease Prevention and    System
 Health Promotion
Development of Lummi Nation Health
Services and Care System Strategic Plan

                                                  Lummi Nation
                      HealthCare   Health Care   Comprehensive
             LNHC                                  Health Care
                     Service Needs Resources

    Strategic Plan       Strategic Plan           Strategic Plan
    Development           Completion             Implementation
Lummi Planning Assumptions
 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.
     Development Coordination
•   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
  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
 Tribal members will expect Tribe to provide this level of
 Lummi Nation will have to collect and protect income
  information from it’s membership.
Questions or Comments?

 Cheryl Sanders –

Maureen R. Kinley –

    Jerry Folsom –

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