ACA/IHCIA Trainings in Fulfillment of the NIHOE Initiative

1. National Council of Urban Indian Health ACA/IHCIA Trainings in Fulfillment of the NIHOE Initiative

2. 38 UIHPs operate in 21 states • UIHPs provide culturally competent health care services to AI/AN in fulfillment of Trust Responsibility to over 100,000 patients each year, from more than 200 federally-recognized tribes. • Urban programs provide primary care, dental, behavioral health, residential substance abuse treatment, and services such as community events, job placement, food banks, smoking cessation, talking circles, and health insurance enrollment.

3. NCUIH visited 11 Urban Indian Health Programs in four states

4. Broad themes of health care reform • ACA/IHCIA will provide more options for AI/AN to receive health care coverage. • The benefits of increased coverage will lead to more options for care and greater choice. • Greater choice will create a much more competitive environment for our patients’ health care dollars. • If successful, urban programs can preserve their base Title V funding for facilities improvements and improvements to services, while relying on third party billing.

5. How do urban programs thrive under ACA? • Get folks insured! • Highlight AI/AN-specific provisions of ACA (and ARRA) • Cost-sharing • Special monthly enrollment • Individual mandate • Broad protections • Pre-existing conditions, lifetime caps, guaranteed issue, community rating • Get IN NETWORK • IHCIA protections- Sec. 206 • ECP • FEHB • VA-IHS sharing agreements • NHSC and HPSA scoring • Importance of tribal consultation and urban participation in formation of exchanges

6. Common Misconceptions and Concerns about Health Care Reform “Won’t I be required by law to purchase health insurance?” “Isn’t health care reform just a way to reduce funding to IHS?” “This is too complicated for many of our patients.” “If I sign up for health insurance, will I still be able to get services from IHS?” “Won’t I have to pay co-pays and deductibles if I sign up for health insurance?” “How will they determine who is an AI/AN – and won’t non-Indians claim AI/AN status?”

7. Next Steps and Needed Resources • Patient guides, waiting-room pamphlets to help demystify health care reform • Assistance and coordination in working with state Exchanges and Medicaid officials • Follow-up assistance for AI/AN providers in states not expanding Medicaid • More direct outreach to clinics, communities, tribes and elders. • A role for elders to play in explaining health care reform • Tribal-urban listening sessions • Spots and interviews on tribal radio and other AI/AN media

8. urbanIndianhealth.org resources

9. Next steps • NCUIH is funded to conduct two more regional site visits in the 2012-2013 project year • We look forward to conducting joint tribal-urban trainings and listening sessions when possible! • Tribal radio spots appear to be a very cost effective way to spread the message about health care reform • Endorsement of our message by IHS, HHS, CMS spokespersons can increase effectiveness of our messaging

10. Questions? Jay Stiener, Policy Analyst 924 Pennsylvania Ave SE Washington, DC 20003 202-544-0344