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The National Indian Health Board (NIHB) advocates for federally recognized American Indian and Alaska Native Tribes to ensure the fulfillment of the trust responsibility to deliver health services. Their mission is to reinforce tribal sovereignty, strengthen tribal health systems, secure resources, and promote the highest level of health and well-being.
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National Indian Health Board Purpose: To advocate on behalf of all federally recognized American Indian and Alaska Native Tribes to ensure the fulfillment of the trust responsibility to deliver health and public health services as assured through treaties, and reaffirmed in legislation, executive orders and Supreme Court cases. Mission Statement: Established by the Tribes to advocate as the united voice of federally recognized American Indian and Alaska Native Tribes, NIHB seeks to reinforce Tribal sovereignty, strengthen Tribal health systems, secure resources, and build capacity to achieve the highest level of health and well-being for our People
Victoria Kitcheyan – Winnebago Tribe of Nebraska NIHB Vice-Chair & Great Plains Area tori.kitcheyan@winnebagotribe.com Charles Headdress - Fort Peck Assiniboine and Sioux Tribes Billings Area ckheaddress@yahoo.com Sam Moose - Mille Lacs Band of Ojibwe NIHB Treasurer and Bemidji Area SamuelMoose@FDLREZ.COM Andrew Joseph, Jr. - Confederated Tribes of the Colville Reservation NIHB Member-at-Large & Portland Area andy.joseph@colvilletribes.com Beverly Cook - St. Regis Mohawk Tribe Nashville Area beverly.cook@srmt-nsn.gov Lisa Elgin - Manchester Band of Pomo Indians NIHB Secretary and California Area lisa.elgin@yahoo.com Marty Wafford- Chickasaw Nation Oklahoma City Area Marty.Wafford@chickasaw.net William Smith Jr.- Valdez Native TribeAlaska Area imeyak@valdezak.net Donnie Garcia- Jicarilla Apache Nation Albuquerque Area docsix@hotmail.com Vinton Hawley - Pyramid Lake Paiute Tribe NIHB Chair and Phoenix Area vhawley@plpt.nsn.us Russell Begaye - Navajo Nation Navajo Area russellbegaye@gmail.com Sandra Ortega - Tohono O'odham Nation Tucson Area Sandra.Ortega@tonation-nsn.gov
Save the Date NIHB Tribal Public Health Summit May 22-24, 2018
AMERICAN INDIAN AND ALASKA NATIVE OUTREACH AND EDUCATION Presented by: Kristen Bitsuie Tribal Healthcare Reform Outreach and Education Program Associate National Indian Health Board
Outreach and Education in AI/AN Communities: A Study on the Affordable Care Act Messaging
Indian Health Background • What is considered a federally recognized Tribe in the U.S.? • A federally recognized tribe is any Indian or Alaska Native Tribe, band, nation, Pueblo, village, or community that the Department of the Interior (DOI) acknowledge as an Indian Tribe, including Alaska Native regional and village corporations. • How many American Indian and Alaska Natives live in the U.S.? • According to the U.S. census there are 5.2 million people in the U.S. who identify themselves as either American Indian and Alaska Native (AI/AN), either alone or in combination with one or more other races. Approximately 2 million receive services from the Indian Health system.
Indian Health Background • Federally recognized Tribes and the federal government have a historical government-to-government relationship based on The U.S. Constitution, treaties, statutes, Supreme Court cases, and Executive Orders. • As part of this unique relationship and trust responsibility, the federal government provides health care, social services, housing, education, and other services to AI/ANs, through federal agencies such as the Department of Health & Human Services (HHS), Department of the Interior, and the Department of Education.
Definition of AI/AN • For purposes of the Marketplace, an AI/AN is limited to members of a federally recognized tribe or ANCSA shareholders. • For purposes of Medicaid and CHIP, an AI/AN is a member of a federally recognized Tribe, an Alaska Native Claims Settlement Act (ANCSA) corporation shareholder or any individual eligible to receive services from IHS.
The ACA for Indian Country • Permanently reauthorizes the Indian Health Care Improvement Act (IHCIA) • Strengthens the Indian Health Service (IHS) • Authorizes the expansion of Medicaid in states • Enhances third-party revenue
Marketplace Explained Cost Sharing Reductions EHB APTC SEP AI/AN Exemption
ACA Positive Impact 12% 473,000 11% 13% Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2017 Website. http://www.edfoxphd.com/
Purpose of Study To investigate the effectiveness of activities widely known as outreach and education on the Patient Protection and Affordable Care Act in Tribal communities at a key time in health care reform.
Marketplace Study Design • Participants recruited from large conferences • Used flyers or approached attendees • Groups of 3 or interviews • Transcription used for analysis • Incentivized with door prizes or gift cards • Qualitative versus Quantitative!
CMS/ITU Training • Rapid City, SD • December 2014 • NIHB Tribal Public Health Summit • Palm Springs, CA • April 2015 Tribal Epidemiology Center Tribal Public Health Conference Tulsa, OK April 2015 • ANA Native American Grantees Conference • Santa Fe, NM • February 2015 • NIHB ACA O&E Training • Tucson, AZ • February 2015 • -Native American Child & Family Conference • -American Indian Higher Education Consortium annual conference • Albuquerque, NM • March 2015 Image source: https://www.ihs.gov/foodhandler/images/areas.jpg
Demographics Gender (More Female) Race (Self Identified) Age 30 - 55 American Indian Alaska Native
Marketplace Study Limitations • Lack of demographic information • Lack of consistent questioning from moderators • Transcript errors • Qualitative versus Quantitative
Marketplace Study Design Assessing the messaging around the ACA and Marketplace • What messages/advertisements/announcements have you heard about signing up for insurance through the Affordable Care Act? • Where did you receive this information from? • What sources/messages do you feel are the most trustworthy? • What sources/messages do you feel are the least trustworthy? • What suggestions do you have for future messages regarding insurance enrollment?
Results What kinds of communication or advertisement have you seen regarding the Affordable Care Act? Respondents stated:
Results What sources or messages do you feel are the most trustworthy? Respondents stated:
Results What sources or messages do you feel are the least trustworthy? Respondents stated:
On this slide you will see the sources of information that NIHB has defined as having “clear trust” with participants. The underlined points are directly related to the work of Outreach and Education Clear Trust • Tribal leaders • Newspapers • Parents • Healthcare providers • Family Partnership Coordinators • Information from IHS Clinics • Head Start programs
Need all tribes identified and listed • Connect directly with tribal community • Incentives to enroll: food, shirts, small gifts • Visual aids • Tribal navigator • Kiosk at clinic • Native American call-in helpline • Engage elders • Convey community benefit • Collaborate with other government programs • Connect at pow wows • Community events • Ceremonies Results What suggestions do you have for future messages regarding insurance enrollment?
Best Practices Moving forward with these lessons Outreach and Education in Tribal communities should involve a multi-pronged approach.
Tribal Days of Action: A Model • In person training • Tribal leaders • Parents • Information from IHS Clinics • Family Partnership Coordinators • Healthcare providers • Community enrollment events • Tribal leaders • Parents • Information from IHS Clinics • Family Partnership Coordinators • Healthcare providers • Advertising and marketing • Tribal leaders • Newspapers • Parents • Information from IHS Clinics • Family Partnership Coordinators
Patient Benefits Coordinators • Patient Benefits Advocates • Certified Application Counselors • Outreach and Education Specialists • Navigators • Medicaid Office Employees • SHIP Counselors Role of the Assister
CMS AI/AN Outreach and Education Materials • Tribal Specific Brochures • Tribal Specific Fact Sheets • Customizable Fliers • AI/AN Targeted PSAs • Radio PSA’s in English and 5 Native Languages • Youtube PSA’s in English and 5 Native Languages • All Materials free to order and ship directly to you. https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/CMS-Tribal-Products.html
CMS Tribal Native American Contact Who to contact for more information in your area on CMS programs: https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/NACTAGlistJanuary2017.pdf
NATIONAL INDIAN HEALTH BOARD OUTREACH AND EDUCATION
Story Banking Campaign • The National Indian Health Board (NIHB) has begun a Story Banking campaign to collect inspirational stories about how American Indian and Alaska Native (AI/AN) individuals are achieving and sustaining health through the variety of health coverage options available. • Health Insurance Marketplace (Helathcare.gov) • Medicaid • Medicare • Children’s Health Insurance Program (CHIP) • Private Insurance
Story Banking Campaign • Importance of Story Banking: • Highlighting the importance of all health insurance coverages for AI/ANs, such as Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP) is vital to the role that NIHB plays in advocating for the health and wellness of AI/ANs. • Advocacy Work • Story Telling • Recording History • Celebrating specific areas
A single parent who is a Tribal member of the Spirit Lake Tribe had 3 children in desperate need of dental care. After enrolling her children in Medicaidcoverage, this mother was able to get her children to see a dentist. As a result of health care coverage of these dentist visits, their teeth were fixed and all three children were happy. North Dakota’s state Medicaid program covered the cost of appointments and surgeries in full. Not only was this mother able to get her children access to dental surgeries but she was also able to ensure her children’s continued access to health care services.
A 42 year old male from Albuquerque, NM had type 2 Diabetes. He lived outside his contract health services delivery areaso he was not eligible for PRC. As a result this patient would have to pay for insulin and diabetic testing supplies out-of-pocket. Due to Medicaid expansion, he qualified for Medicaidand his diabetic supplies and medications were covered. Previous to Medicaid expansion, this man was not eligible to Medicaid as a childless adult. His case worker was even able to arrange for transportation services for his health visits. Because of Medicaid expansion this patient was able to better control his diabetes and receive the medical care he needed.
REQUESTING INPUT • Constantly looking to see what of outreach materials is needed • Training materials for AI/AN
NIHB TOOLKIT • Enrollment Assister • Youth • Medicare
