Centers for Medicaid & Medicare Services (CMS )/Ho-Chunk Nation: Outreach and Education Activities

1. Centers for Medicaid & Medicare Services (CMS)/Ho-Chunk Nation:Outreach and Education Activities

2. CMS(Centers for Medicare & Medicaid Services) Department of Health and Human Services (DHHS) Administers Medicare, Medicaid, Children’s Health Insurance Program (CHIP) and Exchanges Serving over 98 million beneficiaries Annual Budget of approximately $800 billion CMS plays a key role in the overall direction of the U.S. health care system CMS Organizational Overview

3. CMS Organizational Overview 10 CMS Regional Offices

4. CMS Provides Assistance to I/T/Us • CMS is committed to maximizing AI/AN access to Medicare, Medicaid and CHIP. • The Tribal Affairs Group serves as a liaison between the Agency and Tribal communities regarding Indian health and CMS programs. • At each CMS Regional office, there is a Native American Contact (NAC) who is available to provide technical assistance to Tribal programs • Contact your NAC if your tribal program has questions about Medicare, Medicaid and CHIP 4

5. AI/AN populations served by IHS – 1.8 million AI/AN populations enrolled in: Medicare: 180,000 Medicaid: 800,000 SSA authority for IHS to bill Medicare & Medicaid FY 2011, IHS estimates Medicare & Medicaid reimbursements exceed $800 million The revenues collected at each service unit varies and helps supplement the service unit’s hospital and clinics operating budgets CMS AI/AN Beneficiaries

6. My Health, My Community • My Health – when an AI/AN enrolls in CMS programs, they benefit as an individual through access to health services; and they benefit … • Their Community – through Medicare and Medicaid reimbursements to IHS facilities and the revenues supplement resources available for others in the community.

7. Ho-Chunk Nation Comprised of 7,194 Tribal Members 5,046 Tribal Members reside in Wisconsin 2,148 Tribal Members are considered At-Large Majority of our tribal members reside in CMS Regional Office V Ho-Chunk is part of the Bemidji Area for Indian Health Service

9. Ho-Chunk Nation CHSDA • Comprised of 15 counties in Wisconsin • Includes Houston County of Minnesota • Operations Include two Flagship Clinics located in Jackson and Sauk Counties • 4 Satellite Offices located in Monroe, Wood, Shawano and La Crosse Counties

11. Ho-Chunk Nation Eligibility and Outreach Program • Ho-Chunk Nation secured a grant from the Wisconsin Department of Human Services to support the cost of 4 Benefit Specialists • Benefit Specialists primary role was to identify eligible tribal members and enroll them in Medicaid/CHIP programs • The goal was to increase third party revenue through Medicaid and CHIP

12. Community Outreach and Education • Ho-Chunk Nation begins a media campaign to educate tribal member on the importance of enrolling for these benefits to increase access to care, especially for member who do not reside closely to IHS facilities • Tribal members educated on the importance of cost savings to the Nation

13. CMS Barriers to Enrollment • Do not have incentive to apply because can receive care at no cost from IHS • Federal government’s responsibility to provide health care based on treaties -shouldn’t have “to apply” for programs • Mistrust that information provided will be used for other purpose (estate recovery) • Concerned about quality care they might receive from non-Indian providers

14. Ho-Chunk Nation Barriers • Poor tribal to county relations • Transportation • Continued mistrust in regards to giving personal information • No incentive to enroll since tribal members continued to receive services at no cost • No linkage to Contract Health Service payments for services rendered outside IHS clinics

15. CMS Training for Tribal Programs In 2011 and 2012, the TAG, working with NACs and the IHS, will hold Area Trainings on Medicare, Medicaid, and CHIP issues. To register for the trainings and see the schedule of upcoming trainings, go to: www.blsmeetings.net/cmsitutrainings/locations.cfm

16. Ho-Chunk Nation Strategies to increase enrollment • Utilization of multiple forms of media • Increased education of Benefit specialists • Increased presence in the community at monthly area meetings, health fairs, and coordination with other services such as WIC clinics, food distribution and Head Start

17. CMS produces the Medicine Dish: a series of broadcasts for health professionals and AI/AN beneficiaries on CMS programs Broadcasts can be found on You Tube – search for “Medicine Dish” In 2012, we plan to film the Medicine Dish Broadcasts out in Indian Country – in a documentary or magazine format – to showcase promising practices in Indian Country Additional CMS Resources

18. Ho-Chunk Nation Utilization of CMS Resources • Increased technology in waiting room areas allows for tribal friendly CMS videos to be played • Increased education of providers • Protocols set in place to identify uninsured qualified adults and children • Linkage to Contract Health Service Dollars

19. Ho-Chunk Nation Enrollment into Medicaid and CHIP

20. Ho-Chunk Nation Medicaid Revenue Increase

21. Ho-Chunk Nation Reduction in Beneficiary Expenses

22. Ho-Chunk Billing Strategy • Conduct community health assessment • Anticipating increased workload to the billing staff and accounts receivable team • Anticipating increased educational campaign towards childless adult population, tribal council, tribal members, county, state and private insurance companies to ensure appropriate payment for services

23. CMS Tribal Consultation Policy • Tribal Consultation Policy – effective November 17, 2011 • Agency specific policy that CMS is in the process of implementing SOP’s • Agency is committed to consultation and will conduct an annual review of the policy • Can be found at cms.gov/AIAN

24. Tribal Technical Advisory Group CMS Tribal Technical Advisory Group (TTAG) provides advice and input to CMS on issues affecting Indian health programs and AI/AN beneficiaries. TTAG is comprised of 17 representatives, one from each of the 12 IHS Areas and a representative from NIHB, NCAI, TSGAC, NCUIH, and IHS. TTAG meets three times a year in Washington, DC and holds monthly conference calls and subcommittee calls. 24

25. Ho-Chunk Participation: Pro-Active • Tribes have been given a great opportunity to be pro-active in regards to CMS policy rather than reactive • Created a team of elected officials and health officers to tackle health issues affecting Ho-Chunk Nation • Advocacy efforts may even extend beyond tribal healthcare and ensure access to all people

26. TTAG Outreach & Education Subcommittee • O& E subcommittee meets regularly to • Review outreach materials • Review PSA and DVD scripts • Provides input and comments • CMS incorporates advice and feedback from subcommittee into its work • Chaired by: Dr. Alec Thundercloud, Ho-Chunk Nation and Bemidji Area TTAG rep

27. Our Health, Our Community • Our Health, Our Community Video • Developed in 2007 – with Gale Marshall, NIHB, and CMS TTAG • To encourage Indian families to enroll in CMS programs

28. Children’s Health Insurance Program Reauthorization Act (CHIPRA) reauthorizes the CHIP program for FY 2009 through FY 2015 American Recovery and Reinvestment Act (Recovery Act) – Section 5006: Protections for Indians Under Medicaid & CHIP Affordable Care Act: Includes provisions specific to Indians for State Health Exchange Plans Special Enrollment Periods for Indians Cost Sharing Exemptions for Indians up to 300% FPL Members of Indian Tribes exempted from individual mandate CHIPRA, Recovery Act, & ACA

29. Section 201: outreach and enrollment Provides for $100 million for all enrollment and outreach activities – $80 million for outreach and enrollment grants to States and other eligible entities $10 million for national enrollment campaign, including outreach materials for Native Americans $10 million set aside for outreach to Indian children through grants to Indian Health providers and urban Indian organizations CHIPRA and Indian Health

30. AI/AN CHIPRA Grantees • April 16, 2010 – HHS announced $10 million to 41 grantee -- IHS, tribal and urban Indian programs • Purpose of grants is to improve outreach and enrollment of Indian families in Medicaid and CHIP • October 31, 2011 an AI/AN CHIPRA grantee training held to build a community and share outreach and enrollment ideas

31. CHIPRA Outreach Efforts • Billy Mills PSA – 1964 Olympic gold medalist, Veteran, Oglala tribal member • CHIPRA DVD – won ECHOE award at 2nd Annual CHIP Summit, 2011 • “Building a community” of CHIPRA grantees – sharing O & E practices • Lessons learned from CHIPRA grantees will assist in implementation of ACA

32. Affordable Insurance Exchanges • Starting in 2014, Exchanges will be one-stop marketplaces that allow consumers and small businesses to choose a private health insurance plan. • ACA Includes provisions specific to Indians for Exchange Plans • Special Enrollment Periods for Indians • Cost Sharing Exemptions for Indians up to 300% FPL • Members of Indian Tribes exempted from individual mandate • Final rules were published on March 12, 2012 and additional guidance is forthcoming.

33. Medicaid Expansion • Starting in 2014, Medicaid will be available to individuals between ages 19 and 64 with incomes up to 133 percent of the federal poverty level – currently $14,856 for an individual and $30,656 for a family of four. • These changes will become effective in 2014 • Section 5006 – Protections for Indians under Medicaid are retained • Additional guidance is forthcoming.

34. Ho-Chunk Nation Strategies • Engage the state early to develop the exchanges, even if your state has returned the federal monies to set up the state exchanges • Anticipate barriers to state exchanges such as enforcement of the special provisions for AI/AN, lack of internet access by tribal members • Work towards improving county, state and tribal relations

35. Ho- Chunk Strategies (cont’d) • Need to know your State’s Tribal consultation SPA and consultation policies • Invite State Officials to your clinic • Educate State Officials on Tribal issues and protections afforded to AI/ANs • It is not too early to begin working with States

36. Thank you for the opportunity to present information. Questions? Tribalaffairs@cms.hhs.gov