Washington Health Benefit Exchange. Washington Coalition on Medicaid Outreach Deb Sosa, Tribal Liaison March 11, 2016

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1 Washington Health Benefit Exchange Washington Coalition on Medicaid Outreach Deb Sosa, Tribal Liaison March 11, 2016

2 Role of Tribal Liaison The Tribal Liaison works with federally recognized Tribes, Urban Indian Health Programs (UIHP), and the American Indian Health Commission (AIHC), other Tribal regional organizations, state agencies, government and community organizations, and private businesses to address Exchange issues that impact all American Indians and Alaska Natives(AI/ANs). Provide technical assistance to WAHBE staff on government-togovernment relations, cultural competency and impact of policy and implementation to AI/ AN s Communicate regularly with Tribes through tribal assisters and tribal and urban organizations Respond to tribal AI/AN-related questions and issues Facilitate meetings between WAHBE and Tribal representatives through the Tribal Advisory Workgroup (TAW) Perform triage of individual tribal issues and concerns

3 Federal Trust Responsibility Article 1, Section 8 of the Constitution establishes the government-to-government relationship. Treaties negotiated by the U.S. in return for 400 million acres of Indian lands created the trust obligation for health, education and social services.

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5 WA State American Indian Demographics Total AI/AN population for 2014 was 192,114 (2.9% ), of the total state population. the smallest racial/ethnic group in the state Washington has the sixth largest AI/AN population % of the total 4.9 million AI/AN population in the United States. Over one-half of the AI/AN population in urban areas. reside 5

6 Portland Area Indian Health Service Portland Area IHS provides access to care for approximately 150,000 AI/AN residents of 42 tribes in ID, OR, WA 65,000 receive care from WA Tribal and IHS clinics Remaining 85,000 AIANs are without access to IHS and Tribal programs.

7 Urban Indian Population 96,000 AIANs live in Seattle Tacoma metro area. 35,000 in Spokane, Bellingham and Vancouver. 130,000 of 215,000 or 50% live in metro areas.

8 Washington s AI/AN Tribal Services Not a Tribal Health System Each tribe is an independent Sovereign Nation No IHS Hospital or Specialty Care in the region.

9 Tribal Programs There are 34 tribal medical clinics providing primary care 22 of the medical clinics also provide dental care 12 provide pharmacy services, 19 provide mental health treatment and 15 provide chemical dependency services. Only 3 sites are run directly by the IHS Tribes are essential community providers for Washington s AI/AN Tribal population Rural Tribes are often primary care in many areas for non-natives

10 Washington s AI/AN Urban Indians A WA tribal member living away from their tribe ( moved from home state to obtain jobs, school, other opportunities Tribal members away from their home tribe and out of their tribal Contract Health Service Delivery Area. Federal job training relocation programs 60 s and 70 s Numerous military installations across WA Alaskan Native s relocating due to climate change- permafrost thaw and sinking villages Seattle is a Tertiary Care/Specialty Care area for the Alaskan Native Tribal Health Consortium (ANTHC)

11 Special Provisions in the ACA for AI/AN s Enrolled members of Federally recognized tribes can purchase health insurance through the Marketplace and have access to the special provisions. Zero cost sharing plan, and do not have to pay co-pays or other costsharing if their income is between 100 and 300 % of the FPL Income below 100 % and above 300 % of FPL can enroll in a limited cost sharing plan pay no out-of-pocket costs to receive services from an ITU or no out-of-pocket costs from another provider if referred from an ITU Even with a $0 cost share plan, may receive advance premium tax credits if eligible. Monthly enrollment period. Exempt from the shared responsibility payment if they do not maintain minimum essential coverage-includes descendants using IHS facilities. Can file an Indian exemption on federal income tax return.

12 QHP Enrollees by Race/Ethnicity

13 MAGI Medicaid by Race/ Ethnicity

14 EXCHANGE PROGRESS IN 2015 Successful Premium Aggregation Removal Improvements to Healthplanfinder Improvements to Renewal Process Health Literacy Campaign Improved Issue/Complaint Resolution

15 Moving Forward HealthPlanFinder Working with the AIHC to support Tribal Sponsorship AIHC will focus on tribes with under-enrollment of members with health coverage. Focus of outreach this year will be on Urban Indians Providing Support through the Call Center May 2016

16 Tribal Sponsorship Of the 29 tribes currently 8 are participating in the sponsorship program: Jamestown S Klallam Tribe Lower Elwha Klallam Tribe Port Gamble S Klallam Tribe Shoalwater Bay Swinomish Bay. Kalispel Tribe Makah Tribe Muckleshoot Tribe Suquamish Tribe

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18 Contact Deb Sosa Tribal Liaison Washington Health Benefit Exchange

19 Additional Resources WA HBE- Tribal Members website; Federal site-health coverage for American Indians & Alaska Natives website; CMS How to Order Tribal Products Alaska-Native/AIAN/CMS-Tribal-Products.html