# Presentation: 329606

## Working with the State to Improve Access to Alternate Resources 

**Working with the State to Improve Access to Alternate Resources**

- Adam Archuleta, Business Office Coordinator, AAIHS
- Shari Roanhorse-Aguilar, Medical Assistance Division Native American Liaison, NMHSD
- Virginia Alcon, Medical Assistance Division Program Manager

## Objectives

- Describe how the AAIHS, NAIHS and the State of New Mexico are successfully collaborating.
- Present and discuss the unique IHS-State Medicaid Program partnership as a model for success in accessing and increasing Medicaid as a third-party resource.

- 2007 Partnership Conference

## History of Policy Changes

- Medicaid Fee-For-Service
- Medicaid Reform – late 1990s
- Managed Care (Salud! Program)
- Medicare Modernization Act of 2003
- Part D
- Deficit Reduction Act of 2005
- Documentation of Citizenship and Identity

- 2007 Partnership Conference

**Notes:**
MMA enacted on December 8, 2003 with full implementation on January 1, 2006.
MMA provide seniors and individuals with disabilities with prescription drug benefit, more choices and better benefits.

## Why Collaboration & Partnership is Critical to Albuquerque and Navajo Areas?

- $3 billion IHS National Annual Appropriations
- $300M (estimated) collected from M/M/P in FY06
- Over $65M reimbursed to I/T facilities from NM Medicaid
- Medicaid is the largest third-party payor

- 2007 Partnership Conference

## New Mexico Pueblos and Tribes

- (Map Courtesy of the NM Tourism Department)

-  19 Pueblos
-  3 Nations/Tribes

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## New Mexico Demographics 

|  | New Mexico | Native American |
| --- | --- | --- |
| Population | 1,819,046 | 191,475 (10.5% of total population) |
| Medicaid Enrollment | 415,181 | 75,722 (18.2% of total enrollment) |
| Medicaid Managed Care Enrollment |  | 86% Opt-Out
14% Managed Care |

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## Albuquerque AreaIndian Health Service

- Albuquerque Area
- Covers 19 Pueblos
- Mescalero and Jicarilla Apache Tribes
- Alamo, Pine Hill, and Canoncito Navajo Communities
- Ute Mountain and Southern Ute Tribes (Colorado)
- Ysleta Del Sur Pueblo (Texas)
-  Health Care Network
- 4 Hospitals
- 19 Ambulatory Health Facilities
- 75 638 Tribal Contracts
- 2 Urban Health Centers
- User Population
- 86,500 Annually

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## Navajo Area Indian Health Service

- Navajo Area IHS Serves 2 Tribes
- Navajo Nation
- San Juan Southern Paiute Tribe
-  Health Care Network
- 6 Hospitals
- 7 Health Centers
- 13 Health Stations
- 18 Dental Clinics
- User Population
- 238,515 Annually

- 2007 Partnership Conference

## NAVAJO AREA IHSSERVICE UNITS/638 CONTRACTS

- The NAIHS Service Area Is comprised of the Navajo Nation and selected adjacent U.S. Census tracts outside the reservation boundaries (not shown).

**TUBA**
**CITY**
**(638)**

**WINSLOW**
**(638)**

**SHIPROCK**
**(partial 638)**

**CHINLE**

**CROWNPOINT**

**GALLUP**

**HOPI**

**3 NAVAJO**
**SATELLITES**

**SAN JUAN**
**SO PAIUTE**

***NEW MEXICO***

***ARIZONA***

***UTAH***

***COLORADO***

**FT DEFIANCE**
**(partial 638)**

**KAYENTA**
**(partial 638)**

- 2007 Partnership Conference

## New Mexico Organizational Structure

- The Human Services Department (HSD) is one of 17 cabinet-level agencies in the Executive Branch.
- 3 Program Divisions: Medical Assistance, Income Support, and Child Support Enforcement.
- HSD administers the Medicaid, TANF, child support, food stamps, general assistance, Insure NM! Programs, and low income home energy assistance programs.
- HSD has 2 Native American Liaisons:
- Office of the Secretary (since 2004)
- Medical Asst. Division Office of the Director (since 1999)

- 2007 Partnership Conference

## New Mexico Organizational Structure

- The Medicaid program is housed within the Medicaid Assistance Division (MAD).
- Medicaid applications are processed by the county-based Income Support Division offices.
- NM Medicaid Program
- $2.5 billion operating budget

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## HSD Native American Initiatives

- Tribal Issues Subcommittee of the statewide Medicaid Advisory Committee.
- Includes representatives from Tribes, Pueblos, IHS, State agencies, and other community-based organizations that serve Native Americans.
- Targeted Outreach
- Work with the IHS and Tribal Patient Benefit Coordinators at Tribal health fairs, back-to-school events, & other public events.

- 2007 Partnership Conference

## HSD Native American Initiatives

- IHS and Tribal school, health and social services staff certified to grant presumptive eligibility for children and pregnant women.
- Training
- Annual billing and reimbursement training for IHS and Tribes.
- Reports at IHS business office meetings.

- 2007 Partnership Conference

## HSD Native American Initiatives

- DRA citizenship requirement and Medicaid
- Tribal briefing held in August 2006 (also covered TANF & child support changes).
- Radio & newspaper ads on Medicaid requirements.
- Client, Tribal leaders & IHS letters.
- HSD agreed to accept IHS FACE Sheet as level 4 for proof of citizenship.

- 2007 Partnership Conference

## HSD Native American Initiatives

- Certificate of Indian Blood can be utilized as proof of identity.
- Web Portal created to verify births in NM (only for those births recorded in the State but other state eligibility program staff can use this for people born in NM).
- NM supports using CIB as level one proof of citizenship.

- 2007 Partnership Conference

## HSD Native American Initiatives

- Out-stationed Workers Program
- Implemented initially in August 2005 in partnership with Navajo Area IHS.
- 2006 state legislature appropriated funds for the northwest area of the state, which is predominantly Navajo Nation.
- 2007 state legislature appropriated additional funds for the Albuquerque Area.
- August 2007 is the target date to expand to additional sites in the Albuquerque Area.
- Purpose is to increase enrollment of Native Americans in the Medicaid & Food Stamps programs.

- 2007 Partnership Conference

## Focus on IHS and Tribal Programs

- Within MAD 2 staff serve as point-of-contacts for IHS and Tribal programs.
- 1 Native American Liaison in the Director’s Office and 1 Program Manager in the Benefits Bureau.
- Both staff are knowledgeable about the Indian Health system and related federal Medicaid policy and regulation.
- Continual improvements to implement annual OMB rates
- Development of IHS provider policy
- Daily technical assistance to IHS and Tribal programs:
- Eligibility
- Claims
- Systems

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## Focus on IHS and Tribal Programs

- Policy reviews specific to IHS and Tribal programs
- State Contracts and IHS Liaisons
- ACS
- MCOs (physical and behavioral health)

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## Direct relationship between key contacts at both the State and IHS.
MAD staff have knowledge of the Indian Health System and are continually learning from other states.
Questions or topics that are presented by IHS staff contribute to the delivery of quality care and access for Native Americans. 
Not being afraid to ask the “hard questions”.
Liaison relationship with other staff from other states.
NM is at the forefront of Medicaid-Indian health policy.

- MAD staff have knowledge of the Indian Health System and are continually learning from other states.
- Questions or topics that are presented by IHS staff contribute to the delivery of quality care and access for Native Americans.
- Not being afraid to ask the “hard questions”.
- Liaison relationship with other staff from other states.
- NM is at the forefront of Medicaid-Indian health policy.

- Reasons for Success

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## Reasons for Success (con’t)

- Monthly Albuquerque Area RAM meetings
- Quarterly Navajo Area meetings
-  Biannual HSD Native American Initiatives Newsletter
- IHS support for New Mexico legislative changes to Medicaid policy
- Collaboration with Indian Health providers and NM Medicaid have resulted in increased Medicaid revenue for Indian Health facilities!

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##             Contact Information

- Adam Archuleta
- _adam.archuleta__[@](mailto:sharilyn.roanhorse@state.nm.us)__ihs.gov_
- (505) 758-4224
- Sharilyn Roanhorse-Aguilar
- _[sharilyn.roanhorse@state.nm.us](mailto:sharilyn.roanhorse@state.nm.us)_
- (505) 827-3133
- Virginia Alcon
- 	_virginia.alcon@state.nm.us_
- (505) 827-7726

- 2007 Partnership Conference