Supporting the Tribal Health Care System:
The Department of Health and Social Services recently completed its first major reorganization in twenty years. The restructuring created an office of Tribal Programs within the Commissioner’s Office. The Tribal Program’s staff is responsible for collaborating across divisions to ensure that Tribal Health Organizations are a partner to the Department in the delivery of health care to the Alaska Native Medicaid population.
The tribal health care system providers are unique compared to non-tribal providers. Rather than generally one service or specialty, each Tribal Health Organization provides a wide range of services in their region. Examples include from inpatient hospital to community health aides to personal care attendants. The range of services crosses many programs within multiple divisions of the Department. Traditionally, division specific programs’ have focused on one area and did not generally recognize providers and/or services outside their program’s area. This process did not accommodate the uniqueness of the tribal health system and often resulted in conflicting rules and regulations.
Medicaid payments to tribe health care providers have increased substantially over the years; for example FY91 payments to tribal providers were $9.6 million and in FY05 the payments exceeded $180 million. The increase in payments to the tribal health care system providers has been due to improved reimbursement, maximization of billing, service expansions and aggressive enrollment of Alaska Natives in program expansions.
When Alaska implemented the State Child Health Insurance Program in 1998, a grant from the Robert Wood Johnson Foundation was used to target effective outreach and enrollment to the Alaska Native community. Outreach positions were created and funded in each tribal organization and culturally appropriate materials were developed for use with the native community. Because the expansion included pregnant women as well as children at higher income levels, the tribal health programs gained substantial new income as their beneficiaries are younger than other populations and have the highest birth rate.
The Alaska Medicaid program partners with other state agencies in the operation of mental health, substance abuse and home and community based waiver services. The state emphasizes the importance of supporting the infrastructure development of the tribes in these areas by funding staff to work on projects targeted to the tribes. Current projects include the development of a behavioral health system for rural Alaska to combine the resources of mental health and substance abuse programs into a consolidated structure. Supporting the health care needs of elders is a growing concern of the tribes and the state. The state supports tribal efforts to develop nursing facilities and community based care options even at the village level. Given the lower health status of Alaska Natives, the Department and the Tribal Health Care System have been targeting Medicaid eligible children under age 21 to ensure that they receive access to early and periodic screening and diagnosis to ascertain physical and mental defects and treatment to correct or ameliorate the defects and chronic conditions found.