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Medicaid expansion crucial to Tribal health, economy in Montana

By Lailani Upham

Laura John’s (Seneca and Blackfeet) position as the State-Tribal Policy Analyst of the Montana Budget and Policy Center is to collaborate with tribal leaders to help increase awareness of the impact the state budget has on Indian Country. During her workshop she elaborated primarily on Medicaid Expansion in Montana. (Lailani Upham photo) Laura John’s (Seneca and Blackfeet) position as the State-Tribal Policy Analyst of the Montana Budget and Policy Center is to collaborate with tribal leaders to help increase awareness of the impact the state budget has on Indian Country. During her workshop she elaborated primarily on Medicaid Expansion in Montana. (Lailani Upham photo)

HELENA — A discussion on the importance of the state budget and how it affects Indian Country was a crucial subject matter on the agenda last week during the annual Women’s Policy Leadership Institute conference.

The workshop “Why the Budget Matters in Indian Country” presented by Laura John, State-Tribal Policy Analyst of the Montana Budget and Policy Center, was focused on the expansion for Medicaid that is currently on the Montana state budget decision to yay or nay it.

Expanding Medicaid is a bargain for Montana, say officials at the Montana Budget and Policy Center.

John explained the process of the bargain will allow low-income adults earning less than 138 percent of the federal poverty level, which is $26,344 for a family of three to receive health care at no cost to the state from 2014 – 2017. The federal government will pay 100 percent of the cost.

After the four years, Montana will pick up 10 percent of the costs until 2020, John explained. “Any services billed by Indian Health Service to Medicaid for care of American Indians will continue to be reimbursed by 100 percent by the federal government, eliminating any fiscal obligation by the state.”

It’s a bargain for the state budget and a bargain for Montana residents and Indian country and will provide an economic boost throughout Montana.

Medicaid is the state-federal health insurance program for low-income families. As part of the health care reform, the federal government has promised to pay nearly all costs of the expansion for the states – if states agree to it.

According to a report by The Bureau of Business and Economic Research, “The Importance of Public Health Care Funding to the Montana Economy,” University of Montana, dated December 2010, these federal dollars will pay for medical care that wouldn’t otherwise be provided or would be provided at state, local, or private expense. This funding will not only provide health care coverage, it will also help to create jobs in communities across Indian Country in Montana. Expanding Medicaid coverage will effectively increase demand for medical services, as newly covered individuals seek both preventative and critical care. This increased demand will allow medical facilities to purchase new equipment and supplies, hire more medical and support staff, and fund building renovations and new construction

According to a MBPC report John shared with the group, there are 33 states with a large Native population and Montana ranks the highest of any in uninsured American Indians (40 percent), and the second lowest in number of American Indians with private insurance (28 percent). Among Natives ages 18 – 64, 57 percent are currently uninsured. Montana also has the fourth highest number of American Indians reported to have access to underfunded Indian Health Service clinics.

“Expanding Medicaid has the potential to improve health care access for American Indians and in the long-run reverse health disparities in Indian Country,” John stated.

Although IHS clinics serve American Indians regardless of insurance status, it has been severely underfunded with current funding covering only 60 percent, explained John.

John added that with the expansion of Medicaid, up to 19,547 American Indians would be newly enrolled in the program. The expanded coverage would not only expand access to health care for the recipients, but would also increase the capacity of IHS to meet the health care needs of American Indians more generally. Current and newly eligible American Indian Medicaid enrollees may continue to seek care from IHS-run, tribal, and urban Indian clinics.

According to an article in the Missoulian last week, Richard Opper, director of the stated Department of Public Health and Human Services and Gov. Bullock administration’s public health director stated that expanding Medicaid will help thousands of Montanans escape poverty and make the state more economically competitive.

According to Opper and the MBPC, expanding Medicaid would bring $6.5 billion of federal money into the state over the next eight years and create at least 10,000 new jobs. About two-thirds of those jobs would be in the health care sector, but the rest would be throughout the economy, Opper explained.

“I think we have a once-in-a-lifetime opportunity to create some jobs, get more people insured and get more people on a path to better health,” Opper told business leaders from around the state at a breakfast meeting for Leadership Montana, a nonprofit group that mentors community and state leaders.

Montana Gov. Steve Bullock is asking the 2013 Legislature to approve expanding Medicaid to cover up to 70,000 low-income Montanans.

The other angle of the expansion bargain is the potential is to free up monies in the IHS bucket. “When a Medicaid recipient seeks services at such a clinic, IHS can seek reimbursements from Medicaid. These reimbursements free up IHS funds to increase and improve their core services. In addition, the demand for contract health service funds will decline, as patients newly covered by Medicaid can seek services outside of IHS without using limited CHS funds. The potential impact of these changes is far-reaching and will help provide tribal communities the means necessary to close the health disparity gap between American Indians and the general,” explained John.

During the workshop John urged people to get “their voice heard.” “It is very important for Indian country to be knowledgeable and to advocate to their elected officials on the state and national level what they want to see passed in the legislation.”

In the “State of the State” Address last month, Gov. Bullock stated, “Medicaid expansion is federally funded, so if Montana doesn’t expand its Medicaid program, then our tax dollars will be used to help patients in states like Arizona, Nevada and North Dakota - states where Republican Governors are leading the effort to expand Medicaid. Let me make this point abundantly clear: if we fail to act, Montana taxpayer dollars will be used to provide health care to the citizens of states thousands of miles away, while our rates will continue to go up year after year.”

“It’s time we set the politics aside on this issue. Politics won’t treat diabetes. Extremism won’t create jobs. And intransigence won’t provide health care for those who can’t afford it.”

John encouraged folks to step up and get involved in how policy is shaped for Indian country, “Find out who your representatives are; call their office, they do listen, write a letter, an email or find an allied group, Western Native Voice is a good one, to help. You should not be afraid to get involved. The voice of the Indian must be heard.”

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