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Montana Medicaid Health Improvement Program aims to curb the health disparity of Montana tribal people

By Lailani Upham
Char-Koosta News

Montana State Medicaid Director, Mary Dalton discusses the Montana Tribal Health Improvement program with CSKT Tribal Council last Wednesday. DPHHS Deputy Director Laura Smith and DPHHS Tribal Relations Director Lesa Evers joins her at the as a state team inviting Montana tribes to participate in the T-HIP that will bring funding to tribal health centers in the fall of 2018. (Lailani Upham photo)Montana State Medicaid Director, Mary Dalton discusses the Montana Tribal Health Improvement program with CSKT Tribal Council last Wednesday. DPHHS Deputy Director Laura Smith and DPHHS Tribal Relations Director Lesa Evers joins her at the as a state team inviting Montana tribes to participate in the T-HIP that will bring funding to tribal health centers in the fall of 2018. (Lailani Upham photo)

PABLO — The State of Montana is embarking on what it says is an “historic event” to end health disparities in the Native American population.

Last Thursday Department of Public Health and Human Services officials made a visit to the Confederated Salish and Kootenai Tribal Council to invite the Tribes to contract through the state Medicaid program to proactively work together to address health improvement and disease prevention programs.

The visit was part of a statewide reservation tour to offer the contract to all tribal governments in Montana, according to Jon Ebelt, Montana DPHHS Public Information Officer.

According to Ebelt, through an agreement with DPHHS, Montana tribes will lead and operate what is called a Tribal Health Improvement Program (T-HIP) that will allow tribes to choose and prioritize health issues important to their communities.

“This program is the first of its kind in the nation,” Ebelt said.

The program is made possible through a 1915(b) waiver from the Centers for Medicare and Medicaid Services.

Ebelt said the State of Montana applied for the waiver in 2014 after extensive consultation with tribes. “This is a long-term program that seeks to erase existing health disparities between Native American and non-Native populations,” Ebelt said.

Lesa Evers, Tribal Relations director; Mary Dalton, State Medicaid director; Sheila Hogan, DPHHS director; and Laura Smith, DPHHS Deputy director were the team officials to personally invite CSKT to participate in the program.

During the stop last week DPHHS officials explained the program is divided into three tiers to CSKT council.

Tier one focuses on the top five percent of members who are identified as being at high-risk by the State through Medicaid reimbursement claims history. 

Nurses and health coaches employed by T-HIP community providers will work with high-risk members to prevent or slow the progression of disease, disability and other health conditions, prolong life, and promote physical and mental health, Ebelt said.

The goal is eventually for members to increase ability to self-manage their health conditions and reduce costs.        

Tier two and three will provide additional funding for health enhancement or prevention services needed by a broader base of tribal members. 

The health centers on reservations will receive a monthly per member, per month payment (PMPM) for each Medicaid Passport to Health member that is in their service area and eligible for T-HIP whether they participate in the program or not.

Passport is Medicaid’s primary care case management program where members can choose or be assigned to a Passport provider. Most Medicaid clients will be Passport members, however a small percentage will not be members due to being dually enrolled in Medicare and Medicaid; being in foster care; and/or living in a facility such as a nursing home. A Passport provider and a T-HIP provider can be different; a tribe’s health service department does not have to be the client’s Passport provider in order to be the T-HIP provider.

T-HIP providers will be expected to: submit a quarterly report to Medicaid by the 15th day of the month to give providers opportunities to identify strengths and areas of improvement in the program; conduct member outreach; complete healthy survey; contact active member at a minimum of every three months; engage at a minimum of 30 percent of the high risk member; visit and educate at least two health provider partners in the service area every six months; submit monthly health measure reports by the 10th day of the month such as, blood pressure, BMI, immunizations, community resource referrals and educational materials.

The combined tiers will focus on efforts to address: pre-natal and pregnancy services; cardiovascular disease; substance use prevention; diabetes prevention/treatment; obesity prevention; wellness; cancer prevention/early treatment; or other areas identified by specific Montana tribes that are contributing to health disparities on their reservation.

The DPHHS team presented a would-be giant check to CSKT Tribal Council last Thursday to show potential annual revenue for the Tribes if all three tiers are fully implemented for one year as a result of engaging in the T-HIP.

“Tribal governments that decide to sign up in the coming months will be eligible for this projected revenue, which is based on each tribe’s eligible population,” Ebelt said.

The recruitment process will begin within the next couple of months. If CSKT operates at tier three for a full year the Tribes would potentially receive a check in the amount of $12,698,953.92 for billable services in the fall of 2018.
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