PRESS RELEASE: CMS Releases Guidance to States on Medicaid Block Grants

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Washington, DC (January 31, 2020) –  On January 30, 2020, the Centers for Medicare and Medicaid Services (CMS) announced the Healthy Adult Opportunity Initiative (HAO), a guideline for states to convert Medicaid funding into block grants – effectively establishing a cap on federal funding on Medicaid.  The letter, sent to state Medicaid directors, provides guidance for states seeking to carry out demonstration projects under section 1115 of the Social Security Act to include either an aggregate or per-capita cap financing model in their state Medicaid programs – in contrast to the current open-ended financing system that provides for unlimited (i.e. does not cap) federal matching funds for all state spending under Medicaid’s federal rules.

“NCUIH is extremely concerned with the CMS guidance that is completely against the intent of Congress. This harmful guidance paves the way to restrict Medicaid in ways that would violate the United States trust obligation to provide health care services to American Indian and Alaska Natives.  Urban Indians face many barriers with chronic underfunding of the Indian health care system and we are disappointed to see yet another obstacle for Native people who need health care.  By establishing a cap on spending for essential services, this proposal will have negative impacts on our urban Indian organizations (UIOs) and could result in significantly reduced services.  We urge CMS to reconsider this guidance and follow the intent of Congress to ensure that Medicaid funds continue to flow into all Indian Health Care Providers, including UIOs,” said NCUIH Executive Director Francys Crevier.

By tying Medicaid spending to a set cap, states would be incentivized to limit Medicaid spending or assume risk for Medicaid costs that exceed the annual cap.  In addition, if a state imposes an aggregate cap, if the state’s spending on Medicaid falls below the limit, it could receive a portion of the “savings” – or the amount below the spending cap the state’s actual expenditures were.  Because services provided at UIOs are not reimbursed to the state by the federal government at 100% (the Federal Medical Assistance Percentage or FMAP), UIOs already receive lower Medicaid reimbursements than the other components of the I/T/U system.  Under CMS’s guidance proposed yesterday, Medicaid spending for services provided to AI/ANs at UIOs will be included in calculating spending caps.  It is essential that the Medicaid program continue to be a vital lifeline for AI/ANs.

Medicaid is a critically important resource for American Indians and Alaska Natives and Indian Health Care Providers.  Imposing barriers to access to health care, like reducing Medicaid covered individuals and services would impose a significant financial burden on an already severely underfunded Indian health system.  Any state plans that reduce the Medicaid funds that flow into the I/T/U system would further strain the Indian health care system.

UIOs depend on every dollar of limited federal funding, including third-party reimbursements from Medicaid, to provide high quality, culturally competent services to their AI/AN patients.  Restricting these funds would violate the U.S. obligation to provide health care to AI/ANs.  NCUIH calls on CMS to ensure states do not impose limitations on their Medicaid programs that would result in decreased funding available to UIOs and the I/T/U system.

NCUIH will continue to monitor updates and provide further information as it becomes available.

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NCUIH Presents at Families USA Health Action 2020 Conference in Washington, DC

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NCUIH’s Executive Director Francys Crevier and President-Elect Walter Murillo presented at the Families USA Health Action 2020 Conference on January 24, 2020 in Washington, DC. The panel was titled, “Innovative, Resilience-Based Solutions to Improve Health Among American Indians and Alaska Natives” and included Stacy Bohlen of the National Indian Health Board and Jerilyn Church of Great Plains Tribal Chairmen’s Health Board.

The panel was moderated by Denisse Sanchez from Families USA. The discussion addressed how the treaty-bound federal government has a trust obligation to provide health care to American Indians and Alaska Natives (AI/ANs). Panelists explained how access and quality issues persist and health inequities keep growing. An overview was provided of the AI/AN health care landscape and how these communities are taking back their health.

Fifth Circuit Hears Oral Argument on ICWA Case

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Last week, the U.S. Court of Appeals for the Fifth Circuit heard oral argument on the constitutionality of the Indian Child Welfare Act (ICWA).  As previously reported, the court agreed to rehear the case, Brackeen v. Bernhardt, en banc.  Of the sixteen judges hearing the case, six asked the majority of the questions.  Attorneys from the Department of Justice, Navajo Nation, and an attorney representing Cherokee Nation, Morongo Band of Mission Indians, Oneida Nation, and Quinault Indian Nation argued in defense of ICWA.  The states challenging ICWA were represented by the Texas Solicitor General.  An attorney representing individual plaintiffs also presented argument challenging ICWA.  As a reminder, the case centers around whether ICWA is unconstitutional on several bases — including whether it violates the Equal Protection Clause as a race-based statute.  A three-judge panel had previously held ICWA constitutional before the entire Fifth Circuit agreed to rehear the case en banc.

An audio recording of the oral argument is available here.

NCUIH will continue to monitor the case and provide updates as they become available.  Previously, in December 2019, NCUIH joined nearly 400 Tribes and Indian organizations in an amicus curiae brief filed in support of the Indian Child Welfare Act (ICWA).

NCUIH Welcomes Intern Julia Wakeford

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NCUIH Winter 2020 Intern

The National Council of Urban Indian Health is excited to announce that Ms. Julia Wakeford has accepted a six month internship and will serve as a Policy Assistant to the Director of Congressional Relations.  Julia is Yuchi and a member of the Muscogee (Creek) Nation of Oklahoma. She has experience working in tribal government and on tribal political campaigns. While in undergrad, she worked in Diversity and Inclusion as well as in Multicultural Admissions. Julia holds a B.A. in Indigenous Socio-Political Studies from Swarthmore College. We look forward to Julia using her talents and becoming a part of our dynamic team as NCUIH continues advocacy efforts on behalf of our members and Urban Indian health care issues.

NCUIH Submits Comments to CMS, HHS OIG

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On December 31, NCUIH submitted two sets of comments to the Centers for Medicare & Medicaid Services (CMS) and Department of Health & Human Services Office of the Inspector General (OIG), respectively.

NCUIH’s first comment letter was submitted pursuant to CMS’s request for information on the Medicare Program: Modernizing and Clarifying the Physician Self-Referral Regulations.  In the comments, NCUIH strongly encouraged CMS to create new exceptions to the physician self-referral law that are consistent with the trust responsibility to AI/ANs.

The second comments were on OIG’s proposed rule, Medicare and State Healthcare Programs: Fraud and Abuse; Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements.  In the comments, NCUIH noted, among other things, the importance of care coordination agreements to the I/T/U system and opposed modifications that would effectively make the safe harbor completely unavailable to I/T/U facilities.The OIG proposed modifications to the existing safe harbor for local transportation. In general, transportation is a major challenge for Indian Country, tribes, and AI/AN people no matter where they reside. For Indian health care providers and their AI/AN patients, transportation poses a significant barrier to health care access. NCUIH commented on the proposed increase in the mileage limit and encouraged OIG to eliminate the mileage limit for Indian health programs altogether – or to further expand the limit for our health programs. You can also find a copy of the comments submitted by the CMS Tribal Technical Advisory Group here.