Integrating Indian health programs into Medicaid and managed care systems
Authors: Indian Health Service
Publication Year: 1996
Last Updated: 2016-04-06 13:01:52
Journal: Indian Health Service Roundtable Meeting
Keywords: Consumer Participation; Health Maintenance Organizations; Health Services Administration/Economics; Health Services Administration/Trends, Insurance, Health, Managed Care Programs, Medicaid, Public Health Administration, managed care, fqhc, mobility, capacity, tort claims, recommendations, eligibility, IHCIA, ACA
The purpose of this roundtable was to identify options to increase Medicaid managed care participation by Indian health programs. These include programs operated directly by IHS, programs operated by tribes under the Indian Self-Determination Act, and urban Indian programs under Title V of the Indian Health Care Improvement Act.
The Indian Health Service (IHS), recognizing that state Medicaid programs are rapidly purchasing managed care plans for their beneficiaries and that managed care enrollment has significant implications for both Indians and Indian health facilities, convened this Roundtable to discuss options for participation in such care. The purpose of this roundtable was to identify options to increase Medicaid managed care participation by Indian health programs. These include programs operated directly by IHS, programs operated by tribes under the Indian Self-Determination Act, and urban Indian programs under Title V of the Indian Health Care Improvement Act. By design, Roundtable participants were a group with diverse backgrounds in Indian health programs, safety-net providers, (e.g. federally qualified health centers, public hospital), state Medicaid and health departments, and the managed care industry. The overall goal of the Roundtable was to determine how to increase participation in Medicaid managed care among Indian health programs while maintaining their mission and capacity to provide a comprehensive and culturally sensitive health care system for all American Indians and Alaska Natives. Some of the issues raised during the Roundtable are applicable to any health care provider who desires to participate in Medicaid managed care, while others relate generally to safety-net providers. Other issues are important to Indian health programs, as well as to Indians and tribes as consumers of health services. The group's consensus was that all issues must be addressed if Indian programs are to be successful participants. The 21 issues the Roundtable identified can be clustered into five areas: 1) Indian Health Program Mission and Roles; 2) Indian Medicaid Managed Care Populations; 3) Indian Health Program Participation; 4) Legal Issues; and 5) Other Areas Needing Assistance/Training