Managed Care Organizations Look To Cash In On Native American Patients

Sep 26, 2013

State Human Service Department officials present information about the Centennial Care program to members of the Navajo Nation's Shiprock Chapter.
Credit Tristan Ahtone

Hate it or love it, the Affordable Health Care Act is set to roll out soon. And as most already know, the act requires nearly all citizens to obtain health insurance or face penalties. But some of those exempted from the mandate are Native Americans. That hasn’t deterred private insurance companies from launching a campaign in Indian Country to sign up tribal members in New Mexico.

On a cool, Saturday afternoon on the Navajo Nation a crowd of tribal members are lined up at a row of folding tables staffed by insurance company representatives that speak English.

One person looking for more information on insurance is Dahaana Baadaani. His mother-in-law is currently on Medicaid, but gets most of her health care from the Indian Health Service. However, Baadaani says getting services from the Indian Health Service (IHS) can take too long."It takes a while, yes it does," he said. "It takes like three weeks or a month. I think the funding is not really there for everybody. It's only in emergencies."

The companies here today are offering tribal members a supplement to IHS -- expanded access to health care services and assistance to members, like reimbursement for mileage or even cell phones for 24 hour contact to providers. That makes Baadaani’s mother-in-law a potential recruit. "She needs her everyday necessities," Baadaani explained, "and then we're just helping out on the side, travelling with her."

New Mexico is one of 30 states that decided to expand its Medicaid program under the Affordable Care Act. But to do so, they’ve employed four Managed Care Organizations (MCOs) to help manage the money and the care. The plan here is called Centennial Care, and officials are holding presentations on the program around the state, like here in Shiprock.

Under Centennial Care, everybody in New Mexico on Medicaid now, and under the expanded plan, will have to sign up with one of four managed care organizations. The MCO’s get pre-paid by the state every month for every Medicaid member signed up with their plan.  When one of those members needs medical help, the MCO dishes out payments. If a member doesn’t access care, the MCO still gets paid. The exact rates and fees haven’t been released, yet, but there’s a clear, and potentially big, financial incentive for managed care organizations to sell their plans to everybody, including those who don’t have to buy in.

Travis Renville is the director of Native American Affairs with Presbyterian – one of the state's four managed care organizations. "It's about choice. Native Americans are going to have more choice than a regular New Mexican," Renville points out.  "Native Americans could choose their own local IHS. If that particular service unit doesn't have the particular specialty service or ambulatory care, they could tap into our Managed Care Organization service coordinator and get those services that the local IHS would not have."

In a state that is over 10-percent Native American, signing up tribal members is good business for the MCOs. But it could also be a big financial boon to the Indian Health Service. Jennifer Cooper is with the National Indian Health Board."Having that kind of insurance," she said, "will help not only that individual to take that insurance coverage to the IHS facility, but then the IHS and tribal facilities will be able to seek reimbursement from those third party payers."

In other words, the Affordable Care Act could bring in funds to alleviate some of the chronic underfunding and budget cuts IHS faces. For example, a tribal member using IHS and in need of a procedure like chemotherapy would likely have to be referred to a specialist. Under the Indian Health Service the wait could be significant. With Medicaid and an MCO, there would be little wait. An expanded health care network nearby could provide the treatment, and Medicaid would cover the cost.

Having options for care is appealing to some possible members like Dahaana Baadaani in Shiprock."We talked to those people over there," he said. "We got some brochure there and then over here, too, with these guys. Then, I guess we go from there."

Literature in hand, Baadaani said when it’s time to sign his mother in law up with an MCO at the end of the year, he thinks he’ll be prepared.