mmpc - National Indian Health Board

Findings
Adjusted Mean Payments for IHS AIAN without IHS Program Medicaid Claims are Lower than
Others
IHS AIAN who were Active Users but had not IHS Program Medicaid claims had substantially lower payments
than all other groups (Table 12). Payments for the three different subgroups of IHS AIAN created by the linkage
of data with the IHS registry system were analyzed in the same way as in Table 11 to arrive at an overall
measure that allowed comparison of IHS Active Users with no IHS Program Medicaid claims with the two
groups of IHS AIAN with IHS Program claims as well as Other AIAN and Whites (Attachment Table L.5). There
were sufficient numbers of IHS AIAN without Medicaid IHS Program claims under age 65 to allow analyses but
not over age 65, and therefore a total of 4 analyses were possible. The per capita payments for IHS AIAN Active
Users without IHS Program Medicaid claims were substantially lower for all types of Medicaid recipients when
compared to either IHS AIAN subgroup with IHS Program Medicaid claims (IHS Active Users with IHS Program
claims: 64% to 93% lower; and IHS Program claims only: 26% to 100%). Payments were substantially lower
than those of other AIAN who did not use the IHS system (11% to 30% depending on the type of Recipient), and
of whites living in the same counties (14% to 46% depending on the type of Recipient).
Table 12. Difference in Adjusted Mean Total Payment per Recipient for IHS AIAN Active Users (group 3) with no IHS
Program Medicaid claims of each type of Recipient analyzed compared to IHS AIAN groups IHS Program Medicaid claims
(groups 1 and 2), Other AIAN and Whites in each Area.
IHS Area Analysis Group
Recipie
nts
1
FFS Medical
(220,368)
Mean
Paymt
Differe
nce
Recipie
nts
Mean
Paymt
35
Analyses
2 3 4
Recipients Less than 65 years of Age
12 months Enrollment Any Months of Enrollment
Capitated Medical
(34,490)
Differe
nce
Recipie
nts
FFS Medical
(336,888)
Payments per Year Payments per Month
Mean
Paymt
Differe
nce
Recipie
nts
Capitated Medical
(116,277)
All Areas 1.IHS Claims & User -64% -76% -93% -71%
Mean
Paymt
Differe
nce
2.IHS Claims -52% -81% -100% -26%
3.IHS Active User 55670 $ 3,820
13951 $ 4,134 103859 $ 585
46931 $ 465
Other AIAN -16% -11% -30% -16%
Whites -27% -14% -32% -46%
When the overall measure was calculated by IHS Area across the 4 types of Medicaid recipients, only Nashville
Area was found to have overall higher payments (26% higher) for the IHS AIAN Active Users without IHS
Program Medicaid claims than for Other AIAN who did not use the IHS system (Figure 18, Attachment Table
L.6). Only Tucson was found to have substantially higher payments for the IHS AIAN Active User group than
Whites (13%, Figure 19). Nashville had only 1% higher payments than Whites, which is negligible. Oklahoma
Area had lower payments for the IHS AIAN Active User group than all four of the other groups but only 1% to
4% lower (Attachment Table L.6). Aberdeen Area also had lower payments that were only 1% to 9% lower than
the four other groups.