mmpc - National Indian Health Board

Conclusions and Recommendations
IHS AIAN Payments Compared to Others
There is no evidence on a national basis that Medicaid per capita payments for the AIAN user population of IHS
Programs (IHS AIAN) in 2006 are lower than for other Medicaid recipients. Overall in 9 of the 12 IHS Areas
Medicaid payments for personal health care services of IHS AIAN were as high as or higher than either selfdeclared
AIAN who did not use the IHS health care system and of whites living in the same counties. The
exceptions to the general finding in four IHS Areas were: In Albuquerque Area the per capita payments overall
were higher than those of self-declared AIAN who did not use the IHS system, but not higher than Whites. In
Oklahoma Area the payments were higher than for Whites, but not the AIAN who did not use the IHS system. In
Aberdeen and Billings Areas the payments were lower for most types of IHS AIAN Medicaid recipients analyzed
when compared to other AIAN or whites. For the Nashville Area the conclusion requires acknowledgment that
the Medicaid total payments are higher because Third Party payments for Medicaid claims were included in the
total per capita payment analyzed for all the IHS areas. In the Nashville Area the contribution to the total per
capita payment for Medicaid claims due to private insurance is substantial. Nashville Area also was unlike other
Areas in the large number of states that do not report any IHS Program claims. Nashville Area has many states
and counties, but many states have IHS system providers with small numbers of Active Users. These state
Medicaid programs when interviewed were more likely to acknowledge in 2010 they had no special activities to
identify IHS or tribal provider Medicaid claims (Korenbrot and Crouch, 2010).
In the Tucson, Navajo and Phoenix Areas the payments for the AIAN user population of IHS Programs were
highest, which was found to be attributable to the payment levels in the state of Arizona. When Medicaid
recipients in Arizona were excluded, the AIAN payments for Navajo and Phoenix Areas relative to other AIAN
and whites became more like those in other Areas (the Tucson Area is entirely within Arizona and could not be
analyzed with the exclusion of Arizona Medicaid recipients).
In making these comparisons, payments for six different types of Medicaid service recipients were analyzed.
Medicaid recipients were classified depending on whether they were under age 65 or not, enrolled all year in
Medicaid or not, and whether they received only fee-for-service (FFS) medical care or had any of their medical
services in managed care. The payments for each type of Medicaid recipient were risk-adjusted for differences
between the IHS AIAN and comparison groups with respect to age, sex, disability, and dual-enrollment with
Medicare. Adjustments for differences among the groups in morbidity were possible for those enrolled all year
in Medicaid, but not those enrolled less than a year. The payments were also adjusted for variation in health
care prices across the IHS Areas whether analyzed as mean payment per year for recipients enrolled all year, or
mean payment per month for when recipients were analyzed regardless of length of enrollment.
The findings were not found to depend on any particular type of Medicaid recipient analyzed. For any given
Area one or more of the recipient types the AIAN user population might have an adjusted mean per capita
payment higher or lower than a comparison group. One of the implications of this finding is that the overall,
results did not depend on whether the payments were adjusted for differences in morbidity or not, or whether
they received their medical care in a FFS or managed care system.
The IHS AIAN FFS per capita payments were dominated by outpatient services (including claims for clinic,
medical care practitioners, laboratory and imaging, and dental services). Inpatient payments were a small
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