mmpc - National Indian Health Board

Background
Analysis of Tribal Consultation Policies
For Health Insurance Exchanges
Mim Dixon
November 11, 2012
On September 14, 2011, Secretary of Health and Human Services (HHS) Kathleen
Sebelius sent a letter to each State governor regarding Tribal consultation on all health
and human services programs that are supported with federal funding, including Tribal
consultation in the development of health insurance exchange under the Affordable
Care Act (see Attachment A). The Secretary cited the Executive Order on Tribal
Consultation signed by President Obama in 2009, and the HHS Tribal Consultation
Policy. The letter states,
States must consult with Tribes to ensure the programs that they administer with
federal funding meet the needs of the Tribes in that state. Tribes should be
considered full partners by states during the design and implementation of
programs that are administered by states with HHS funding. The requirement of
states to consult with Tribes in the development of the Affordable Insurance
Exchanges is an example of how states can proactively include and partner with
Tribes during the planning stages of a program that has the potential to benefit
Tribal members greatly.
While this letter requires States with federal funding to consult with Tribes on the
development of Health Insurance Exchanges, it does not actually require that States
adopt a Tribal consultation policy for their Exchanges. At an HHS Tribal Consultation
on Federally-Facilitated Exchanges held in Washington, DC, on July 26, 2012, a Center
for Consumer Information and Insurance Oversight (CCIIO) representative stated that
the requirement for Tribal consultation would be considered in the certification process
in 2013 when CCIIO decides whether States have the readiness to implement
Exchanges.
Federal Funding for Exchange Planning
Every State except Alaska applied for and received an initial planning grant to consider
whether or not they would create an Exchange, with the understanding that the federal
government would create exchanges for States that did not create their own
Exchanges. States were then able to apply for Establishment Grants to do the work of
designing Exchanges. Level 1 and Level 2 Establishment Grants were available to
States.