mmpc - National Indian Health Board

Analysis of Tribal Consultation Policies For Health Insurance Exchanges
Tribes understood from the HHS Secretary’s letter to Governors that States with
federally-funded Planning Grants and Establishment Grants would be consulting with
Tribes in their respective States during the planning and implementation process.
Establishment Grant funding could be used for this purpose. However, this has not
happened in every State that received this federal funding.
Partnership Exchanges
CCIIO issued Blueprint for Approval of Affordable State-Based and State Partnership
Insurance Exchanges on August 14, 2012. It outlines ways that States that decide not
to operate their own Exchanges can assume some of the responsibilities for the
Federally-facilitated Exchange (FFE). States may take on functions related to plan
management, or consumer assistance, or both. States that want to take on these
functions must submit a “blueprint” to CCIIO by February 15, 2013. 1 CCIIO is expected
to make decisions in early 2013 2 , about the readiness of States to operate their own
Exchanges or to take on responsibilities in a Partnership Exchange.
Within the Partnership Exchanges, States could take responsibility for a number of
functions that have great interest for Tribes and Urban Indian programs, such as
certifying Qualified Health Plans with regard to network adequacy and essential health
benefits (EHB), as well as administration of the navigator program and in-person
assister program. Furthermore, States must be involved in the coordination of other
programs that they manage with federal funding -- Medicaid, Medicaid Expansion and
Child Health Insurance Programs (CHIP) — with the FFE for purposes of a single,
streamlined application, determination of eligibility, and enrollment. States are also
encouraged to run the re-insurance program that is required under the Affordable Care
Act (ACA) through 2016.
Tribal Consultation Approaches
The Indian Health Service (IHS), Tribes, and Urban Indian clinics (collectively called the
“I/T/U” or “Indian health programs”) have the experience and perspective to advise both
the federal government and state governments about how to structure policies and
procedures to be workable in the unique context of Indian health programs. Indian
health programs have a strong interest in making sure that all of the activities of both
state and federal Exchanges are carried out in a way that preserves the protections for
American Indians and Alaska Natives (AI/AN) and makes it easy for the Indian health
1 Original deadline of November 16 was extended by HHS on November 9 to February 15, 2012.
2 Originally, the federal government was to decide by January 1, 2013, whether states were ready to operate their
own Exchanges or participate in partnership arrangements. However, the deadline for states to submit their
blueprints was extended from November 15 until December 14. Therefore, it is assumed that HHS may not be able
to assess readiness by January 1, 2013, as originally intended.
2