mmpc - National Indian Health Board

Analysis of Tribal Consultation Policies For Health Insurance Exchanges
facilities to bill for services that they provide to people who are enrolled in Exchange
plans.
Some States have a better history of working with Tribes than other States where there
may be hostility over a variety of issues that may be unrelated to health care. In States
with good relations with Tribes, there may be state law that requires Tribal consultation
and provides the infrastructure to make it happen. In those States, there may also be a
state policy for Tribal consultation in the Medicaid program and cooperative efforts at
planning. However, in most States – even those with a history of good relationships
with Tribes-- the Exchange planning process is being conducted in the Department of
Insurance or by an off-shoot of that type of agency, which has had very little experience
working with Indian health programs. State Health Insurance Commissioners typically
are ignorant about Indian health programs and federal Indian law. Their focus is on
regulating insurance companies so that they do not lose money and fail to live up to
their contractual obligations.
Survey of State Exchange Consultation Policies and Approaches
In 2011, CCIIO provided to Tribes and to the Tribal Technical Advisory Group (TTAG),
an advisory group to the Centers for Medicare and Medicaid (CMS), a list of contact
people in each State that would serve as liaisons with the I/T/U. Starting in July 2012,
Tribal representative began contacting people on that list by e-mail to inquire about
whether or not their Exchange had a Tribal Consultation Policy. By that time, many
people had moved to other jobs, their e-mails were not working, and Tribal
representatives were referred as often as four different times to other people. In some
cases, there was no response to Tribal e-mails and no further names in State
government to pursue. Tribal representatives tried again to contact people in August,
September and October and were unable to make contact with anyone in the following
states: Alaska, Florida, Idaho, Kansas, North Dakota, Texas, and Wisconsin. One can
only assume that if this survey failed to make contact, then the I/T/U also could not use
the list provided by CCIIO to contact anyone involved in Exchange planning in those
States. Tribal representatives asked for an updated list of contacts from CCIIO in
September 2012, but have not yet received it at the time this report is written.
A summary of the findings from the States that responded to this survey is provided as
Attachment B. Only 3 of the 34 states with Tribes had a final, signed Exchange Tribal
Consultation Policy: Colorado, Minnesota, and Oregon. In addition, 6 States reported
that they were working with Tribes on an Exchange Tribal Consultation Policy that they
expected to have signed and completed by the November 16, 2012 deadline for the
State Exchange and Blueprint applications. These are: Arizona, California,
Connecticut, Mississippi, New York, and Washington.
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