mmpc - National Indian Health Board

Analysis of Tribal Consultation Policies For Health Insurance Exchanges
In a New Mexico and Utah, there are State Tribal consultation policies that cover a
broad range of health topics, including Medicaid. These are being used to guide State
Exchange planning activities. Utah has been consulting with Tribes about updating their
policies, but this process has not been finalized. Nebraska State officials report that
they are using the New Mexico policies as a template and adapting them for Nebraska.
While Oklahoma has returned its Establishment Grant funding is not planning an
Exchange, they note that the Oklahoma Health Care Authority, which runs the Medicaid
and CHIP program, has a Tribal Consultation Policy. As long as an Exchange or
Partnership is within State government and a separate quasi-governmental organization
has not been established to operate an Exchange, these States believe that their
existing policies apply to Exchange planning.
Another approach is being used by Rhode Island, which has one federally-recognized
Tribe. Instead of developing a formal Tribal Consultation Policy, they have chosen to
include the Tribal Health Director in a variety of State health advisory committees that
have already been established. They have documentation to submit to CCIIO that
describes discussions with the Tribal Health Director about Exchange planning issues.
Alabama is another State with one federally-recognized Tribe that seems to think a
formal Tribal Consultation Policy is unnecessary; however, they have put their
Exchange planning on hold until after the elections.
An additional 3 states responded to the survey saying that they are not establishing a
state Exchange and therefore not working on a Tribal Consultation policy: Louisiana,
Montana, and Wyoming. The survey response from Montana reported that the state
was advised by CCIIO that they would be handling Tribal Consultation for the FFE.
Timing of Tribal Consultation
Many States that have received Establishment Grants believe that they do not need to
have a Tribal Consultation Policy until they have state legislation or executive orders to
establish an Exchange, or until they apply to CCIIO for certification to operate an
Exchange or to assume Partnership functions in the FFE. Meanwhile they are going
forward with planning many details that are important to tribes.
For example, according to Reforum website (http://www.statereforum.org/stateprogress-on-essential-health-benefits)
by the end of July 2012, 7 states with Tribes had
formed workgroups on essential health benefits (EHB) (Alabama, Colorado,
Connecticut, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, and New
York). In addition, 3 States with Tribes had already enacted benchmark plan type
(Arizona, California, and Nevada). Other States with Tribes had conducted
assessments of benchmark plan options (Maine, Michigan, Mississippi, North Carolina
and New York.) Tribes need to be involved with these discussions and decisions
4