mmpc - National Indian Health Board

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Contents SUMMARY I Findings .......................................................................................................................................................................................................... ii Conclusions and Recommendations .................................................................................................................................................. iii INTRODUCTION 1 Purpose of this Report .............................................................................................................................................................................. 2 METHODS 3 Data Sources ................................................................................................................................................................................................. 3 Medicaid-IHS Linked Person Summary File ............................................................................................................................... 3 Medicaid Inpatient, Prescription Drug and Other Services Claims Files ........................................................................ 3 Analysis Groups ........................................................................................................................................................................................... 4 IHS AIAN .................................................................................................................................................................................................... 4 Other AIAN ............................................................................................................................................................................................... 5 Whites (Non-Hispanic) ........................................................................................................................................................................ 5 Analysis Plan ................................................................................................................................................................................................. 6 Outcome of Analysis: Mean Total Payment per Medicaid Recipient ................................................................................ 6 Determinants of the Outcome .......................................................................................................................................................... 7 Statistical Adjustments ........................................................................................................................................................................... 15 FINDINGS 19 Payments for AIAN Medicaid Recipients ........................................................................................................................................ 19 Recipients with Fee-for-Service Medical Services ................................................................................................................. 19 Recipients in Medical Comprehensive Managed Care Plans (CMCP) ............................................................................. 28 Compiled Findings for All Analyses and Areas ........................................................................................................................ 32 Medicaid Paid Fraction of Total Health Care Costs of IHS Active Users ............................................................................ 37 IHS Calculated Health Care Costs for IHS Active Users ........................................................................................................ 37 Medicaid Fraction of IHS Active User Health Care Costs ..................................................................................................... 38 Medicaid Fraction Paid to IHS and Tribal Providers for IHS Active Users ................................................................... 39 CONCLUSIONS AND RECOMMENDATIONS ..................................................................................................................................... 41 IHS AIAN Payments Compared to Others ....................................................................................................................................... 41 Medicaid-enrolled IHS Active Users without IHS Program Medicaid claims .................................................................. 42 Medicaid-paid Fraction of IHS Active User Costs ........................................................................................................................ 42 REFERENCES 43
Summary T he Indian Health Service (IHS) provides only part of the health care needed by the American Indians and Alaska Natives (AIAN) who rely on the IHS health care system because of the limited funding appropriated to the agency by the federal budget. The largest alternate resource to IHS for the health care funding of AIAN who rely on the IHS health care system is Medicaid. Medicaid pays for care received not only at the IHS and tribally operated health care facilities, but from other providers when specialized or emergency care is needed. The federal Medicaid program pays 100% of state Medicaid claims from IHS health care system providers for IHS funded services provided to AIAN (IHS Program claims). Together with its companion program, the Children’s Health Insurance Program (CHIP), Medicaid has grown to provide a substantial but largely unknown fraction of the coverage of health care for the AIAN who use the IHS system. The first objective of this report to determine whether Medicaid (including the Medicaid portion of CHIP not operated by states alone) pays as much for the personal health care services of AIAN who rely on the IHS system of health care providers (IHS AIAN) as it does for other Medicaid recipients. If the per capita amounts paid for the IHS AIAN are comparable to those of others, then a basic measure of health care equity for AIAN served by the IHS system has been achieved. If not then efforts are needed to achieve equity. A second objective is to determine whether there are any Areas of the IHS health care delivery system, or subgroups of AIAN who rely on the IHS system that do not have Medicaid payment levels as high as those of other AIAN subgroups served by the IHS System. Where the payment levels for IHS AIAN are not as high as those of others in an Area, it can be because IHS AIAN have more difficulties obtaining Medicaid paid care, or because the state and IHS system provider need to work more closely to see that Medicaid claims are filed and paid successfully. If IHS system providers do not file and collect claims for services provided to Medicaid enrolled AIAN they serve, they are in effect substituting IHS funding for Medicaid funding of health care costs. In this report, analyzing only the Medicaid data of the counties of the IHS Areas allows comparison of payments across IHS Areas and using Medicaid data that has been linked with IHS registry data allows examination of AIAN subgroups served by the IHS System. A third objective of this report is to determine what fraction of the personal health care costs of the AIAN user population of the IHS system is actually provided by Medicaid payments. The IHS has current data on the Medicaid collections of the IHS and tribal facilities that they operate, but not the tribal facilities operated by tribes. About one-third of the IHS system facilities are tribally-operated facilities. The IHS estimates that about 25% of the per capita costs of health care needed by AIAN they serve is paid by third-parties including Medicaid, Medicare and private insurance. The AIAN survey data on which this calculation is based is now more than 20 years old, however. Medicaid payment data provides a way to update the Medicaid portion of the third-party payment fraction. In addition it offers a way to estimate how much this Medicaid fraction varies across IHS Areas. Determination of the fraction is critical because the IHS estimates that it provides only about 54% of the per capita costs of health care needed by AIAN they serve. The extent to which the 25% fraction is too high, underestimates the remaining unmet health care need of the AIAN, the extent to which the 25% fraction is too low overestimates the unmet health care need. The IHS allocates new federal funds it receives to the IHS and tribally-operated facilities based on its calculated estimates of the unmet health care need of the AIAN served by the facilities. To achieve the first two objectives, after excluding longterm care and institutionalized Medicaid recipients the per capita payments for six different types of Medicaid recipients of the remaining medical, behavioral health
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MEDICARE, MEDICAID, & HEALTH REFORM
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GENERAL INFORMATION TABLE OF CONTEN
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Last Updated: November 12, 2012 2.
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Ref. # 2. Task/Issue Person(s) CMS
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Ref. # II. POLICY Task/Issue Person
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Ref. # Task/Issue Person(s) 9. Stra
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Ref. # Task/Issue Person(s) 15. Eva
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IV. OUTREACH AND EDUCATION MMPC: SU
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Ref. # Task/Issue Person(s) 25. Med
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MMPC October 9, 2012 Teleconference
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To do List: -Myra will have draft b
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Internal Revenue Service Meeting No
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Page 29 and 30: Indian Self-Determination and Educa
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Page 35 and 36: (1) ISDEAA, 25 USC §450 et seq.; (
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Page 39 and 40: edits on documents are due back fro
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Page 45 and 46: i. CMS rep. commented that an analy
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Page 49 and 50: Letter: Dr. Robert Petzel, Under Se
Page 51 and 52: October 17, 2012 Dr. Robert Petzel,
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Page 75: Prepared by James Crouch MPH Chair,
Page 79 and 80: Summary providers that were either
Page 81 and 82: Introduction Reliable determination
Page 83 and 84: Analysis Groups IHS AIAN Methods Th
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Page 119 and 120: Findings Figure 21. Medicaid Altern
Page 121 and 122: Conclusions and Recommendations pro
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defined in Sections 8 and 9 of this
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2. Office of Intergovernmental Affa
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will give equal consideration to th
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provide Indian Tribes with a region
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4. Each Operating Division Head/Dep
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Department’s ability to address i
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17. Sovereignty - The ultimate sour
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1. Selection of workgroup co-chairs
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It is unclear if this was just an o
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November 14 -15, 2012 TTAG FACE TO
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AGENDA: Day 2 Thursday - Nov. 15, 2
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Subpart G--Social Services Block Gr
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organization applying for or receiv
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members of a tribe receiving direct
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is at or below the poverty line. (d
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under this part. Grantees that rece
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income home energy assistance progr
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Need for Uniform Operational Guidan
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Dear Tribal Representatives, Octobe
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There is a strong correlation betwe
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Wed. Nov 14 th : SDPI National Call
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Future MMPC Meetings & Conference C
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Regulation Review and Impact Analys
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64. Policy on Conferring with Urban
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RRIAR Ref. # 1.c. 8. 9. 13. Short T
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premium tax credit assistance and c
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Access to this benefit is criticall
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community providers for purposes of
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November 12, 2012 Centers for Medic
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_________ American Indian or Alaska
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November 9, 2012 Page 2 We are comm
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Tribal Consultation for Health Insu
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Background Analysis of Tribal Consu
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Analysis of Tribal Consultation Pol
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D. FFE Data Analysis of Tribal Cons
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John O'Brien Director, Healthcare &
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mmpc - National Indian Health Board

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