mmpc - National Indian Health Board

Summary
providers that were either not being billed or paid or both. This would be substitution of limited IHS funding for
Medicaid covered care.
The ‘Medicaid fraction’ of health care costs needed by the IHS AIAN Active User population that is paid by
Medicaid (and Medicaid-CHIP) for personal health care costs is at least 25% in 9 of 12 IHS Areas, but varies
from 19% to 65% depending on the Area. Areas with the lowest fraction of about one-fifth are Nashville (19%)
and Oklahoma (21%). Aberdeen, California, Albuquerque, Portland and Bemidji Areas have mid-range fractions
of between a little more than one quarter and a little less than one-third (27% to 31%). Alaska and Billings are
in the middle of the Area rankings with a little more than one-third of the costs paid by Medicaid (34% to 38%).
It was found that very high Medicaid payments in the state of Arizona for AIAN contributes to the highest
Medicaid fractions found: nearly one half for Navajo and Phoenix Areas (46% and 49% respectively) and nearly
two-thirds (65%) in Tucson Area.
Conclusions and Recommendations
The findings reported here from 2006 support the general conclusion that in most Areas the IHS system
providers and the state Medicaid programs with which they interface in these Areas were as a whole are doing
well at billing and collection for services provided to AIAN Medicaid recipients in the IHS system.
In Aberdeen, Billings, Albuquerque and Oklahoma Areas, it is possible that either the IHS system or others who
provide Medicaid paid care could improve billing and collection. Alternatively, in Albuquerque Area the reason
that lower payments were found only compared to self-declared AIAN who do not use the IHS system could be
because these other AIAN have higher demands for health care when ill because they are not in the IHS system.
The morbidity risk-adjustment is only a partial adjustment for health status differences, because it depends on
the extent to which people use their Medicaid health care provider for completeness.
In every IHS Area there were IHS Active User Medicaid recipients for whom billing and collection could be
improved. This group with no IHS Program claims and such low risk-adjusted Medicaid payments that it is
likely that their IHS system providers are not billing or collecting for a portion of the care of these AIAN they
serve. In addition, IHS system providers were not billing or collecting for prescription drugs.
The IHS estimation of unmet need of the AIAN user population for health care funding needs to use more
recent Medicaid payment data and recognize higher levels of coverage of the health care costs by Medicaid and
Medicaid-CHIP programs, and the variation of the coverage across IHS Areas. Data like that analyzed in this
report but restricted to services included in the Federal Equivalent Health Benefit plan. Medicaid benefits vary
in the state programs, though more and more states are starting to provide only the mandatory services, and
dropping the optional benefits that made the services provided across states particularly variable.
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