mmpc - National Indian Health Board

Introduction
Reliable determination of the proportion of AIAN health care costs covered by this largest source of third-party
payments in the IHS system is critical. To determine how to allocate any new funds that it receives for health
care services among its system providers, the IHS calculates the unmet need for health care funds of the AIAN
user population of its system providers by subtracting from the total calculated need the amount of funding
provided by both the IHS and these alternate sources. The IHS uses data from that 1987 household survey of
AIAN to estimate that Medicaid, Medicare and other third party coverage provides to allocate new health care
funds to IHS and tribal facilities. Because of the relative unreliability of the aging household survey data, they
estimate that a fixed 25% of the health care funds needed at any given Service Unit in the system is provided by
third-party payers. They are unable to determine how this varies across the service delivery areas of the
various Service Units.
Purpose of this Report
The first objective of this report is to determine how much the Medicaid and Medicaid-CHIP programs pay for
the personal health care services of AIAN served by IHS provider system, and then compare those payment
levels to how much is paid for AIAN without access to the IHS system of care, and for non-Hispanic white people
living in the same counties. To achieve this objective it is necessary to understand how variation in enrollee
characteristics and Medicaid payment systems determine the differences in the Medicaid funds paid for the
three groups. Then adjusting for these determinants, we analyze how Medicaid payments for the three groups
vary across the IHS Areas for all three groups of Medicaid enrollees.
A second objective is to determine what fraction of the IHS Active User population with Medicaid paid claims,
does not have any IHS Program Medicaid paid claims and whether their per capita costs are lower than
expected compared to IHS Active Users with IHS Program Medicaid paid claims, and the other AIAN and white
comparison groups. If their Medicaid per capita payments are lower than the other groups after adjustments
for determinants of payment differences, this implies that the rest of their health care costs are not being paid to
IHS providers by Medicaid. To achieve this objective we divide the IHS system users with Medicaid paid claims
into those who were IHS Active Users without IHS Program Medicaid paid claims and those with IHS Program
Medicaid paid claims and determine how adjusted Medicaid per capita payments compare for the two groups
across the IHS Areas. We also compare how payments for IHS Active Users without IHS Program Medicaid paid
claims compare to those of the AIAN and white comparison groups not in the IHS system.
A third objective of this report is to determine what percent of health care funding needed for personal health
care services of AIAN calculated by the IHS is actually provided by the Medicaid and Medicaid-CHIP payments.
How reliable is the assumption based on 1987 data that as much as 25% of the health care costs are met by
Medicaid funds? How reliable is the assumption that the proportion of Medicaid paid health care coverage is
unvarying across the IHS Areas?
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