Mark Trahant: Effortless Indian Country care
"Indian country has a different financing mechanism. Plan A is, of course, the Indian health system, the combination of federally-run Indian Health Service facilities plus those health care programs managed by tribes or urban Indian organizations. Plan A is a system that’s regularly characterized as “starved” because it is funded with annual appropriations, instead of based on patient need. Here is the rub: the Indian health system is so under funded that it does not count as a qualified insurance plan (despite the treaty and statutory promises).

So Plan B is Medicaid. Medicaid is the country’s insurance plan for low-income families, pregnant women, people with severe disabilities and older people who do not qualify for Medicare (and for long-term care, but that’s another column). The funding for Medicaid is an entitlement. If someone is eligible, the money is there. Medicaid is a partnership between the federal government and state governments. States write the rules, under broad guidelines, and the federal government pays for part of sometimes all of the cost.

Medicaid is a growing source of funding for the Indian health system (and under law is supposed to supplement, not replace, IHS revenue). The Government Accountability Office found that the range of Medicaid reimbursements at IHS facilities were from 2 to 49 percent “and the facilities with higher reimbursements had additional funds to hire staff and purchase equipment and supplies.”

“Medicaid is a key element of American Indian Alaskan Native health care financing reform,” wrote Andy Schneider in the American Journal of Public Health in May 2005. Schneider went on to serve as the chief health counsel for the House Committee on Oversight and Government Reform."

Get the Story:
Effortless health care? Not in a Medicaid plan (Mark Trahant 10/5)

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