It’s been almost a year since the Medicaid eligibility redetermination process began following the COVID-19 public health emergency. Over 20 million people They were excluded from joint federal and state programs for low-income families.
Story Chorus They look back at how dismantling the system has upended people’s lives, but Native Americans are especially at risk of losing their insurance and face significant obstacles to re-enrolling in Medicaid or finding other coverage.
“From my perspective, it didn’t work the way it was supposed to,” said Christine Meli, a pediatric nurse practitioner in rural Kalispell, Montana, who also provides telehealth services to tribal members on the Fort Peck Reservation.
The redetermination process exacerbates long-standing problems people on reservations face when seeking health care, she said. She has seen patients who are still eligible for benefits disenrolled. And the rise in uninsured tribal members weakens their health care system, threatening already fragile access to health care in Native communities.
State, tribal and federal efforts to curb SD’s syphilis epidemic
One teenage girl, Meli recalls, lost her insurance while seeking life-saving treatment. A routine test revealed something was wrong, and during a follow-up visit, Meli discovered the girl had a potentially fatal disease if left untreated. Meli declined to share details to protect the patient’s privacy.
Meri said she worked with tribal nurses for weeks to coordinate lab monitoring and specialist consultations for her patient. She didn’t get a call saying Medicaid coverage was no longer in place until the girl was seen by a specialist.
The girl’s parents told Meli they reapplied for Medicaid a month ago but haven’t heard back. Meli’s patient eventually got the medication she needed, with the help of a pharmacist. This revocation was an unnecessary and burdensome obstacle to her care.
Montana Democratic Senate Minority Leader Pat Flowers said at a political event in early April that 13,000 tribal members have been disenrolled in her state.
Native American and Alaska Native adults are covered by Medicaid. At a higher rate More tribal leaders have been removed than whites, but some tribal leaders do not know the exact number of tribal members who have been removed in the investigation. February and MarchThe survey was conducted and released by the Indian Health Service’s Tribal Governance Advisory Council, and respondents included tribal leaders from Alaska, Arizona, Idaho, Montana and New Mexico.
Tribal leaders reported many challenges associated with redetermination, including a lack of timely information provided to tribal members, patients not knowing about the process or disenrolling, long processing times, staffing shortages at the tribal level, lack of communication from states, concerns about obtaining accurate tribal data, and difficulties interpreting data when states share it.
Research and policy experts initially worried that vulnerable populations, including rural Native American communities and families of color, would face greater and unique obstacles to renewing their health insurance and would be disproportionately affected.
“They have a lot at stake and a lot to lose in this process,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families and a research professor at the McCourt School of Public Policy. “I fear that prediction is coming true.”
Get morning headlines delivered to your inbox
Cammie Dupuy Pablo, tribal health communications director for the Salish-Kootenai Confederated Tribes of Montana, said she doesn’t know exactly how many tribal members have been disenrolled since redetermination began, but she knows some members who lost insurance dating back to July have yet to reenroll.
The tribe held its first outreach event in late April as part of its efforts to support its members, and the Health Resources Department is meeting with people in their homes, making phone calls and planning more events.
Dupuy Pablo said the tribe receives a monthly list of its members’ Medicaid enrollment status, but a list of those who are not on Medicaid would be more useful.
Because of this lack of data, it’s unclear how many tribal members have been disenrolled.
“It’s at our discretion what state Medicaid agencies are willing to share,” said Yvonne Myers, an Affordable Care Act and Medicaid consultant for Potawatomi Nation Health Services in Oklahoma.
In Alaska, tribal health leaders signed a data-sharing agreement with the state in July, but it took about a month for information about tribal members’ insurance to arrive, by which point more than 9,500 Alaskans had already been dropped from coverage for procedural reasons.
“We’re already losing these people,” said Jennifer Morrow Johnson, senior policy counsel for intergovernmental relations at the nonprofit Alaska Native Tribal Health Association. “This is a really big impact.”
Federal regulations don’t require states to track or report race and ethnicity data on dropouts, and fewer than 10 states collect such information. Data from those states don’t show racial disinsurance rates, but According to the KFF report: Data is limited, and a more accurate picture will require more state demographic reporting.
Medicaid work requirement question to appear on South Dakota ballot in November
Tribal health leaders are concerned that high numbers of members leaving are putting financial strain on the health system and its ability to deliver care.
“Just because they’re dropped from Medicaid doesn’t mean we stop providing services to them,” said Jim Roberts, senior executive liaison for the Alaska Native Tribal Health Association’s intergovernmental relations division, “it just means we become even more reliant on other funding sources to provide care that is already underfunded.”
Three in 10 Native Americans and Alaska Natives under age 65 rely on Medicaid, compared with 15% of whites. The Indian Health Service is responsible for providing health care to approximately 2.6 million of the 9.7 million Native Americans and Alaska Natives living in the United States, but services vary by region, clinic, and health center. The agency itself is chronically underfunded and unable to meet the needs of its residents. For fiscal year 2024, Congress approved $6.96 billion for the IHS, far less than originally budgeted. $51.4 billion The tribal leaders called.
Because of this historic deficit, tribal health systems rely on Medicaid reimbursements and other third-party payers, such as Medicare, the Department of Veterans Affairs, and private insurance, to make up the shortfall. As of 2021, Medicaid accounted for two-thirds of third-party IHS revenues.
Roberts noted that some tribal health systems receive more federal funding through Medicaid than IHS.
Tribal health leaders worry that cuts to Medicaid funding will exacerbate long-standing health care disparities. Short life expectancyhigh rates of chronic disease, and poor access to health care are some of the issues that plague Native Americans.
Monique Martin, vice president of intergovernmental relations for the Alaska Native Tribal Health Association, said the dissolution effort has become “all-consuming.”
“The state is focused on the administrative details of how to send a text message to 7,000 people,” Martin said. “We’d rather have a conversation about how to address the social determinants of health.”
Meri said he hasn’t heard of any tribal members on the Fort Peck Reservation losing Medicaid coverage, but he wonders if that means those who were disenrolled didn’t seek help.
“What really worries us are all these silent cases. … All we know are the cases that we’re actually seeing,” she said.
KFF Health News is a national newsroom producing in-depth journalism on health issues and is one of the flagship operating programs of KFF, an independent source of health policy research, polling and journalism. KFF.
subscribe Join us for KFF Health News’ free morning briefing.
