Authors: Andy Schneider

Publication Year: 2005

Last Updated: 2016-04-06

Journal: NCUIH

Keywords: Governors, Cost sharing, Medicaid, Indian Health Service, Tribal, Urban Indian, I/T/U, Urban Indian Health, National Governors Association, NGA

Abstract: 

National Governors Association Proposals for Medicaid August 2005

by Andy Schneider, Medicaid Policy, LLC

In all likelihood, Congress this fall will enact legislation making changes to the Medicaid program, and the President will sign the measure into law. Most if not, all of these changes will be designed to reduce federal spending on Medicaid by up to $10 billion over the next five years, which implies a total reduction in federal and state Medicaid spending of up to $17.5 billion over this period. Prominent among the proposals for change are those presented to Congress on June 15 by the National Governors Association (NGA). In a 13-page "Preliminary Report," the NGA sets forth a series of recommendations for short-term and long-run changes to the Medicaid program. While none of these recommendations is directly addressed to American Indians and Alaska Natives in fact, the document does not mention Al/ANs-many of these recommendations have important implications for low-income Al/ANs as well as the Indian Health Service, Tribal, and Urban Indian (I/T/U) providers from whom many All AN Medicaid beneficiaries receive their health care. This paper discusses three of the NGA recommendations: (1) cost-sharing, (2) benefit package "flexibility," and (3) waiver "reforms."

Health care for AI/AN populations is "severely rationed." Medicaid cannot by itself solve the chronic underfunding of all AI/AN health care generally and the l/T/U system in particular. That being said, the Indian healthcare financing problem cannot be solved unless Medicaid is improved. Regrettably, the NGA recommendations could well make matters even worse for Al/ANs and the l/T/U providers that serve them. The NGA proposal to increase beneficiary cost-sharing could impose additional financial. burdens on I.R.S. and tribal health budgets. The NGA proposal for more benefits package "flexibility" could result in significant reimbursement losses to l/T/U providers.  The NGA proposals for waiver "reforms" could lead to radical structural changes in the Medicaid programs of individual states that limit both federal and state government financial support for health care for low-income AI/ANs. Tribes and tribal health programs need to ensure that Congress understands the implications of the NGA recommendations as it considers policy changes to reduce federal Medicaid spending.

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