NATIVE AMERICANS: Managed Medicaid Could Improve Health
A new report from the National Academy for State Health Policy says managed care could significantly improve the health of Native Americans, provided that states, the federal government and Native American tribes collaborate to ensure continuity of health care services. The report, "Medicaid Managed Care and Native Americans," stems from a symposium held last October that brought together representatives from Medicaid agencies, Native American tribes and the federal government to address ways to shift Native American health care from a fee-to-service system to managed care (NASHP release, 12/28). Study authors Neva Kaye and Joanne Rawlings-Sekunda note that the Indian Health Service (IHS) has markedly improved the health status of Native Americans, as indicated by a steady decline in maternal death and infant mortality rates. As a result, Native Americans are concerned that "any changes to this system might cause them to lose this hard-won ground. On the other hand, there is still room for improvement in the health care delivered to Native Americans." In general, Native Americans tend to have poorer health and less access to specialty care, long term care and chronic disease care. While managed care has the potential to improve treatment, a shift would require special attention to maximize funding to providers in the IHS, maintain strides made in Native Americans' health status and recognize "the potential impact on" state budgets.
Participants in the October symposium addressed the "pressing" need for long term care services for Native Americans with chronic illnesses or disabilities, suggesting that Medicaid reimburse home health aides or allow "tribes to apply directly to the federal government for HMO and Community-Based Service waivers." In addition, participants called attention to the inadequate treatment of chronic diseases under the fee-for-service Medicaid systems, asserting that a managed care scheme could provide better treatment for chronic disease patients, such as diabetics.
In an effort to "minimize the impact of managed care on policies that were designed to function under fee-for-service" plans, states and Native Americans have proposed several options: allowing Native Americans to choose between managed care and fee- for-service payment systems; reimbursing providers directly through Medicaid; and creating new strategies to allow IHS providers to participate in managed care as subcontractors, their own plans or as primary care case management providers (PCCMs). The authors note that while no IHS provider "has yet established its own plan, the Native American Health Plan, Inc. is working with New Mexico to establish a health plan that serves only Native Americans" (Study text, 12/98). The report, funded by the Henry J. Kaiser Family Foundation can be purchased for $20 for government and nonprofits or $35 for all others by contacting NASHP at 207/874-6524 or email: firstname.lastname@example.org.