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Medicaid expansion for tribes and descendants possible under new bill

Nov 8, 2013 - By Alejandra Silva, Staff Writer

The state of Wyoming so far has opted not to expand Medicaid for all residents due to concerns from Gov. Matt Mead on whether the federal government would uphold its financial support through 'Obamacare.'

Wind River Indian Reservation health officials say the State of Wyoming has an obligation to expand Medicaid coverage to the tribes under the Affordable Care Act.

Leaders addressed the Wyoming Legislature's Joint Labor, Health and Social Services Interim Committee on proposed legislation that would provide Medicaid coverage to individuals of American Indian descent through a demonstration waiver if the state chose not to expand Medicaid for everyone.

So far, Gov. Matt Mead has not agreed expanded Medicaid services funded by the federal government under the act, nicknamed "Obamacare."

Treaty obligation

Chief executive officer Richard Brannan of the Wind River Service Unit in Fort Washakie and Arapahoe, said the bill not only would cover more people but also would fulfill a treaty responsibility with the federal government on aiding tribal health care.

"It's very key and essential that we get expansion on the reservation in order to improve the services that we provide," he said. "There's a lack of adequate funding."

Eastern Shoshone Tribal Health director Catherine Keene reiterated that the bill would apply to all citizens of American Indian descent and not just enrolled tribal members. Also, in order for the services to be covered 100 percent through federal aid, patients would have to be treated at Indian Health Services centers.

IHS relies heavily on third party insurance, Brannan said, including private insurance, Medicare and Medicaid. With this bill, an additional 1,700 people would be able to obtain health services in the Wind River Indian Reservation aside from the roughly 11,000 IHS already serves.

Millions for care

Eastern Shoshone tribal liaison Sara Robinson read a statement from the tribe's chairman, Darwin St. Clair, that reported 38 percent of those 11,000 would have Medicaid through the waiver. The bill also would provide about $6.9 million to the Wind River Service Unit, she said.

"With the ability to have these available we can begin to solve our health care issues and close the gap on health disparities," Robinson read from the letter.

She also pointed out the top causes of death on the reservation: cancer, diabetes, heart diseases, accidents and suicides.

Northern Arapaho tribal liaison Gary Collins carried a statement from that tribe's chairman, Darrell O'Neal Sr., and added that employment for tribal members is influenced by unhealthy situations and lack of insurance coverage.

"Our priority is to build a strong health care system in the Wind River Indian Reservation," Collins read from the letter.

Dr. Garth Reber of the Fort Washakie office added a different perspective on the benefits the bill would have with patients he couldn't help. He said a woman who was unable to get pregnant could not get the necessary services because she didn't have the coverage. A man who was hurt while working had to stay

unemployed after not being able to get the help he needed on a status of limited coverage.

Mental health component

Brannan also told the committee there was a "significant need" for mental health services and intervention. If the bill finds success in the next legislative session, with the governor's approval, the tribal department of health could apply for a demonstration waiver under section 1115 of the federal Social Security Act.

Committee co-chairman Sen. Charles Scott, R-Casper, said the bill could be offered through the Wyoming Select Committee on Tribal Relations if that committee wished, but he said the Labor, Health and Social Services panel is prepared to move ahead with it as well.