Valerie Davidson is Alaska’s Lt. Governor and the principal architect of the state’s Medicaid expansion.
The Indian Health system was on the ballot across the country last week (even if the words were not explicit.) A few wins. And Alaska is at risk for a big loss.
This is Trahant Reports.
Voters in three states added new money that will go directly to clinics and basic health services through Medicaid expansion. One of the most important provisions of the Affordable Care Act was to allow states to expand Medicaid making it easier for citizens to quality for basic health insurance. Medicaid is a third-party insurance fund that directly benefits Indian health clinics and hospitals.
But in other states there were costly setbacks. Montana rejected a funding mechanism for Medicaid expansion sending it back to the legislature for further debate.
And the election of Mike Dunleavy as the new governor in Alaska means changes ahead for Medicaid in that state. (And Republicans, who never did favor Medicaid expansion, now control both houses in the state legislature.)
Medicaid has become a significant funding stream for the Indian health system, it’s particularly important for the non-profit and tribally-operated clinics and hospitals because by law that money remains at the local unit. And, unlike federal appropriations for the U.S. Indian Health Service, the amount of money grows as more patients become eligible for services. What’s more: The federal government reimburses states 100 percent for treatment at Indian health clinics or tribal facilities.
This is how it works: The Indian Health system — the federal Indian Health Service and the facilities operated by tribes and non-profit organizations — gets funding directly from Congress through appropriations. That appropriation is currently $5.5 billion but Medicaid is a partnership with state governments, and thus, must be approved by each state.
Nebraska is one of the states that voted for expansion.
The Winnebago Tribe of Nebraska recently assumed operational control of the Indian Health Service hospital and renamed it the 12 Clans Unity Hospital. Medicaid expansion could add revenue streams to this facility because more patients would qualify for the insurance. One specific benefit is that Medicaid claims are processed on a regular basis to help facilities cover operational costs, including infrastructure.
Medicaid expansion could also benefit urban clinics in Lincoln and Omaha (as well as a clinic in Salt Lake City). According to the Kaiser Family Foundation one urban Indian health program in Arizona reported that its uninsured rate fell from 85 percent before the Affordable Care Act to just under 10 percent after.
Alaska’s election could result in the biggest changes to Medicaid and the Alaska Native medical system. Nearly 40 percent of Medicaid clients are Alaska Natives and one in five Alaskans is now covered by Medicaid. Last month at the Alaska Federation of Native convention, Lt. Gov. Valerie Nurr’araaluk Davidson, Yup’ik, said Medicaid expansion has benefited every community in the state. As director of the state’s health agency, Davidson was the architect of the state’s Medicaid expansion.
I am Mark Trahant.