ACA & INDIAN COUNTRY:BARRIERS, ADVOCACY & OVERCOMING OBSTACLES

Jim Roberts, Policy Analyst

NIHB Annual Consumer Conference

September 10, 2014

Albuquerque, NM

HHS Data

StateTotal No. Determined Eligible to Enroll in a

Marketplace Plan

No. of Individuals Eligible to Enroll

with Financial Assistance

Number of Individuals Who Have Selected a

Marketplace Plan

United States 13,547,592 8,748,037 8,019,763

    64.6% 91.7%

Idaho 107,849 83,662 76,061

    77.6% 90.9%

Oregon 124,840 99,902 68,308

    80.0% 68.4%

Washington 240,880 151,441 163,207

    62.9% 108%

Washington State Enrollment

WA State QHP Enrollments

Who Expanded Medicaid: Low ACA enrollments indication many AI/AN going into Medicaid

Challenge to evaluating AI/AN Participation in ACA

1. Lack of AI/AN enrollment data in both the FFM and SBE

2. Can not effectively evaluate take up rates for AI/AN participation in ACA

3. Enrollment could be improved by developing Tribal sponsorship programs and group payer arrangements

4. Resolving QHP contracting issues with I/T/U providers could also improve enrollment

Portland Area Training:“Lesson Learned & Things to prepare for”

• World Cafe Discussion on many issues including Lessons Learned and what we found: • Many AI/ANs excited to have options for insurance! • Through research and patience Navigators and Assisters able to

work through most problems • Exchange websites worked less than 50% of the time • Paper Applications proved most effective and still required phone

follow up • Communications between Exchange and state Medicaid programs

has problems • Lengthy wait times on phone lines • The process overpromised and under delivered

Portland Area Training:“Lesson Learned & Things to prepare for”

• Premium miscalculation on mixed households is a real problem

• Application assistance if AI/AN has been assigned to another navigator or assister – locked out

• Call Centers are not always helpful and in many instances cause more confusion

• Tribal navigators listed publically • Applications for Exemptions needs to be improved • State staff and call centers do not have Tribal

experts and return calls take a very long time • QHP contracting and reimbursement is unclear

Questions?