Recently, there has been much discussion regarding funding of Medicaid Expansion programs in New Mexico. Very often missing from the discussion is how Medicaid is impacting tribal health programs and their primary health care delivery source, the Indian Health Service.
First, New Mexico doesn’t have to pay the federal medical assistance percentage, known as the FMAP, for Native Americans, who make up approximately 10 percent of New Mexico’s population.
The FMAP is a big deal because it tells us who pays for what portion of a state’s Medicaid program. Currently, the federal government shoulders 100 percent of the cost of Medicaid Expansion.
However, as of 2020, the FMAP is approximately a 90 percent federal and 10 percent state mix, meaning that for every dollar spent by the Medicaid program, the federal government covers 90 cents and the state covers 10 cents.
For a Medicaid-eligible Native American enrolled in a federally recognized tribe, the FMAP is and will continue to be 100 percent, meaning the federal government pays the whole bill.
Accordingly, the state does not pay for the Medicaid services provided to Native Americans, even if services are sought off the reservation or outside of the Indian Health Service.
Many do not know that Native Americans are guaranteed health care under the 1921 Snyder Act and Treaties, and various tribal compacts – but this care is not free.
The Indian Health Service has been historically underfunded by Congress, receiving only about 40 percent of needed funding, resulting in diminished services, and closures of hospitals and facilities.
This scaling back of the Indian Health Service means that Native Americans are referred to private-sector providers for their care. Native American patients are referred to private doctors through an Indian Health Service division called Purchase and Referred Care.
Waiting for a referral to a private-sector provider is why Native Americans have the saying “don’t get sick after June,” because that’s when federal funds typically run out.
After June, the government pays only for what are referred to as “priority one” cases, where a patient has to be in danger of losing life or a limb.
Additionally, before Medicaid Expansion and the Affordable Care Act, it was common for Native Americans to be put on waiting lists for important services like mammograms, X-rays, MRIs, CT scans and cataract procedures.
This practice often caused these types of conditions to go unchecked and become worse, resulting in higher costs to the Indian Health Service.
These practices only worsened the problem. Higher costs for more severe conditions meant no Purchase and Referred Care funding for preventative services and tests.
But now, as a result of the Affordable Care Act, the Indian Health Service is experiencing an influx of funding due to third-party reimbursements from Medicaid Expansion.
Native Americans are signing up and taking advantage of the benefits of Medicaid. The Indian Health Service’s Albuquerque Area Service Unit has reported that they are now paying for priority three and four cases as a result of increased enrollment in Medicaid by Native Americans.
Now, some Native Americans might say, “Why should I sign up for health coverage through Medicaid? What about the federal government’s obligation to provide free health care for Native Americans?”
I would argue that Medicaid Expansion makes good on that promise.
If determined eligible, Medicaid provides free coverage to tribal members, is paid for by the federal government and increases access to health care providers outside of the Indian Health Service system.
Medicaid Expansion is good for New Mexico, good for New Mexican tribes, good for Native Americans living in urban areas, costs the state nothing for tribal members and pours money into local economies.
New Mexico would be foolish to eliminate or scale back the Medicaid Expansion program.