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Copyright © 2020 Albuquerque Journal
After nearly two decades of preparation, a first-of-its-kind effort to establish a Navajo Nation-administered Medicaid program is nearing reality.
Last month, the governing body of the sovereign nation unanimously passed legislation setting up the Navajo Managed Care Organization. The new approach would replace traditional Medicaid access and establish a Medicaid program managed by a tribal entity, something that’s never been done in the United States.
The managed care organization, which could be up and running as early as this fall, will be managed jointly by Molina Healthcare and Naat’aanii Development Corp., a business arm of the Navajo Nation.
Tribal leaders maintain the organization will increase access to health care for the tribe’s approximately 75,000 Medicaid-eligible residents, helping a long-overlooked population take more local control over its health outcomes.
“If we could enroll every single Navajo person in New Mexico, I think the opportunity to change the way we do things will be right before us,” said Naat’aanii Development Corp. board Chairman Manley Begay Jr. “It just presents this tremendous opportunity to make things better.”
Health statistics are grim for the approximately 100,000 Navajo people living in New Mexico. Navajos have a mortality rate more than 30% higher than the United States’ overall rate, according to a report on the managed care organization.
The report also says Navajos have a higher prevalence of diabetes, coronary artery disease, obesity, alcoholism, traumatic injury and cancer than the general population, and more limited access to resources to treat those ailments.
“Long-lasting social and economic pressures have guaranteed that these health disparities persist,” the paper says.
Begay noted that a lack of infrastructure on the largely rural Navajo Nation, which spans more than 27,000 square miles in Arizona, Utah and northwestern New Mexico, creates a significant challenge for health care providers. Begay said that effects of colonialism still linger in health policy in Indian Country and that current Medicaid offerings aren’t tailored to the specific needs of the Navajo people.
The managed care entity would allow the tribe to take back some of its sovereignty, Begay said.
“This is a wonderful chance to be in the driver’s seat,” he said.
The effort to establish a Medicaid program on Navajo Nation land is not new, but has intensified in recent years. Congress passed the American Reinvestment and Recovery Act in 2009, which allows for managed care entities controlled directly by tribes and tribal entities.
In 2017, the New Mexico Human Services Department requested support from the Centers for Medicare and Medicaid Services to operate a managed care entity on tribal land, after a formal tribal consultation in Santa Fe, according to the report. The center approved the request the next year.
As of November, more than 735,000 New Mexicans were enrolled in Medicaid and the Children’s Health Insurance Program, according to data from the Kaiser Family Foundation. In 2018, Medicaid enrollment in McKinley and San Juan counties, which include most of the Navajo land in New Mexico, averaged 58.3% and 43.7%, respectively.
Currently, most Navajos enrolled in New Mexico’s Medicaid program use a fee-for-service approach, in which medical providers are paid for each service rendered. The report says patients often lack assistance in navigating the health care system to access appropriate doctors and treatment.
By contrast, the proposal would deliver Medicaid health benefits and additional services through a contract between the state Medicaid agency and the managed care organization, based on a set payment per member.
The Medicaid and CHIP Payment and Access Commission says managed care organizations “can allow for greater accountability for outcomes, and can better support systematic efforts to measure, report and monitor performance, access and quality.”
A spokesman for the Human Services Department declined to comment on the new program’s potential impact on statewide Medicaid funding. However, Jerry Pacheco, a board member for Naat’aanii, said he doesn’t expect any changes to state Medicaid funding.
Initially, the program would be open only to American Indians and Native Alaskans who are eligible for New Mexico’s Medicaid program and who reside in ZIP codes within the Navajo Nation. However, family members of enrolled members are eligible even if they don’t meet the criteria.
Additionally, Naat’aanii CEO Robert Joe said the approach would allow tribal leaders to add elements that alleviate poor health outcomes, such as food boxes designed to help combat diabetes.
Advocates are optimistic that the new program, in addition to improving health outcomes for Navajos, will improve the local economy. Pacheco said the Navajo Nation could help keep much-needed health care revenue in the region.
“This is a big first step in pulling some of that money back,” Pacheco said.
Although the number of jobs created by the program will depend on the number of members, Begay said he hopes the jobs created would be enough to help mitigate the loss of jobs from the planned closure of the Farmington-area San Juan Generating Station in 2022.
Pacheco added that the next step is meeting with state government officials and answering any questions they might have about how the program would work, adding that Gov. Michelle Lujan Grisham has supported the effort in the past.
“We want to make sure it is a powerful, positive tool for everyone,” Pacheco said.