Tribal officials told Oklahoma’s health care working group Medicaid expansion could make a difference in their under-funded health systems.
The Oklahoma area is last in funding for Indian health care. Choctaw Nation Office of Self-Governance Senior Policy Analyst Melanie Fourkiller said that’s looking at not only federal funding, but also reimbursements from Medicare, Medicaid and private insurance.
"So, Oklahoma area — once we made those calculations and account for all those revenue streams — we’re funded at 39% level of need funded. So, meaning if we needed a dollar, we’re getting 39 cents of it," Fourkiller said.
Medicaid accounts for the largest portion of Indian health care reimbursements from any one source. Many tribal citizens, however, are in the same boat as other uninsured Oklahomans: They make too much for Medicaid but too little for insurance subsidies.
There are reasons Native Americans need health insurance, said Chickasaw Nation Divison of Health Senior Advisor Melissa Gower.
Sometimes a private hospital is much closer or easier to get to. And tribal hospitals don’t always offer all the specialized care citizens need, whether that’s orthopedics or cancer treatment. Gower said that means tribes purchase a lot of care from private hospitals — $121 million worth — but that doesn’t go far.
"You can see how rationed it is, because it is a very low amount: $321 per year is what we have in Oklahoma per person to buy needed specialty and tertiary care," Gower said.
Gower said increasing the income limit for Medicaid would extend coverage to thousands more citizens, letting Indian health systems bring in millions more dollars through a 2017 federal agreement to reimburse 100% of costs for services to enrolled tribal citizens.
"That new revenue into our health systems … would allow us to continue to expand our access to services, bring more of those specialty services in-house and to add additional health care services," Gower said.
