Published June 26, 2017
Over one-quarter, nearly one million, American Indians and Alaska Natives (AI/AN) live with a disability. More than a million of all AI/ANs are enrolled in Medicaid and the Childrens’ Health Insurance Program (CHIP). And, many more are eligible for health coverage through these programs. Without Medicaid and CHIP dollars, the Indian Health Service (IHS) system will not survive. AI/ANs with disabilities living both on the reservation and in urban areas stand to lose not only “essential health services”, but also the programs and services that keep us out of institutions and in our own homes with our families. In addition to direct health care, the program pays for critical supports like wheelchairs, hearing aids, prosthetics, bathroom and house aids. Most importantly, Medicaid pays for in-home care.
Both the House and Senate versions of the effort to repeal the Affordable Care Act institute a per capita cap for Medicaid. This means that the federal government would offer a fixed amount of money for each beneficiary, including AI/ANs with disabilities. The Medicaid shift would also have implications for the 90 percent of AI/AN children attending public schools. Currently, Medicaid reimburses schools for everything from speech and occupational therapy to wheelchairs. Disability advocacy groups assert that under this proposal, states would no longer have to consider schools as eligible Medicaid providers, which would mean that districts would have no Medicaid dollars to provide medically-necessary services.
The Consortium of Citizens with Disabilities declares that betraying the Medicaid guarantee for people with disabilities while slashing federal support will force states to cut services and eligibility that put the lives, health, and independence of people with disabilities at significant risk.
The repeal of Medicaid Expansion, which also covers people with mental illnesses and substance use disorder, will only compound the massive funding shortages that states face.
Medicaid is a crucial program for the federal government in honoring its trust responsibility to provide healthcare to AI/ANs. The National Indian Health Board is heartened that the Senate health care bill retains the provision that permanently authorizes the IHS and Tribal facilities to bill Medicaid for services provided to Medicaid-eligible AI/ANs in order to supplement inadequate IHS funding and as part of the federal trust responsibility.
However, that does not help the over 70 percent of AI/ANs who live outside an IHS service area. Medicaid’s home- and community-based care services also enable many with disabilities to work outside the home. Medicaid’s in-home services also makes it possible for family members who care for a loved one with a disability to remain employed.
The National Center for American Indians with Disabilities (NCAID) is hopeful that those AI/ANs with disabilities who use the IHS system will not lose the desperately needed long-term supports funded by Medicaid. The hope is also that those who live outside an IHS service area will not be forced into institutions. There is a danger that IHS will be stretched beyond its already meager funding capacity in order to serve AI/ANs who may be forced to move into an IHS service area to receive services.
NCAID urges Congress to fulfill its trust responsibility to the most vulnerable members of an already vulnerable population. AI/ANs with disabilities deserve a life of self-reliance, dignity, and self-respect.
Cinda Hughes is the executive director of the National Center for American Indians with Disabilities, the only national tribal organization solely dedicated to the needs of all Indians with disabilities. She is an enrolled member of the Kiowa Tribe who has lived with a severe disability since birth. Please email [email protected] for more information.
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