American Indian and Alaska native children will not have to make a co-payment to receive medical care through the Children's Health Insurance Program. State officials hope that will increase their use of the program -- and open new doors to cooperation between the tribes and federal and local governments.
The Western Governor's Association and the U.S. Department of Health and Human Services announced Thursday that the two native groups would be exempt from the required co-payment. The exemption applies to health care received at Indian Health Services or tribal facilities."We're excited because there are a lot of firsts (in the agreement). This is the first time we've seen HHS respond to a problem that has gotten in the way of Indian health care," said Rod Betit, director of the state's Health Department and founder of the Western Summit on Indian Health Care, which recommended the co--payments be dropped. The governors' group unanimously approved such a resolution, proposed by Gov. Mike Leavitt and Arizona Gov. Jane Dee Hull. It was then sent on to HHS Secretary Donna Shalala.
"The Western governors and tribes worked effectively to agree on a policy change and get it done."
The agreement signals that, though federal and state governments and tribes sometimes butt heads over land, environmental and other issues, the agreement says the two can work effectively in terms of health issues. Maybe they'll work together on other issues, as well, Betit said.
Although American Indian children seem to have more health problems than other children in America, enrollment of American Indians in the Utah CHIP program has been minuscule compared with the number who qualify. While half of American Indian children in Utah could likely qualify, between 5 and 10 percent -- about 200 -- are enrolled. But the others are not necessarily getting their health care instead through Indian Health Service.
The only IHS clinic in Utah is at Fort Duchesne. So Betit said officials suspect that most American Indian children "have been cut off from any primary care or preventive services, when most of them should be enrolling in CHIP."
Some families have stayed away because they couldn't afford the co-payment. Gov. Mike Leavitt called the co-payment a "troublesome financial barrier." Others have said they feel the payment denies them the access to free health care that they were guaranteed under the trust responsibilities that the federal government negotiated, Betit said.
"It's beginning to send the message that for Indian kids, IHS is not the only program the feds are looking at to meet their needs. They can use others to their full potential to provide safety nets for those kids."
The exemption also means that individual governors won't have to try to negotiate such a copayment exclusion for American Indian kids in their state, while not for the other children, which "gets problematic," he said.
This also changes state and community health program's efforts "to go out and try to get Indian families to join without seeing it as a diminishment of their Indian Health rights," Betit said. "This is an extension of the IHS trust entitlement they have, which is a better message.
"This decision suggests that finally the stars are lining up and things are beginning to happen. The tribes can quit trying to find individual solutions for problems. This is a small pay off, hopefully followed by others in the not-too-distant future, said Betit.