The News and Updates page will highlight various measures. To see a complete list of all legislative action and for more details on the bills below, visit the State Tribal Legislative Tracking Database.
Medicaid Reimbursement Changes for American Indians and Alaska Natives
The Center for Medicaid and Medicare Services made a policy change expanding Medicaid reimbursement to 100 percent for all American Indians and Alaska Natives. Prior to this change, states shared the costs for low-income American Indians and Alaska Natives who were not able to receive complete services through the Indian Health Services or tribal facilities. Those services included primary care for American Indians/Alaska Natives that did not have access to an IHS or a tribal facility or for those that required certain types of specialty care.
The change is expected to relieve states’ portion of the burden for coverage to low-income American Indians and Alaska Natives. In a letter from CMS issued to state health officials, “IHS/Tribal facilities may enter into care coordination agreements with non-IHS/Tribal providers to furnish certain services for their patients who are AI/AN Medicaid beneficiaries, and the amounts paid by the state for services requested by facility practitioners in accordance with those agreements would be eligible for the enhanced federal matching authorized under section 1905(b) of the Social Security Act at a rate of 100 percent.”
The policy change took effect in March, CMS is expected to issue additional guidance to states and tribal facilities in the coming months.
State and Tribal Energy-Opportunities for Collaboration
States and tribal nations are dealing with changing energy policies that go beyond cost and energy supply and demand. Today’s energy policy encompasses efficiency, economic development, job creation, energy independence, security and sustainability.
As state legislators and tribal nations develop energy policies, they consider the balance of costs and the benefits of various energy resources, whether renewable (such as wind and solar) or non-renewable (fossil fuels, including oil, gas and coal).
In some cases, states can work collaboratively with tribes to meet demanding energy needs. For example, the Shakopee Mdewakanton Sioux Community in Minnesota developed Koda Energy, incorporating biomass technology to generate electricity.
A blend of agricultural and plant seed byproducts, such as wood chips, oat hulls, malt byproducts, sawdust and ground-up wood pallets, are burned to create steam that generates electricity. Koda Energy supplies heat and power to the community and then sells excess electricity. This project helped the state reach renewable energy goals and offset growing energy demands.
In 2015, 14 states considered 44 measures related to state-tribal environment, land and natural resources, according to NCSL’s State-Tribal Legislative Database. In Montana, legislators enacted a bill approving and reauthorizing renewable resource projects and renewable resource loans for which tribes may apply. Notification of the Act was sent to all seven federally recognized tribes in the state.
When it comes to energy development on tribal lands, federal environmental laws generally apply to Indian lands and the federal government approves non-Indian use of Indian lands. Although state tax laws do not apply to tribal land or members on it, states do have the authority to collect taxes from non-tribal companies that work with tribes on energy projects on tribal lands. While this structure can impose conflicts, it can also create opportunities for states and tribes to establish mutually beneficial agreements for tax collection. For example, this year, North Dakota enacted a bill that provides legislative confirmation of state-tribal tax collection agreements and provides clarification for the governor to enter separate agreements relating to taxation and regulation of oil and gas exploration and production within the boundaries of the Fort Berthold Reservation, Standing Rock Sioux Tribe Reservation, or Turtle Mountain Band of Chippewa Indians Reservation and on trust properties outside reservation boundaries.
To address the evolving energy situation on tribal lands, NCSL will host a National Tribal Energy Summit, Sept. 23-25, in Washington, D.C., that will give tribes, states and federal officials’ opportunities to discuss energy priorities. Meeting attendees will have the chance to establish common goals and share best practices around increased energy innovation and technology deployment on tribal lands.
Did you know?
- Coal provides 39 percent of the nation’s electric power through coal-fired power plants.
- Natural Gas supplies 27 percent of U.S. electricity.
- Nuclear Power provides 19 percent of U.S. energy.
- Renewable Energy such as biomass, geothermal, solar and wind supply seven percent of electricity in the U.S.
Source: U.S. Energy Information Administration, 2014
Medicaid Expansion- A Growing Conversation in Indian Country
American Indians and Alaska Natives have a unique interest in Medicaid expansion under the Affordable Care Act.
Although most Native Americans receive health care from the Indian Health Service (IHS), a tribal program or an urban Indian health program, these facilities need improvements and often do not receive full reimbursement for the services provided. In addition, access to facilities and specialty care can be challenging for tribal members.
As a result, tribal members and leaders are reaching out to their state legislatures in states that have not expanded Medicaid. They are doing so because Medicaid expansion can provide more coverage options and increase revenue to service sites. Tribal members can still file for exemption from the individual tax penalty associated with the ACA whether or not the state expands.
In Montana, the Little Shell Tribe of Chippewa Indians, a state recognized tribe, urged policymakers to consider expanding Medicaid during a State of Tribal Nations address at the state capitol. If expanded, Medicaid could increase revenue to Indian health services by providing third party payments that support direct care and contract services. Montana lawmakers are introducing a series of bills related to health care coverage for the low-income and disabled residents, but do not plan to expand Medicaid as defined under the ACA.
In Wyoming, members of the Northern Arapahoe Tribe spoke in support of Medicaid expansion during the public testimony hearing for the Senate Labor, Health and Social Services Committee. However, this week, Wyoming Senators voted against Medicaid expansion, leading to House versions being pulled.
While Oklahoma lawmakers remain opposed to Medicaid expansion, some tribes are supporting the expansion of a federal Medicaid waiver. The state’s pre-ACA program, Insure Oklahoma, which operates under a federal Medicaid waiver, provides cost-sharing coverage to the state’s low-income residents but is set to expire at the end of this year. The expanded version of the waiver that includes tribal members could potentially provide coverage to an estimated 80,000 Native Americans in the state who are currently not insured, according the Oklahoma Health Care Authority.