At the 2023 Arizona State of Reform Health Policy Conference in October, two state leaders working in Tribal healthcare met to discuss current issues and initiatives within Tribal healthcare. Topics of discussion included challenges with bad actors and challenges with receiving healthcare.
Marcus Johnson, deputy director of community engagement and regulatory affairs at the Arizona Health Care Cost Containment System (AHCCCS), said the most obvious and top-of-mind initiative is reforming the fee-for-service American Indian Health Program. Johnson explained that when a Tribal member enters Medicaid, they have the option of going to a managed care organization or can be serviced through the American Indian Health Program.
“When you go into the American Indian Health Program, since its inception, you have been required to self-attest that you are Native, that you are of a Tribe. That was put into place to ensure that we didn’t have a ton of barriers at the front of our Tribal members, in order to access services through the American Indian Health Program,” Johnson said.
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Johnson said bad actors have entered and exploited the system by recruiting Tribal and even non-Tribal members into the fee-for-service program, and fraudulently billing against the Medicaid program. Johnson said these perpetrators take individuals from Phoenix and Tribal communities, pump them full of drugs and alcohol, put a roof over their heads, and advertise it as sober living.
To combat this fraud, Johnson said more robust infrastructure needs to be built within the American Indian Health Program. Enacting system changes, like meeting with Tribal partners and reframing the way they conduct Tribal consultations—like an open mic session—is a focus area, according to Johnson, who added that there have been over 350 suspensions to providers due to fraud.
Monica Antone, Lieutenant Governor of the Gila River Indian Community, spoke on the lack of access to Tribal healthcare services, specifically for more rural Tribal communities. She said each of the state’s seven Tribal districts has one service center made up of nurse representatives who can go out and distribute medications.
“Not all reservations of the 22 Tribes have that type of access, and that’s a disparity,” Antone said.
Johnson added that Tribal members who don’t have access to Medicaid or a commercial health plan are nearly three times more likely to experience morbidity and mortality from childbirth, and said simply getting members on a plan will reduce disparities. He said more one-on-one visits between AHCCCS and Tribal leadership are needed going forward.