Medicaid Options Available to American Indian/Alaska Native Members

The unique status of American Indian and Alaska Native (AI/AN) tribes as independent tribal nations give AI/AN AHCCCS members access to multiple programs, including: the American Indian Health Program (AIHP), the American Indian Medical Home (AIMH) Program, Tribal Arizona Long Term Care System (Tribal ALTCS), and the Tribal Regional Behavioral Health Authorities (TRBHAs). 

Federal Medicaid law requires that AI/AN members have the “freedom of choice” to enroll in either managed care health plans or a Fee-For- Service (FFS) health plan. The American Indian Health Program (AIHP) is a statewide, integrated program that covers physical, behavioral, and Children’s Rehabilitation Services, serving more than 117,000 AI/AN members as of October 2019. Those who choose AIHP may see any AHCCCS registered provider that serves FFS members. Additionally, AI/AN members have the choice to switch between managed care and FFS at any time. 

The American Indian Medical Home (AIMH) Program is a care management model that puts AHCCCS members enrolled in the American Indian Health Program at the forefront of care. The AIMH Program supports qualified Indian Health Service (IHS) and Tribal 638 facilities in the provision of Primary Care Case Management, diabetes education, and care coordination for AIHP enrolled members. By enhancing  case management and care coordination, and providing 24 hour access to a care team, the AIMH program aims to help address health disparities between AI/AN and other populations in Arizona. Currently, there are six AIMHs throughout the state, including: Chinle Comprehensive Health Care Facility, Phoenix Indian Medical Center, Whiteriver Indian Hospital, Winslow Indian Health Care Center, San Carlos Apache Healthcare, and Fort Yuma Indian Health Center. To date, nearly one in five AIHP members are enrolled in an AIMH. The AIMH Program is the first of its kind in the nation, created through a robust partnership between AHCCCS, IHS and tribal leadership.

The Arizona Long Term Care System (ALTCS) is an integrated health plan for people who are elderly and/or physically disabled who require an institutional level of care. Tribal ALTCS provides the same medicaid services as ALTCS, but specifically to AI/AN populations. In order to deliver care through Tribal ALTCS, AHCCCS works in partnership with seven tribes and one urban American Indian Health Center. This partnership is formed by an Intergovernmental Agreement between AHCCCS and some tribal nations to provide long term care case management services. Payment for Long Term Care Services are paid at the Fee for Service (FFS) rate and reimbursed through AHCCCS FFS System.

Tribal Regional Behavioral Health Authorities (TRBHAs) are Tribal entities that have an Intergovernmental Agreement with AHCCCS Administration for the provision of behavioral health services to AI/AN members. There are five TRBHAs across the state that serve members according to tribal affiliation and geographic location: Colorado River Indian Tribe, Gila River, Navajo, Pascua Yaqui, and White Mountain Apache. Approximately 64,000 AHCCCS members are currently enrolled with a TRBHA. While TRBHAs are responsible for coordinating care for the enrolled members, members may access any AHCCCS registered provider for behavioral health care and are eligible for all AHCCCS covered behavioral health services. 

The robust services available to AI/AN members are designed to address health disparities across tribal nations and boost positive health outcomes, while respecting tribal sovereignty. AHCCCS coordinates closely with the tribal nations on administering AI/AN specific programs. 

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Project AWARE Welcomes Dr. Christine Stein

Dr. Christine Stein recently joined the Arizona Project AWARE team as Co-Coordinator and Suicide Prevention Specialist with AHCCCS. Christine has a master’s degree in public health and a doctorate in social policy. She brings considerable experience planning, implementing, and evaluating health and wellness programs and services, as well as experience working with schools, tribal communities, non-profit organizations, and government agencies.

Christine is welcomed to the team by other Project AWARE staff at both the Department of Education and the Arizona Health Care Cost Containment System. The AWARE grant is managed through a partnership between the two state agencies. For more information about Project AWARE,
visit: http://www.azed.gov/shs/projectaware/

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The Role of Tribal Consultations at AHCCCS

American Indian tribes have historically been recognized as inherent sovereign nations by the federal government – a distinction that arises out of the unique political relationship between the United States and Indian tribes and is the basis for the work of Tribal Relations at state and federal agencies. While each tribe has independent governmental structures and programs serving their citizens, there are also federal and state programs that serve American Indians and require coordinated efforts between tribal, state, and federal entities.

AHCCCS recognizes our responsibility, as a state-federal Medicaid program, in upholding the sovereignty of tribes in forming our policies and programming. AHCCCS engages in quarterly tribal consultation meetings to receive feedback and guide discussion on these important topics. Our agency is entrusted with providing a space where AHCCCS leadership, tribes, Indian Health Service facilities, and Urban Indian Health Programs, engage in open, continuous, and meaningful consultation on a government-to-government basis.

Tribal consultations are an important way in which AHCCCS receives input from tribal leaders, stakeholders, and community members prior to implementing program changes or policies that impact AHCCCS-enrolled tribal members. The tribal consultation process is guided by the AHCCCS Tribal Consultation Policy and complies with Arizona Revised Statute 41-2051 Section C, which is meant to ensure that there is ongoing information exchange and mutual understanding between tribes and AHCCCS which leads to informed decision-making. Topics of discussion at each tribal consultation meeting includes any State Plan Amendments, State Waiver updates, and routine cross-division updates.  [Include with Source Article: Agency staff who wish to be included on the agenda or invite list for future tribal consultations should reach out to AHCCCS Tribal Liaison, Amanda Bahe for coordination.] AHCCCS Tribal Consultation locations are alternated between the Central AHCCCS office in Phoenix, statewide tribal nation lands, and partner IHS and Urban Indian health program locations. 

For more information on the AHCCCS Tribal Consultation Policy and Process, and 2020 dates and locations, visit the AHCCCS Tribal Consultation page.

Amanda Bahe, AHCCCS Tribal Liaison, is the point of contact for any questions related to the AHCCCS Tribal Consultation process. She can be reached at Amanda.Bahe@azahcccs.gov.

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