Tribal-Call-Center

  • State exchanges have their 'own' training and many use healthcare.gov.  

  • This site does not have the latest information.

  • Medicaid Training
Outreach, Eligibility and Enrollment Training,
Navigators, Certified Application Counselors, In-person Assisters
  • CMS Outreach and Education
  • Outreach and enrollment resources: 

  • Insurekidsnow is another, by the Department of Health and Human Services.  
  • Service Centers / Call Centers

  • Every state will have a service center to supplement the outreach and enrollment function to maximize enrollment in Medicaid and Exchange health plans, answer questions about health plans and webportal application process, receive and process complaints and provide positive feedback to operations. 
  • There are several reasons to expect a large role for application assisters in 2014 for AIANs:
  • 1.  Reluctance stemming from feeling that there is a treaty obligation for health care services
  • 2.  Stigma in applying for means tested program
  • 3.  Complexity resulting from special provsions in the ACA for AIANs-even though beneficial.
  • 4.  Special IRS and treaty required treatment of income for AIANs.
  • 5.  Desire to use Indian health program.
  • 6.  Reluctance to buy insurance from Managed Care Organizations (QHPs) with no clear understanding of how these Carriers and their health plans will utilize Indian Health Programs.  
  • Outreach-inform about the health insurance opportunity 
  • Enrollment-determine eligibility, choose a health plan, and enroll
  • Customer service, answer questions, complaints about qualified health plans.

  • O and E goal, for health exchanges, is to connect coverage opportunities through the affordability programs(Medicaid or subsidies) offered by health insurance exchanges, federal, partnership, or state.

  • Knowledgeable people, trusted and known by Tribes, will be the best to provide outreach on the ACA and its impact on Tribes and urban Indians.

  • Although states will have to be responsive to many unique populations, none have more special provisions in the ACA than AIANs(see also NPAIHB's summary).
  • Navigators
  • Navigators support the outreach and enrollment for health insurance exchange health plans.
  • Development of Navigator programs with federal funds
  • No federal funds for ongoing cost of Navigator programs
  • Tribes' status as governments and health and social service providers is an opportunity for effective outreach programs since tribes operate both health and social service programs with multiple 'touch points' to connect to the very population health care reform wants to reach.
  • Certfied Appication Assisters, In-person Assisters and Navigators should receive support from Call Centers staff with Indian expertise and understanding who serve as Indian liaisons or an established Indian desk.  
  • Who can best convince eligible AIANs to enroll? 
  • What financing is available?
  • Tribal/ Urban Navigator Training 
  • AIAN program Navigator training Add-ons:
  • Cultural Competency
  • Indian Provisions-in depth
  • Indian income 
  • Tribal Sponsorship
  • Website for the Tribal Outreach and Education Consortium, TEOC, has training materials
  • NIHB is the leading Indian Health Organization monitoring health care reform. It is a partner with NCAI to "Tribalhealthcare.org" a good place to get a 'primer' on health care reform and informational materials is their  health care reform website
  • The American Indian Health Commission will provide technical assistance, not as a Lead Agency, but including training
  • Navigators support outreach and enrollment for health insurance exchange health plans.
  • Outreach 101 (8-15-2013) is Enroll America's brief guide based on Oregon's outreach for its Healthy Kids Children's Health Insurance Program outreach.
  • CMS Navigators and other Assistance Programs, May 2013.
  • Washington's assisters training see AIHC website for training information.


  • The Best Outreach is undermined if Eligibility Determination Training is neglected
  • As 2014 began many Tribes were unaware of their role in determining eligibility for coverage and all exchanges underestimated the complexity of the process for AIANs.
  • Training improvements should be based on first year experience.

  • Assisters should not be 'overtrained' and confused by all the details of health care reform or many of the details not  germane to determining eligibility.  Larger tribes should invest in full-time benefits counselors (perhaps over 2,500 user pop size), but smaller tribes should not.  CHS/Business office staff are likely candidates for cross-training to determine eligibility for Medicaid.
  • Tribal Assister designation should be examined to determine if it is a 'temporary' start up position or a permanent one (very expensive option).
  • Once exchange websites fully integrate Indian provisions Tribes should not assume tribal members can't enroll themselves or re-certify existing Medicaid enrollment.  

  • CMS Marketplace - links to assister training-federal & supported state exchanges
  • State exchanges have their 'own' training.
  • Set Goals based on number eligible for Medicaid or Marketplace Plans-see Census for ACS data.
  • Washington leads the nation in financial support for tribal outreach and enrollment with over $1.5 million in contracts and grants to Tribes and the American Indian Health Commission for Washington State.
  • Lessons from Tribes, IHS, and Urban Programs Outreach and Education 
Suggested Citation: Website,  Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2014
105 Maple Park Ave SE Olympia,WA 98501
Free and unlimited use granted, citation appreciated
edfox_phd@yahoo.com  360 790 1164
Free and unlimited use granted, citation appreciated
These charts depicts the % of total AIAN uninsured in two key age categories 19-34, 35-64
Resource Guide, Income and Exemptions
 September 29, 2014
  • Outreach and enrollment resources:
CBPP series:  Beyond the Basics