|WA Health Care Authority |
|Basic ACA components|
|1. Health Care Reform|
|2. Medicaid Expansion|
|5. Premium Sponsorship |
|6. Outreach & Enroll|
|Often an afterthought |
|1. Urban Indians |
|2. Direct ServiceTribes|
|3. Community's View|
|4. Director's view|
|Census Data |
|A. 33 States Uninsured|
|B. Am Community Survey|
|State Reform, Exchanges|
|Colo, Utah & Nevada|
|MASS, ME, RI, CONN|
|Michigan & Wisconsin|
|ND, SD, Montana, WY|
|*AL, FL, LA, MS, NC, SC|
|*Iowa, Neb, Kansas|
|d. 33 State PPTs 2012|
Tribal Premium Sponsorship
- Generic Guidelines Policies developed by the Port Gamble S'Klallam Tribe for free and unlimited use/adaption by other large tribes for Premium Sponsorship Programs.
- Policies not recommended for smaller tribes.
- TPSP Program Began: July 1, 2013
- TPSP began its enrollment on Thursday, November 7, 2013.
- Covers CHS-eligibles who qualifiy for tax subsidies in exchange and are under 300% income level.
- Coverage Begins January 1, 2014.
- Fall 2012 Develop Initial Program proposal
- Present a draft proposal to council in January 2013.
- October 1, 2012 Health Care Reform Staff Meeting so staff can prepare for community input
- Februrary 2013 Community Mtg
- December 2012 Approve Budget for 2013
- January - March 2012 Develop Eligibility Guidelines
- June 2013 Approve Program (and budget)
- July 1, 2013 Program Launch Date
- July 1 to October 1 Community Members can review their eligibility, view options while they help the TSP program estimate costs.
- September 2013 Appointments for enrollment
- October-December 2013 Application Assistance
- January 2013 set aside $240,000 for proposed 2014 Health Insurance Trust Fund ($200,000 to $300,000) to be approved for 2014 budget.
- January 2014 Coverage Begins, first monthly payment ($30,000 to $75,000 ) to health insurance exchange.
- Monthly reports on Insurance payments to health program
- July, 2014 consider changes to eligibility based on revenues from new payors (insurance) and CHS savings. Estimate the cost of insuring any remaining uninsured community members.
Goal of the
Klallam Tribal Premium Sponsorship Program (KTPSP)
- Ensure that a Tribally-defined set of community members is 'connected' to the most appropriate coverage for their families.
- CHS program enhanced to provide more services for all CHS eligibles and those who may still not have health insurance in 2014.
- Added resources used to address Tribal Council's Priority Goal on Prevention
- It is likely in 2014 many more will have health insurance coverage, but some may not change anything and still depend on the clinic and CHS program without insurance coverage.
- Sign contracts with Exchange health plans so health program can be paid for services provided (using Indian Addendum)
- All tribal members and their families will have expert application assistance at their disposal beginning July 1, 2013 we can determine likely eligibles.
- Tribal financial support program will have certain conditions of participation (e.g., provide income and insurance information, agree to update, use our health services program).
- Enrollment in new health insurance coverage begins October 1, 2013 and actual coverage January 1, 2014.
- We needed to determine (we did not know) how many will be eligible for financial assistance from the Tribe for the purchase of health insurance but we will examine:
- 1. How many are uninsured patients of the clinic (100-200)
- 2. How many community members are uninsured, but not currently patients of the clinic
- 3. Who is underinsured-some coverage, but not the best value for what they or their employer are paying.
- 4. Who is paying too much (for example more than 10% of their income) for insurance.
- Estimates of the number of the above will be refined, but it is between 500 and 200, not the 200 and 500 persons originally estimated. This is the group who may receive financial assistance to become fully insured.
- What are the insurance options for the above....?
- 139% Medicaid threshold WA and OR and lower threshold for exchange plans and subsidies
- 300% upper limit for no-cost sharing for AIANs in exchange health plans
- 400% upper limit for subsidies and reduced rate insurance (for elders)
February 1, 2012 Ready for Reform Meeting with Washington Tribes (18 tribes, attendance 75)
October 1, 2012 Health Services Department Health Care Reform Meeting Agenda
Tribal Council, November 27, 2012 Sponsorship Update (w corrections)
- Sponsorship will cover all uninsured CHS-eligible and Exchange-eligible PGST tribal members (adults) under 300% of poverty because cost sharing exemptions make plan choice easy and very affordable and a great value (Children will be Apple Health/CHIP). A high value plan at the cost of the Bronze Plan.
- The sponsorship program considers the tribal employee health benefits in planning, but it operates separately from decisions on that program that are develop by Human Resources Dept.
- Don't Overestimate how many are eligible for your sponsorship program.
- Our first estimate was $425,288 in premiums for 195 'lives' in 125 families in 3 income categories and 3 different family sizes
- Second estimate $300,000 in premiums for 120, $500,000 for 180 if spouse of employees who are tribal members are included.
- After several more estimates we currently expect 50 to 75 eligible for the program with premium costs from $120,000 to $160,000 including $20,000 reserve for tax reconciliation.
- For families with both Indian and non-Indian family members CMS will require Qualified Health Plans (QHPs) to offer 2 separate Indian-specific plans for each plan offered in the Exchange.
- 2 plans but can look and feel like one plan depending on family's choice of plan.
- Premium Sponsorship Program approved by Port Gamble S'Klallam Tribal Council on May 25, 2013
- Program began November 7, 2013
- 60 patients gained health insurance by Nov 29 (1st week of December Healthplanfinder down most of the week)
- 6 will have insurance paid by tribe.
April 5, 2013 Community and Staff Pizza and Health Care Reform Meeting
- Tribal Premium Sponsorship Programs are the key to enrolling Tribal Community Members into Medicaid and Marketplace plans; without a TPSP it is unlikely AIANs will buy health insurance.
- See Keep it Simple page for basic information to plan a tribal premium sponsorship program for 2014.
- Select % of income (not dollars)
- Scroll below table results to "Bronze" to see premium cost (in the text)
This calculator gives you an estimate of how many of your program's CHS-eligibles are uninsured AND are under 300% of federal poverty level AND an estimate of premiums AND potential for payments for medical care.
May 9, 2013 Sponsorship Meeting, Seattle
- Since February 1, 2012 the Port Gamble S'Klallam Tribe has hosted meetings with other NW tribes, with community, council, and department staff.
- HHS reports on Premiums September 2013
- Port Gamble S'Klallam first two sponsored were young men with premiums of $28 per month and $98 per month.
Healthplanfinder list 3 QHPs that include the Port Gamble S'Klallam Health Programs as In-network providers (Good news, tribe is now contacting other plans to secure contracts with all
Suggested Citation: Website, Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2013
105 Maple Park Ave SE Olympia,WA 98501
Free and unlimited use granted, citation appreciated
firstname.lastname@example.org 360 790 1164
Free and unlimited use granted, citation appreciated
This Page updated December 7, 2013
Private insurance will cover our first sponsored tribal member who, like many other eligibles, is young, healthy and whose insurance is gained at very low cost to the tribe.
Tribal Premium Sponsorship Planning Website (2013)