Tribal Arts
  •  Innovation CMMI grants.
  • Minnesota received a $45 million CMMI grant and offered minigrants to Tribes (however none applied).
  • Oregon received up to $45 million

  • How Many Uninsured WA AIANs in 2012-13?  Well there are about....
  • 46,600 uninsured (ACS 2013)
  • 44,000 uninsured (ACS 2012)
  • These are estimates from American Community Survey (likely within margin of error for both years, i.e., no difference)

  • 19,000-20,000 uninsured Medicaid eligible 
  • The goal ---make 20,000 uninsured Medicaid eligible AIANs NEWLY INSURED in  2014

  •  12,310 newly insured AIAN in Medicaid 
  • 8,000-10,000 remaining uninsured eligibles; 
  • many who ARE INSURED are also MEDICAID eligible-perhaps another 10,000 AIANs
Income distribution of uninsured in Washington
OR and WA comparative analysis
  • Will it reach the 20,000 AIANs potentially eligible in 2014? 
  • An estimated 10,000 uninsured will be newly eligible for Medicaid/Apple Health in 2014; 
  • perhaps 10,000 are currently eligible, but not enrolled in Medicaid. ACS reports 20,700 AIANs under 138% of FPL are uninsured.
  • 25% increase in eligibles likely in 2014 for AIANs
  • Washington Connecton  is a WebPortal to start the eligibility and enrollment process for Social Service Benefits.  Linked to Healthplanfinder.
Apple Health​
Washington's Medicaid Program
  • Letters of Support for Uniform Definition of Indian
KFF FACT Medicaid Fact Sheet Compare OR and WA
Regional Variation in WA Uninsured AIAN 
Large error rates(in excess of 25%) are likely.
  • GAO report (9-2013) says 2.3 million Washingtonians potentially eligible for Medicaid January 1,2014, 1.2 million more than currently enrolled.
See August 2013 Medicaid Expansion report at Kaiser Family Foundation with Urban Institute for benefit of 50 state and District  expansion
Explanation of these Medicaid expansion estimates (made in 2011) are in  Health Care Reform:  Tracking Tribal, Federal,and State Implementation
  • GAO report (9-2013) says 2.2 million Washingtonians potentially eligible for Medicaid.
  • However, most have private insurance through their employer so this estimate is both accurate and misleading.
12 WA Regional Estimates of Uninsured AIANs
  • 2011 Estimate of Likely New Medicaid/CHIP Enrollment in 2014 for American Indians and Alaska Natives.  CMS 2011 Report: page 23.
Tribes who started October 1, 2013 with effective eligibility determination capacity saw immediate increases in Medicaid Payments, January, 2014 and large increases in payments compared to 2013 levels in first six months of 2014.
Latest Insurance Coverage Estimates for American Indians and Alaska Natives, compiled by Ed Fox, 2014.
 American Indian Health Commission
for updated information and calendar.
Medicaid Payments to Indian Health Programs ( for American Indians and Alaska Natives and Non-Indians)
Medicaid Payments to Indian Health Programs 
Per Person Spending
  • Medicaid Payments for AIANs had been stable for 6 years; then an increase of over 25% in 2014.
  • Source of Data:  Washington Health Care Authority Annual reports 2007-2013 received annually by tribes requesting reports.  Reporting has changed since 2014 implementation of the Affordable Care Act.
Most WA Indian Health Programs serve primarily AIANs (85% AIAN average for all tribes), but 3 are majority Non-Indian.  
These amounts include pharmacy and other special payments,i.e., more than claims paid data.
These amounts include pharmacy and other special payments,i.e., more than claims paid data.
  • 2014 Medicaid
  • 18,000 AIAN s with Medicaid are patients of IHS or Tribal Health Programs.
  • 2,000+ are patients of Urban Indian programs.
  • 15,000+ AIANs with Medicaid are not.
Pharmacy, meaningful use, and some other payments not included here.
SFY 2013 Medicaid Payments to WA I/T/U
2016 Enrollment report:  47,200  AIANs have used exchange to enroll in MAGI Medicaid.
2015 WA Medicaid report
Suggested Citation: Health Care Reform for American Indians and Alaska Natives, Ed Fox, 2016 Website.
Free and unlimited use granted with citation (suggested citation above).
edfox_phd@yahoo.com  
Financing Indian Health Programs in Washington State:  Sources of Funds for Reservation-based Programs that serve both Indians and Non-Indians.  November 2016. See spreadsheet on 2013 Medicaid payments to Indian programs for Indians and Non-Indians.
2015 ACS estimates 
Portland Area Medicaid by IHS 
Two ways to determine the level of Medicaid enrollment and payments:

1.  Claims data-actual payments made and enrollment in state-maintained Medicaid Management Information System-ProviderOne in Washington.
2.  Survey estimates, with only the American Community Survey able to produce AIAN estimates.

1.  Claims data also allows tribal reports for patients by tribe and Indian or Non-Indian.