Ellen Thompson
Havre Daily News
ethompson@havredailynews.com
ROCKY BOY'S INDIAN RESERVATION - The Rocky Boy tribal council has decided to return a reservation health care program it can't afford to operate back to federal control - the first self-governing tribe to do so.
The change is bound to mean less funding for doctor's visits, hospital care and other medical services not offered on the reservation, officials said.
"I don't think we have failed. Congress just didn't provide enough money," council member and Rocky Boy Health Board co-chair Brian "Kelly" Eagleman said at a meeting held Thursday night to explain the change. About 40 people attended.
"It is hard to let go of something we worked so hard to get," Eagleman said later.
Contract Health Services is responsible for administering and paying for medical services tribal members receive off the reservation when they go because of an approved referral. CHS is meant only to fund health care if there is no third party payer - Medicaid, Medicare or private insurance.
Council member and Health Board co-chair Jonathan Windy Boy said only about 20 percent of tribal members are on Medicaid or Medicare and few have private insurance.
The tribe has accumulated a $1.7 million debt operating the program after exhausting a $5 million reserve in the decade since it took on the program, Windy Boy said. He and Eagleman said they don't know how the tribe will cover the debt.
When the tribe first took over the program in 1995, it received $2.1 million from the federal government to operate CHS, Health Board chief executive officer Dr. James Eastlick said. Last year the tribe received $2.8 million. The increase in funding over 10 years did not keep up with an increase in the tribe's population, inflation or rising health costs that have outpaced inflation, Eastlick said.
The problem is not just at Rocky Boy, it's happening all over the state and all over the country, Billings Area IHS director Pete Conway said.
"I believe this in my heart, that the Indian Health Service and the federal government owe 100 percent" for off-reservation health care costs, he said. "We're not there yet."
In fact, Conway said, the federal government funds about half the need nationwide. The Billings area office has the second highest incidence of disease among the populations IHS provides health care for, and CHS is the biggest need among the communities the Billings office works with, he said.
The Chippewa Cree Tribe took over all health care programs in 1995 through an agreement with the federal government when it became a self-governing tribe. Rocky Boy is one of two self-governing tribes in Montana.
The tribe will return Contract Health Services to the control of Indian Health Services on Oct. 1. The tribe has until then to change its mind, as it can do any time after the federal government takes over the program.
The council is working on ways to avoid returning the program, including an effort with the state and federal government to enroll more tribal members in Medicaid and Medicare, and is asking for a bailout from Congress, but in the short term, the chances the turnover can be forestalled are "slim," Eagleman said.
"Are we going to create more red tape for our people to get outside health services," Suzanne Billy asked from the audience. "I know this process, from a personal experience, can take up to five months. Will this take longer?"
The answer Billy received from IHS representatives was yes.
Billings Area IHS associate director Garfield Little Light said the turnover could mean an extra hurdle when tribal members try to get referrals to doctors outside the reservation, especially because there will be two layers of administration.
Rocky Boy will still be running all health programs other than Contract Health Services, which could mean referrals will have to pass from the clinic to the Billings office of IHS and then back to patients, Little Light said.
IHS will not be operating the program with any more funding than the tribe had, Conway said. The only possible benefit to IHS operating the program, Conway said, is that IHS sometimes has the ability to pool and transfer contract health funds.
It's more likely, Conway said, that less money will go to contract health once IHS takes over.
"Our job will be not to run a $1.7 million deficit," he said in an interview. "If we have $2.8 million available, and it's costing $4.5 million, our attempts will be to spend $2.8 million."
Already, only ailments that threaten "life or limb" are referred to specialists outside the Rocky Boy Health Clinic, Eastlick said.
Conway said IHS will use the strictest standard in deciding about referrals to limit costs.
Meanwhile, Eagleman said, the tribe is negotiating with IHS to see how much control it can maintain over who is referred.
The turnover will affect two positions funded at the Rocky Boy Health Clinic through the CHS program, Eastlick said.
Conway said IHS uses only federal employees to administer its programs and he said IHS and the tribe have not yet figured out what to do with the two positions.
Windy Boy is working on a pilot project to change the way Contract Health Services is funded. It involves asking Congress to cover the Rocky Boy and Flathead Indian reservations' shortfalls while both work on a program that will help more tribal members enroll in Medicaid and Medicare.
Windy Boy, who is a state representative, sponsored a bill adopted by the Legislature to begin the process by asking the state to study the possibility.
Anna Whiting Sorrell, policy adviser to Gov. Brian Schweitzer, said the study is under way.
Windy Boy said culture and geography are obstacles to Native Americans enrolling in federal health programs. He wants a tribal member to determine Medicaid and Medicare eligibility and help members through the application process.
Most people, anywhere, are turned down the first time, Windy Boy said, but tribal members are less likely to keep trying, especially if they have difficulty getting to a county seat and if English is their second language.
Sorrell said the governor's office has found that a Minnesota tribe has been authorized to determine Medicaid and Medicare eligibility because that tribe already operates another federal program, Temporary Assistance for Needy Families. The Rocky Boy, Flathead and Fort Belknap Indian reservations also have TANF offices, so they may also be able to operate a Medicaid and Medicare office, Sorrell said.
