Ready for Reform!

1. Ready for Reform! Port Gamble S’Klallam Tribe May 5, 2014 Tribal Self-Governance Conference Washington State on the pleasant side of the Puget Sound on the Kitsap Peninsula with treaty rights stretching to the Olympic Peninsula, the Pacific Ocean and Canada

2. Tribal Sponsorship of health insurance • One key aspect of health care reform will allow tribes to pay premiums for the health care insurance of its community members. • The Port Gamble S'Klallam Tribe has many years of experience in doing just that through the Basic Health Plan and Medicare Part B and D. • We assist tribal members in understanding their choices for Medicare Part D and Medicaid. • Over 10 years of ‘sponsorship’ of experience assisting individuals and families and that may continue under the health exchange’s Qualified Health Plans-especially if those plans allow our health program to be the medical home for our patients in their plans (hopefully with referrals to their network of providers).

3. Tribal Sponsorship Program • Vision of the Program: To Connect Tribal Members and their families to the health insurance coverage that is most appropriate for them and the health services department program. • We use tribal or community members to do enrollments as part of our CHS / Purchased Referred Care program • Work with our PRC/CHS funding to pay for insurance, pay for cost sharing, buy specialist care. • Work with the State Medicaid Program, Apple Health-now as large as our Indian Health Service Funding. • We encourage all community members to work with us as they make decisions with us on how to compare, combine, and choose all the options available to them. Come to us for assistance.

4. Alignment with 2 Key elements of Health Care Reform • Medicaid Expansion • We have enrolled 250 in Medicaid (since November 7) • Health Insurance Exchange • We have enrolled 20 in Qualified Health Plans in Washington’s states’ Healthplanfinder. • Washington’s exchange is one of the best in the nation, but there have been challenges • Some tribes have been stymied in training application assisters and only about 200 QHP’s have been sponsored by tribes.

5. Key Income Level is 300% FPL Bronze level has lowestrates No deductibles No copays AIANs eligible for Exchange who under 300% on average save over $2,000 with Bronze plan Bronze is cheaper because for non enrolled tribal members there is higher cost sharing

7. Eligibility for Sponsorship • 1. Currently CHS eligible • 2. Eligible for Tax Credits in the Exchange/Marketplace • 3. Under 300% of federal poverty level-now that we’ve past open enrollment we buy only if there is no cost sharing. • We expect to buy $32,000 of insurance for 40-50 uninsured, CHS eligibles, who are under 300% FPL. • We expect $40,000 to $50,000 will be paid to us for their care and another $229,000 to $286,000 will be paid by health plans to specialists and hospitals.

8. Washington State QHPs

10. Revenue Increases; March, 2013 to March 2014

11. Increased insurance has resulted in increased revenue

12. 6 Elements of Port Gamble S’Klallam Tribe’s readiness • Staffing: Support current, monitor need for additional • Outreach and Education on Health Care reform tied to our Eligibility and Enrollment capacity • Make the Accounting system produce needed information for decision making-which option--- buy insurance or buy ‘risk’ • Continue to pay for health insurance and prepare for expansion of sponsorship • Work with other Tribes through other organizations; we have shared our policies and procedures with other tribes including the Quinault Nation, Coeur d’Alene Tribe, Muckleshoot Tribe, Nisqually Tribe and Lummi Nation.

13. Ready for Reform Initiative began 27 months ago, February 1, 2012.