1. Northwest Portland Area Indian Health Board Quarterly Meeting Skagit Valley Resort & Casino October 17, 2012

2. Establishment of the Lummi Nation Health & Wellness Reform Task Force

3. Purpose of the Task Force Secure the maximum benefit available from the National Health Reform Initiative consistent with Lummi members health care needs. To Seek Benefits including: –Expansion of health care services to all Tribal members Elimination of the barrier of income to accessing health care consistent with identified need. –Establishment of Disease Prevention and Health Promotion Programs & Services.

4. Development of the Strategic Plan Evaluate Costs Determine population by collecting data from Clinic & Behavioral Health Systems Work with State to determine number and level of service provided to Lummi children, pregnant women, parents, seniors and individuals with disabilities. Identify and Estimate the cost of the uninsured Tribal Members Review and analyze all aspects of health care provided by the Lummi Government Pursue Formal Accreditation including Public Health

5. Community Involvement Coordinate Lummi Community Listening Sessions Identify Lummi Nations Health Reform Public Education needs. Gather public comments about Lummi Nation Health Care Systems Plan for community review of the draft strategic plan as developed. Identify the need for community involvement in annual performance evaluation.

6. Task Force Membership Two (2) Members of the Lummi Indian Business Council (LIBC) Three (3) Members of the Health and Family Services Commission Tribal Health and Family Services Administration, Managers and Staff Support Staff – From Lummi Nation Treasurers Division

7. Lummi Nation Health System Overview Lummi Nation Health Systems Service Entities Ambulatory Health Clinic – Physical and Dental Health Services Contract Health Care – Referred Care – Hospitalization, Hospice, Physical, Occupational and Speech Therapy, Oral Surgeon, Orthodontics, optometrists. Specialty Clinics, Geriatrics, Diabetic, STD Awareness Behavioral Heath Division – Mental Health, Substance Abuse Lummi Nation Self-Funded Employee Health Insurance Plan

8. Lummi Nation Schools Head Start and Day Care Center Little Bear Creek Senior Living Center Youth Academy Residential Services Se-Ye-Chen Youth Home Self-Funded Employee Health Insurance Plan -1200 employees of Tribal government, College and Enterprises. Lummi Nation Health Outreach Services

9. Tribal Members & Health Care Insurance Coverage *Members of Federally Recognized Tribes who have had Health Services appointments at LNTHC in the last three years **CHS Eligible – Patients whose assessment determined that no other sources of payment for medically necessary health care is available. Patient Descriptions PercentageStatusNumber *Eligible Patients100%All Eligible Patients 6,016 **CHS Eligible53%100% of CHS3,217 CHS Eligible88%Lummi Nation2,820 Total CHS Lummi & Non-Lummi40%No Insurance2,427 Lummi & Non-Lummi34%Medicaid2,040 Lummi & Non-Lummi29%Private Insurance1,739

10. Lummi Nation Health System Lummi Nation Health Care System Cultural &Traditional Knowledge and Practices Current Clinical, Behavioral Health, Rehab & Recovery Services Disease Prevention and Health Promotion

11. Development of Lummi Nation Health Services and Care System Strategic Plan Strategic Plan Completion Strategic Plan Implementation HealthCare Service Needs Health Care Resources LIBCLNHC LNHRTF Lummi Nation Comprehensive Health Care System Strategic Plan Development

12. Lummi Planning Assumptions Critical planning assumptions Most Lummi Tribal members will be eligible for subsidized health care insurance through the Federally Mandated/State operated Health Insurance Benefit. Most Lummi Tribal members will not see the need to secure additional health care insurance at their own expense. Most Lummi Tribal members would not be able to compare plan services and costs and select one. Most Lummi Tribal members will not be aware of their rights provided by the ACA, which incudes the following: Limits individual tax penalties, co-pays to persons over 300% of FPL, Prohibits managed care plans, more than monthly enrollment periods Allows the I/T/U system billing of Qualified Health Plans for services provided to Tribal participants.

13. Identifying/Tracking Income Lummi Nation will need to add income as a major component in their health planning activities. Lummi needs to track tribal member income ranges in order to successfully mange their health care cost recovery activities. Tribal Enrollment status is still critical but other categorical qualifications have been eliminated. Lummi will need to develop the capability to move tribal members from Medicaid (0 to 133% of FPL) to subsidized insurance (134% of FPL to 300% of FPL) without interrupting Health Services - based on their income as a percentage of the Federal Poverty Levels.

14. Tribal/State/Federal Development Coordination Lummi Nation is involved, at the federal level, through CMS TTAG and at the state level, through the Washington State American Indian Health Commission. H.B. 2319 Washington State law authorizing the development of the State Health Benefit Exchange requires Tribal consultation. Lummi Nation is concerned that State Exchanges will not support waivers & prohibitions provided to Indians in the ACA Tribal Leaders know the Federal government will create the Health exchange plans in several states. Unanswered questions – Affordability of Employer Plans & Spouse & Dependents Coverage Coverage of incarcerated individuals. Requiring Qualified Health Plans to contract with Tribal Health Systems as Providers.

15. Qualified Health Plans (QHPs) Lummi Nation is interested in participating in Qualified Health Plans as a provider of Health Care Services. All Tribes must be able to participate as providers in approved qualified health plans. Tribal leaders have tried to get federal regulators to identify Federally funded health care services as essential community service providers but have not been successful. Federal regulators have stated that they will review closely how the plans incorporate members of the I/T/U services systems.

16. Lummi Strategic Plan Component Assumptions Tribes must have the option of sponsoring Tribal members as insurance customers of Qualified Health Plans. Coordinate Develop and Implement a Plan of how to utilize benefits coordinators to get people enrolled or determine eligibility for a plan Special provisions and rights of tribal members will not be part of Navigator programs designed to assist the general public. Tribal members will expect Tribe to provide this level of assistance. Lummi Nation will have to collect and protect income information from its membership.

17. Questions or Comments?

18. CONTACT INFORMATION: Cheryl Sanders – CherylLS@lummi-nsn.gov Maureen R. Kinley – MaureenK@lummi-nsn.gov Jerry Folsom – JerryF@lummi-nsn.gov