1. Ready for Reform! Port Gamble S’Klallam Tribe 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 Kerstin Powell, Business Office Manager Port Gamble S’Klallam Tribe 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 Kerstin Powell, Business Office Manager

2. 2. Outreach, Eligibility and Enrollment Port Gamble S’Klallam Tribe Medicaid and Food Stamp Eligibility Pilot Project

3. Port Gamble S’Klallam History The Port Gamble S’Klallam Reservation is comprised of 1,341 acres, located on the northern end of the Kitsap Peninsula within Kitsap county of Washington State. The Tribe has over 1,045 enrolled tribal members of which approximately 350 are children (under age 18). About ½ live on the reservation. The majority of the rest live near the reservation.

4. Background The Tribe began discussions about eligibility determinations over 10 years ago. (Project was proposed to then Governor Locke in year 2000) The Tribe has been fortunate to have continued leadership that just didn’t give up through years of being ignored and discouraged The Tribe has a history of great success in providing many new services that enhance the quality of life of its members such as; Tribal TANF since October 1, 1998 Child Support since 2000 Tribal Foster Care since 2004

5. How/process It wasn’t until 2007 that the discussions between the State and the Tribe began to formulate into something that seemed it could become a reality. We began meeting regularly with State staff about the necessary steps for the Tribe to begin Eligibility determinations. The State had to apply for a waiver to FNS to allow the Tribe to determine food stamp eligibility. An Intergovernmental Agreement was signed on May 11, 2009. A five year pilot project started. No grants or monetary assistance received form the State for this pilot The tribe budgeted for two FTE to run the program

6. Tribal Staff were required to attend training 2-3 days per week for approximately 3 to 4 months while still performing their other work duties. It takes less time, about 6 to 8 weeks depending on the trainer’s schedule, if you can concentrate on just the training and not perform other job duties at the same time although it can be overwhelming Three health business office staff trained on the medical Three Children and Families/TANF staff trained on food stamps and medical eligibility Training & Cost

7. It is very helpful to have a designated trainer right at your facility and for ongoing assistance Costs include eligibility staff, computers, IT staff time to get access to all state programs We requested that an experienced support staff from the State be available to us a few days per week to assist staff as necessary After beginning training in Augusts 2009, on November 1, 2009 staff started determining eligibility for Family, Pregnancy and Children’s Medical In January 2010 staff started determining eligibility for Food Stamps and issuing EBT cards. Training & Cost Continued…

8. Eligibility Staff The Children and Families Department has two Tribal TANF staff that determine eligibility and provide other social services while a third person is designated just for eligibility Of the three in the Health business office, one is currently doing medical eligibility with a supervisor and one back up staff

9. Benefits to Tribal Members Tribal members can apply for and receive basic food benefits and medical coverage right here on the reservation saving a round trip of 70 miles to the local CSO (The tribe serves all Native Americans in the zip codes closest to the reservation) Tribal members can immediately replace a lost EBT card so they may access their benefits right away and not have to wait for a ride to Bremerton More tribal members apply for benefits because they are comfortable coming to tribal staff Low income families can access food stamps, medical and Tribal TANF all at the same time

10. Benefits to Tribal Members More families can provide healthy food for their children Families can get medical coverage right away when coming to the Tribal Clinic which lowers the Tribe’s costs The local DSHS CSO (Community Services Office) case manages any Non-Natives

11. How it helps The tribe is eligible to receive match dollars at 50% for Medicaid and 75% for Food Stamps Increased and faster access to Medicaid and Food Stamps for tribal members The tribal clinic can collect the Encounter Rate for Medicaid eligible visits that they in the past were not able to (waiting for the client to apply for Medicaid and eligibility to be processed by the State, eligibility not being backdated to cover prior medical care)

12. How it helps continued… Savings of Contract Health Services dollars with increased and faster eligibility for Medicaid Pregnant women applying for Medicaid sooner Tribe will have an opportunity to help tribal members have a Medical child support order established before the State does

13. Important Considerations It is important to train staff that expect to stay around for quite some time Those determining eligibility need to have excellent computer skills Must be detail oriented with good follow through especially to get backup documentation It is not just determining eligibility but working the case for mid- certs, and eligibility reviews, and getting more documentation, and cleaning up audits which is very labor intensive at first Tribal staff do not have the various levels of experienced workers you find in a CSO so they immediately get very complicated cases that a new financial worker in a state office would not see for perhaps a year.

14. Audits In the first year foodstamps and medical are 100% audited After the first year the foodstamps will still be audited monthly by the state’s process review panel after which those cases will be audited by the Feds just like every CSO

15. Who to contact Doug Porter, Assistant Secretary, Health and Recovery Services Administration, 360-725-1867 Jolene Sullivan, Port Gamble S’Klallam Tribe, 360-297-9636 Colleen Cawston, Indian Policy Support Services Director, DSHS, (360) 902-7816 Rebecca Henrie, Project Coordinator, ESA, DSHS 360-725-4615