1. NATIVE ELDER CAREGIVER CURRICULUM NECC: 3.2 HEALTH CARE SYSTEM Caring for Our Elders: Health Care System: Accessing Resources for Native Elders 3.2 1

2. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 2  “System” can be very confusing  Elders & Families have many questions about access  Who to go to?  Where to go?  How to pay?

3. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 3  Excuse me…Could you tell me how to access the health care system????

4. By Understanding a Piece at a Time… Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 4 Tribal Health County & State Social Services MedicaidMedicare Indian Health Services

5. Health Care System: Overview  I.H.S. (Indian Health Service)  Medical, public health nursing, dental care, pharmacy services  Hospital & Clinic access  No nursing homes  No defined system of long-term care 5 Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

6. Health Care System: Overview  I.H.S. (Indian Health Service)  Available services vary depending on: Federal Budget Alternative services Contract care partners Service Area 6 Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

7. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 7  Tribal CHR Program (Community Health Representatives)  “Vital Link” between health care system & community’s access to services  Services vary by Tribe: determined by Tribal leadership  Some CHR programs are very dedicated to eldercare services

8. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 8  Tribal CHR Program  Need to know each Tribe’s priorities for the CHR program in their community  Potential for CHR programs to improve health care access is an untapped resource !! Would be logical for CHRs to lead HCBS

9. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 9  Other Tribal Health-Related Programs  Access for all tribal members  Services vary Tribe to Tribe  Administered by Tribe directly  Variety of services dependent on available funding sources

10. Health System Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 10  Contract Health Services  Mechanism to purchase health-care services  Services that cannot be provided by I.H.S. or Tribal facilities

11. Health System Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 11  Contract Health Services  Person must be referred by I.H.S.  Eligibility is generally restricted to: those living on or near their home reservations students/dependents away at school  Because of limitations on funding Priorities given to “life-threatening” & “urgent” needs

12. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 12  Diabetes Programs IHS  Special Diabetes Program for Indians (SDPI) Administered by I.H.S. or Tribal Health Programs Programs designed to be specific to local Tribal needs

13. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 13  Diabetes Programs I.H.S.  I.H.S. Department of Diabetes Treatment & Prevention Clinical guidelines & public health approaches Research & training & technical support Develop educational materials

14. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 143) MEDICARE & MEDICAID* * with appreciation to the following resources: 1)Baldridge, Benson, Carlson & Redford: 2004 “Tribal Guide for Elder Care: A Primer on Long-Term Care Services & Financing for Indian Elders” 2)“Building Partnerships: CMS, States, Tribes & Aberdeen Area I.H.S.” 2009 CMS Medicare & Medicaid Training, Sioux Falls, SD June, 2009 3) Wallace, S.P., Satter, D.E., Zubiate, A. 2003 “Medicaid Home Care and Tribal Health Services”: A tool kit for developing new programs.

15. MEDICARE as Health Insurance Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 15  A few slides about “Medicare”…

16. Health Care System: Medicare Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 16  Medicare: FEDERAL program  People 65 years and older  People who are disabled  Based on a work history of the individual (or the individual’s spouse) that entitles them to Social Security benefits

17. Health Care System: Medicare Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 17  Medicare: Special “eligibility”  If not 65 years old yet & need services?  For knowing about special eligibility, it is best to visit with: Contract Health (CHS)  Contract Health Services at IHS IHS works with insurance eligibility and reimbursement issues full-time! Easy to visit with CHS in own community

18. Health Care System: Medicare Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 18 Medicare PART A Covers:  Hospitals for in-patient care  Including I.H.S. hospitals  Skilled Nursing homes  Home Health Care  Hospice Care  Blood transfusions

19. Health Care System: Medicare Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 19 Medicare PART B Covers:  Outpatient medical/surgical services  Medical supplies  Diagnostic tests  Outpatient therapies

20. Health Care System: Medicare Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 20 Medicare PART B Covers: (cont’d)  Hospital and clinics (including I.H.S.) for health care services from:  Doctors, nurse-midwives, clinical social workers, clinical psychologists, registered dieticians, physical therapists & occupational therapists

21. Health Care System: Medicare Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 21  Medicare PART B Services (cont’d)  Part B can also cover:  Outpatient Mental Health  Some Preventive Services  Other medical services

22. Health Care System: Medicare Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 22  Medicare PART C  A form of “managed care” insurance plan Not really applicable to Tribal communities

23. Health Care System: Medicare Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 23  Medicare PART D  Prescription Drug Coverage  Available to all people with Medicare eligibility  IHS is approved as a prescription drug provider Elders can get their medications from IHS

24. Health Care System: Medicare Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 24 Medicare Regulations for Home Health:  Must require “skilled” care in the home professional nurse, therapist skills, etc.  Must be “homebound”, but can go to: religious services an adult day care program clinic or hospital

25. Health Care System: Medicare Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 25 Medicare for Home Health  Will NOT be provided permanently  Will NOT cover Personal care services Unless part of the “skilled care” package for a limited period of time only  May cover medical supplies & equipment  Will cover Hospice Care under Part A

26. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 26  Medicare: Federal program Standardized services are available across the nation according to national eligibility regulations  Medicaid: A Federal-State program  But is State administered  Eligibility is determined by states  Services are determined by states

27. Health Care System: Medicaid Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 27  Medicaid: STATE- ADMINISTERED program… SO,  Services & eligibility vary from State to State “could you say that again?”

28. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 28  Medicare & Medicaid are both government funded health- related programs  Medicare is FEDERAL Program  Same services across the nation in every state

29. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 29  Medicaid is STATE – ADMINISTERED Program… so,  Services vary from “state to state”  Eligibility is determined “state to state”  “thanks for the clarification!”

30. Health Care System: Medicaid Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 30 Medicaid  Usually is the “Payer of last resort”  But in Indian Country, I.H.S. is usually the “payer of last resort”  IHS will pay for services after all other insurance options have been utilized for health care payment  Including CMS* payment *Center for Medicare & Medicaid Services

31. Health Care System: Medicaid Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 31 Medicaid: Eligibility for ELDERLY  Based on financial need  Not based on work-history  Elders 65 years of age & older  Elders who are disabled  Elders on Social Security Income (SSI) automatically are eligible for Medicaid

32. Health Care System: Medicaid Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 32 Medicaid Eligibility for Elders (continued):  Elder must have extremely low amount of assets Varies from state to state Don’t have to count the elder’s home, car, clothing, household goods, burial plot

33. Health Care System: Medicaid Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 33 Medicaid  Pays for nursing home care  The elder’s resources have to be extremely limited they can keep their home, car, belongings

34. Health Care System: Medicaid Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 34 Medicaid… (continued)  Can ask the “estate” for some “pay-back” after a person passes away… BUT Medicaid will NOT take Tribal land or income from Tribal land or items with spiritual or cultural significance to the Indian community

35. Health Care System: Medicaid Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 35 Medicaid… (continued)  Home Health Care Options under Medicaid  Will pay for “personal care” if elder is eligible Bathing, dressing, cooking, cleaning Different from Medicare… more “non-medical” type of services in the home  Each State has its own mechanism for Personal Care Services through Medicaid Some states are very generous with elder benefits for Home & Community-Based Services (HCBS)

36. Health Care System: Can feel confusing! Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 36

37. Health Care System Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 37  Challenge is to learn to navigate all of these agencies and services !  It can be done…  Work with the “people” who are in the system…  A “system” is only as good as its people! Essential to Build partnerships!

38. Can Find the Way to Resources! Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 38

39. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 39  Know the PEOPLE  For every program, find the “key person” to “unlock the network resources” !  Use the RESOURCES  MANY AVAILABLE!  Websites, literature,  Toll free phone numbers, etc.

40. Understanding a Piece at a Time Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 40 Tribal Health County & State Social Services MedicaidMedicare Indian Health Services

41. Health Care System: Medicare Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 41 QUICK REVIEW ! Medicare A “standard” federal program Part A: Hospital insurance Part B: Medical insurance Part C: Medicare Advantage Part D: Prescription Drugs

42. Health Care System: Medicaid Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 42 QUICK REVIEW ! Medicaid Federal-State Health Care Program, but… Services & eligibility determined “state by state” Need to find out what is available for elderly in EACH state

43. Health Care System Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 43  Resource people can be the “guides through the maze”:  Contract Health Services staff at IHS Extremely knowledgeable of CMS funding resources, eligibility requirements, deductibles, monthly premiums, etc.  County Social Service Programs Particularly well-informed about Medicaid funding & eligibility

44. Health Care System: Overview Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders 44 “Thanks very much…”

45. Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

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