1. Lesa Evers Tribal Relations Manager Department of Public Health and Human Services State of Montana for 2015 Cover Montana Outreach & Enrollment Summit October 15, 2015 ACA

2.  Federally funded health program  Unique service delivery (IHS Service Unit (hospital/clinic), Tribal Health Clinic, Urban Indian Health Center)  Current service does not meet 10 essential benefits outlined in the Affordable Care Act  Not considered health insurance coverage... not portable, no card, no network  Care is either Provided or Purchased  Provided Care differs at each location, each reservation and each urban center  Purchased Care is also known as Purchased and Referred Care (PRC), formally known as Contract Health Service(CHS)  Purchased Care is subject to complex regulations (referral, committee review, priority system, budget availability, etc.)  Result means this... ◦ access is limited and at times non-existent ◦ lack of quality care ◦ inability to be in control of personal health care decisions ◦ untreated health conditions ◦ health disparities that lead to early death

3.  Concept of private health care insurance is very new  Insurance language is complicated  Unsure of the need and why its mandated  May be content with penalty exemption  Not sure of the benefit  Skeptical even when free or low cost  Affordable versus Unaffordable  Unclear how private health insurance and IHS will work together  Information can be overwhelming  Need to understand how their investment brings value, choice and decision making  Many different “open enrollments” create confusion  Multiple conversations can be hard to grasp and figure out where one might fit ◦ Tribal Large Employer Mandate ◦ Tribal Premium Sponsorship ◦ ACA/Marketplace/Exchange/FFM/Determination State ◦ Medicaid Expansion

4.  Build relationships  Commit to learning about local health care delivery system(s)  Begin to understand the differences and what that might mean to your approach  Reach out to partners – tribal, CACs, benefit coordinators, navigators  Be inclusive, invite others  Decide to work together, even with differences, every person has a gift and brings value  Have realistic expectations  Only make promises you can keep  Follow through  Use available resources  Be willing to ask questions AND most importantly, be willing to wait for the answers  Realize that words have different meaning to different people  Inform, educate and empower individuals  Allow time for processing and understanding  Be patient and respectful  Be kind and gentle  Keep making a difference

5. Lesa Evers Tribal Relations Manager Director’s Office Department of Public Health and Human Services State of Montana PO Box 4210 111 North Sanders, Room 301 Helena MT 59604-4210 levers@mt.gov (406) 444-1813 office (406) 431-2709 cell