ADMINISTRATION AMBULANCE CHEMICAL COMMUNITY DENTAL CONTRACT ELDERLY FOOD DISTRIBUTION MEDICAL INDIAN WELFARE MENTAL SERVICES SOCIAL SERVICES VERMILION (753-4542) AMD Bois Forte Reservation Health Services Box 25 Nett Lake, Minnesota 55772 FAX: (218) 757-3636 Page #2 As is obvious from all foregoing discussions, Tribes and the IHS, must operate: a system of providing health services which is often based on prioritizing, and therefore rationing, care to Indian patients. At Bois Forte, we have had to withold eye exams and eyewear to patients who are not a diabetic, or a child. This is less than the Medicaid standard is. While this is an an especially acute problem for the Tribes of the Bemidji Area due to Demographics, geographics, and self-determination, it is a difficulty suffered by all of Indian Health Service. But In the Bemidji Area we are forced to rely heavily on Contract Health Services, At Bois Forte, we are 40 miles from the nearest Hospital, nearest X-Ray Unit, and nearest Internal Medicine Doctor. Without the capacity to provide many of the direct services to our Indian patients we must use the already scarce health care resources to purchase care from the private sector. Such care easily exceeds 30 to 40% more what it would cost us to provide in direct service. This further erodes our purchasing power, and at Bois Forte that erosion cost our clinic 2 personnel positions. It should be noted that many Health Preventative Activities, by their nature, occur outside the confines of a health facility, and that these activities are not counted toward total workload in the IHS system. It is also significant that transportation to and from Contract health providers is often provided by Tribes. This further burdens an already inadequate financial resource. Little credit is given for such services in terms of workload. Smaller tribes like ourselves who are quite rural are forced to provide longer more costly transportation services. If the tribe could be credited with the equivalent workload for this service provided, the relative need would be more fairly reflected. Our Tribe currently purchased and maintains 3 vehicles just for transportation and homevisits by the Community Health Program. We are 70 miles from Virginia, 75 miles from Hibbing, and 125 miles from Duluth, these are the places of specialty care. I would like to emphasize a point in the proposed budget cuts. It has been proposed that the Base Budget Authority be reduced by 86 million dollars, due to the expected 3rd party collections. Our Tribal Government has had to purchase health Insurance for it's employees in order to try to balance this within our own reimbursement system. BOIS FOATE BAND Bois Forte Reservation Health Services Box 25 Nett Lake, Minnesota 55772 Phone: (218) 757-3295 FAX: (218) 757-3636 Page #3 This has been at the request of those of us who are forced with the decision ADMINISTRATION of who may or may not receive care. I doubt that this was the intended AMBULANCE CHEMICAL COMMUNITY DENTAL CLINIC SERVICES CONTRACT ELDERLY SERVICES scenario of the participants on both sides of Treaties. This purchasing of Tribal leaders are working to meet this challenge of maintaining and improving AMERICAN INDIAN Wellstone Hearing Letter Bemidji, MN 39 level. Thank you for the opportunity to present a statement on behalf of There the American indian Health Clinic in St. Paul, Minnesota. over 4.500 American Indians living in Ramsey County according to the 1990 the poverty percent. live below Clinic data indicates that of the 2.500 persons served, two-thirds of the Clinic's leve. patients have incomes belon the poverty Just 37 percent t the line': patients have Medicaid. only 3 percent have any other insurance, and 60 percent have no coverage. Last Yeal the Amer teab Indian Health Clinic provided over 5,000 medical, dental, and mental health visits to the St. Paul American Indian community. Al: hough The American Indian Health Clime is supported by city, county, and foundation funding, is well AS revenue from medicaid, insurance. and The Clinic has no! patents. 121 received Indian Health Service funding like other Urban Indian Health Clinics. The Clinic is open Monday through Friday, the waiting time for a dental appointment is in months and for a medical appoint me in weeks. Additional staffing is needed to meet the present patient demand for services reduce waiting times, and insure accessible services to the local American Indian communit. Indian Health Service funding from the Urban Programs Branch desperately needed. There are also other urban areas with a significant American Indian population that at pre-ent have no Urban Indian Health Program due to lack of funding for the IHS Urban Health Program. The IS has conducted a sturly nder Contract that identified eighteen other urban :eas with. a significant American Indian population meeting criteria for an rban Indian Health Center. but NO funds have been made available to servree those over 10,000 urban American Indians. The American Intian Health Clinic is seeking to meet The needs of the American Indian perniation prior to 1998 which is the Target date for any systear to he implemented. The issue is for funding in the years 1991. 139. 1996, Ana 1997. Thank you for your support that wi presenting increase banding to the meet American Indians who have relocated to urban healthcare herds ot FROM: RICHARD CARPENTER 947 PAYNE AVENUE ST. PAUL, MINNESOTA 55101 (612) 776-9519 NORMAN DESCHAMPE - CHAIRMAN, GRAND PORTAGE BAND + VICE CHAIRMAN MINNESOTA CHIPPEWA TRIBE Grand Portage Reservation Tribal Council P.O. Box 428 Grand Portage, Minnesota 55605 218/475-2277 OR 475-2239 For: Presentation to Senator Paul Wellstone, on May, 9th, 1994. The Grand Portage Band of Lake Superior Chippewa health delivery system is an example of a Tribal CHS (Contract Health Service) model. The intent of this overview of our system is to provide information on the different way in which we provide services to our Indian, non Indian, and employee population. The Grand Portage Reservation is situated in the tip of the Arrowhead. We are 150 miles from Duluth, where we must go for any specialist care. We are 36 miles from Grand Marais, which is the nearest hospital which offers a limited amount of service. We have a Clinic on the Reservation. The Grand Portage Health Service is staffed by two PHNS and one RN, with one of the PHNS also functioning as Health Director. We have two full time CHRS (Community Health Representatives) who provide outreach, transportation, and referrals in the community. We have one Office Manager who handles all of our Contract Health Service payments which is the dollars that are paid out for primary care services not provided by our staff. At the present time Cook Co. Community Clinic, (which is a Federally Qualified Health Center), sends a physician to Grand Portage two half days a week at Grand Portage. Cook Co. Clinic uses our space and staff when providing primary physician care. Cook Co. Clinic then bills our Contract Health Service and other 3rd Party payers for services rendered. We also have a licensed ambulance service with 14 EMTS and one First Responder. The resident Indian population of Grand Portage is around 300 individuals. In 1993 we served an additional 115 Indians which demonstrates the mobility of a segment of the Indian population. In total the Grand Portage Health staff served 696 individuals in 1993, the non-Indian portion being employees and members of Indian families and permanent residents of the Grand Portage area. The only direct services provided by Grand Portage Health staff are not presently billable, this includes "wrap around" services such as outreach, referral, Public Health services, WIC, Mental Health, Chemical Dependency, immunization, Maternal Child Health, prenatal services and a variety of skilled and other services in the home and community. The costs for these services are partially covered by Indian Health Service funds with the balance made up by State grants and Tribal funds. All other primary care services are provided on a fee for service basis by Cook Co. Community Clinic, North Shore Hospital and a number of primary care providers in Duluth, and in some special cases Mpls. Of the 696 clients served at Grand Portage in 1993, 383 were covered by the Self Insurance plan provided by the Grand Portage Tribal Council. Only 7 clients are presently covered by Medical Assistance and 25 are enrolled in Medicare. The total cost of purchased services for the Grand Portage Indian service population was $478,490. This included only $184,500. in funding from Indian Health Service. The unmet needs for contract care not provided by Indian Health Service is a whopping $293,990. The portion paid by the employee health plan was $225,672. The balance of unmet need totaling $63,318. was covered directly by the Tribal Council and by other third parties. PRIMARY CONCERNS: 1.) Tribal sovereignty must be maintained in any planning and discussion of Health Care Reform as it relates to Reservations. This includes the reality that each Tribe is a unique political entity. The way that each Tribe delivers health care is unique. 2.) The inclusion of Tribal entities in lists of "minority" populations that can be considered "Essential Community Providers" is unacceptable. Tribes are political entities, not minorities, and for the purpose of Health Care Reform they should be singled out to be considered an Essential Community Provider separate from "Minorities". 3.) All decisions as to the inclusion of individual Tribes in Health Care Reform and health systems that are developed must be left up to individual Tribes. Each Tribe may very well decide on different courses of action that will affect both the Indian people they serve and their non Indian employees. 4.) Tribal participation in Health Care Reform must be an "option" and not a mandate. 5.) The Federal Government is responsible for the care of Indian people. Congress and the President needs to recognize the grossly under funded status of Indian health care. They must also recognize that Tribal subsidies for health care may not last if political forces in the state and nationally have negative effects on Tribal economies, e.g. Indian Gaming. The Tribes should not have to subsidize health care at all. The fact that the Grand Portage Tribe is subsidizing 70% of all the health care costs for the Indian people at Grand Portage is inexcusable. Congress and the President should be funding us at 100% of need. 6.) At the present time Grand Portage is able to purchase contract health services from providers we choose. In this method we are able to monitor quality, along with costs. The concern is that we may not have any control over the quality and suitability of the services provided by Health Care Reform. This is of special concern in the area of having providers that are culturally sensitive to the needs of Indian people and to the unique health care needs of our isolated rural population. |