The federal government is making headway in assisting the Indian Health Service to register tribe members for Medicare and Medicaid services, according to an August 7 report by the General Accountability Office (GAO). However, many American Indians still face financial and transportation barriers in accessing services, the study found.
The GAO report, prepared for the Senate Finance Committee, examined the Centers for Medicare & Medicaid Services' efforts to work with the 562 federally recognized Indian tribes to ensure adequate access to Medicare and Medicaid.
For the study, GAO officials reviewed documents, interviewed federal and state officials and visited tribes and IHS-funded facilities in six states. They also searched for barriers that American Indians and Alaska Natives face when enrolling in Medicare and Medicaid.
The CMS and IHS have been working on policy initiatives to ensure that existing healthcare policies meet the needs of IHS-funded facilities and the populations they serve. The report concludes that the CMS and HIS have had "mixed success" in identifying whether proposed CMS regulations would improve barriers to access.
The GAO found that the CMS has provided education and technical assistance and requested input from tribal representatives on program operations, according to mandate.
CMS officials have used tribal liaisons and an advisory board to interact with representatives from Indian tribes and have relied primarily on annual regional sessions sponsored by the Department of Health and Human Services to consult with Indian tribes. However, consulting with tribes is "an inherently difficult task" due to variation in tribes' size, location, economic status and the limited time allowed by the sessions.
According to the GAO, five of the six states studied reported having policies in place to govern the interactions between the state's Medicaid program and Indian tribes, with most of these policies establishing guidelines for how consultation should be conducted. Five states reported consulting with tribes about changes to their Medicaid programs.
To help eligible American Indians and Alaska Natives enroll in Medicare and Medicaid, almost all of the IHS-funded facilities GAO visited had staff who assisted patients with the application process.