Oklahomo expands Medicaid health care coverage for Indians

TAHLEQUAH, Okla. — There’s a saying in American Indian country: “Don’t get sick after June.”

The warning alludes to a problem that has long dogged the Indian Health Service, which provides government medical care to 2.2 million of the 3.7 million American Indians and Alaska Natives in the nation and which is routinely criticized for providing substandard care.

A lack of medical expertise and specialists often forces members of tribal communities to seek treatment outside the system, with no guarantee that the health service will cover their medical bills once it exhausts its yearly allocation from the federal government for referred care — often by summer.

That has left many families to choose between an expensive trip to a private hospital and forgoing specialized care — until now. In July, Oklahoma expanded free Medicaid coverage to an additional 200,000 low-income adults, including many tribal members, after voters passed a ballot initiative compelling the state to do so.

Since the expansion took effect July 1, more than 23,000 eligible American Indians have enrolled in the program, according to state officials — about 13% of the total 171,056 people who signed up statewide.

Dana Miller, director of tribal government relations at the Oklahoma Health Care Authority, said the state had been working with its tribal partners to enroll as many people as it could, especially in its most rural and remote communities.

Dr. Stephen Jones, executive director of Cherokee Nation Health Services, said the expansion would have the largest effect on uninsured patients who had been unable to seek medical services outside their tribal hospitals.

“There is quite a large population that weren’t eligible for Medicaid and couldn’t afford marketplace insurance, so they were left kind of uninsured,” Jones said.

Joshua Barnett, a spokesperson for the Indian Health Service, said Medicaid collections were an important source of revenue for the agency and would be all the more so now that the program covers more of its patients.

“By increasing our third-party collections, it allows us to hire more people, add more equipment, extend our purchased/referred care program dollars and ultimately provide more services,” Barnett said. “Ultimately, it’s a benefit for the patient and the Indian Health Service.”