Navajo Nation’s revolutionary biz approach awaits gov’s OK

In 2020, we saw the destruction caused by a pandemic across the United States. There was no place where the impact of COVID-19 was felt greater than the Navajo Nation. With infection rates greater than any state in the country, the Navajo Nation struggled to keep up with the effects the pandemic had on our health care system and our economy. Almost a year later, the situation seems nowhere near ending. Through it all, the Navajo people banded together to fight against the virus and protect our elders, children and families. One of these efforts is the Indian Managed Care Entity (IMCE).

An IMCE is a Medicaid-managed care organization owned and controlled by a tribe or tribal entity.

For 17 years, Navajo leaders pushed to create a Medicaid program for the Navajo people. They needed a change to break the recurring cycle of health and health care inequity among Native Americans. As federal and state policies allowed for an IMCE, the Navajo leadership took the opportunity to create the first-ever managed care entity specific to Native Americans. They knew some families were fine with how things were, but this program would be for those that felt like their health care could be better.

The IMCE would prioritize Navajo health needs, incorporate traditional and Western modes of healing, and improve access to care by addressing the unique barriers to health care experienced on the Navajo Nation. The IMCE would partner with tribal health care providers to supplement existing services, make connections to diabetes and behavioral health specialists throughout New Mexico, provide enhanced transportation and offer broadband connections for telehealth.

Most importantly, this allows us to control our own managed care program — something no tribe has done to this day.

We took action to assert our self-determination and sovereignty to direct our health care future. We approved legislation to create an IMCE for Native Americans in New Mexico. The New Mexico Human Services Department estimated that with 50,000 members, the IMCE could manage up to $486 million in Medicaid dollars. This means more jobs and a new revenue stream for the Navajo Nation.

We also established the Naat’áanii Development Corporation (NDC), a federally-chartered corporation under Section 17 of the Indian Reorganization Act of 1934 and whollyowned by the Navajo Nation, to boost economic opportunities for Navajo. The Navajo Nation Council selected NDC to be the designated entity to contract with the state of New Mexico for the IMCE. It is the Navajo Nation Attorney General’s legal opinion that the IMCE contract should not be with the Navajo Nation, but with NDC.

The beauty of a Section 17 corporation is that there is a clear separation of government and commercial functions that protects the tribe’s sovereignty and treasury, while empowering these corporations to raise revenue. Section 17 corporations also permit partial waivers of immunity while preserving the tribe’s sovereignty and immunity.

NDC partnered with industry leader Molina Healthcare to design and build the IMCE. This past year, the HSD, Molina Healthcare and NDC have already spent thousands of hours working tirelessly to get the IMCE established, meeting weekly to design benefits, negotiate the contract and update systems. We can’t stop now.

The Navajo Nation is in a crisis again, facing a second wave of COVID-19 infection with hospitals filled to capacity. The Medicaid resources are invaluable. The IMCE can take targeted actions to combat COVID-19 among the Navajo population in New Mexico. Had the IMCE been started sooner, the IMCE would have been operating and serving Navajos with additional resources during this second wave, but we are still waiting.

The IMCE’s work cannot be delayed any longer. After 17 years of advancing this goal and considering the impacts of the COVID-19 pandemic, we strongly encourage the governor to comply with the Navajo Nation’s position, and we look forward to working with her to see this program come to fruition. The potential for the IMCE is immeasurable.