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TRIBAL OPPORTUNITY IN BUILDING LONG TERM CARE …

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Denise Pommer, DirectorDepartment of Aging and Long Term CareMenominee Indian Tribe of WisconsinAugust 12, 2015
2015 National Title VI
A Glance at the Menominee TribeLocation and U.S. Census Data
Located in the State of Wisconsin the Menominee Indian Reservation is largely coterminous with Menominee CountyReservation land base is 235,523 of which roughly 223,500 acres are heavily forested84.5% of the 4,317 population estimates for 2013 are Native AmericanPer capita income in 2012 dollars was $14,47923.2% of people live below the poverty level
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The Tribe at a Glance2014 Wisconsin County Health Rankings
Menominee County ranks 72 out of the 72 counties in the stateranking last in health behaviors, factors, and outcomes, social and economic factors, and mortalityUnemployment in 2014 is 15.3%(compared to 5.2% State of Wisconsin rate and 6.2% 2014 National annual average -U.S. Bureau of Labor Statistics)47% of children live in poverty16% experience severe housing problems17% are in poor or fair health(12% in the state)Premature death is 63% higher than the state and 66.6% higher than the National benchmark
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Why the Tribal Waiver Program is Important(key goals)
Given the expanse and rural land base where our population lives it is thought that isolation, early onset of chronic disease, unemployment, poverty, historical trauma and reluctance of membership to seek outside services are among the many concerning factors and challenges that contribute to the health care gap in critical risk areas experienced by Menominee people.The key goals of the program include to:improve health and mortalitymaintain a culturally competent service delivery systemafford a trusted alternative that improves access to care and health care utilization
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Key Goals (continued)
keep Tribal members in their homes, within the community, and out of costlyinstitutionsimprovetimeliness of service deliveryimprove living conditionspromote job creationstrengthen the Menominee Tribal economic baseexpand the role for Tribal departments thereby alleviate the Tribe’s financial challenge to provide servicessustain a long-term care program that aligns with Tribal Sovereignty and Self Determination
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Identifying Stakeholders
Tribal Leadership (requires buy-in)State Department of Health ServicesTribal departmentsCounty Health and Human ServicesTribal or local collegeLocal Nursing Homes and HospitalWaiver participants and family membersAging and Disability Resource Center (ADRC)
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The Menominee Model of Long-Term CareConceptualizedin 2012, the concept of the Menominee Model of Long Term Care is that it is not just an agency providing care, rather this is acommunity caring for its own people
Administered through the Tribe’s Department of Aging and Long Term Care -Director is responsible for and provides oversight of overall program operationsProgram serves Indian Health Service/waiver eligible personsFinancial and Functional Eligibility:Tribal Income Maintenance Department determines financial eligibilityADRC and/or Tribal Aging and Disability Resource Specialist conduct functional screens, outreach, and provide options counselingCase Management (Tribal Hires and Contracted)Service consistent with tribal values and beliefsLTC Administrative CoordinatorLimited case management, HSRS, coordinates the Supportive Home Care worker pool, and other
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Menominee Model (continued)
Participant is theemployerContracted fiscal agentHome RepairProgramFundedwith county costsavingsCollaboration with the College of Menominee Nation for pool of qualified Supportive Home CareworkersUtilize Tribal departments and private Tribal entrepreneurs as potential service providers
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Of Significance in the Menominee Model of LTC
Expanded role for Tribal departments and Tribal members in service delivery provides added CHOICE of culturally competent providersOpportunities for economic development for Tribal members, businesses that exist or may be developedIncreased number of eligible waiver participants from 32 to 140There are currently over 100 supportive home care workers employedNo greater cultural competence than the Tribe caring for its own members
2015 National Title VI
Of Significance in the Menominee Model of LTC
Forged a partnership and strong working relationship with the StateDHSA Tribal/County Human Services Planning Committee serves to address the coordination and integration of long-term care services to residents of theReservation/CountyBenefits thestate, the county and of greatest importance to theTribe:the waiverprogramserves as a viable avenue for the Tribe to address the health, social, and mortality concernsby utilizingthird party revenue to reduce the shortfall between capacity and need thereby helping to meet the financial challenges that the Tribe and Tribal members face
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Sustainability
Implementing long term services and supports is made possible by language that amends the Indian Health Care Improvement Act of 2009 and included in the Affordable Care ActProvides Indian Health Service specific authorities for provision of long term care services provided to American Indian/Alaskan Natives in IHS or tribal facilitiesTribes must include LTSS language in their Tribal 638 health contract100% Federal Medical Assistance PercentageClaims are processed throughout the year so payments are received on an ongoing basisAdministrative fee received based on total cost of services
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In Summary
The Menominee Model of Long-Term Care is a leading example of how the Menominee Indian Tribe of Wisconsin is exercising its right to self-governance and self-determination to meet the unique needs, culture, values, and expectations of the Tribal community.The demonstrated capability of the Menominee Tribe to successfully administer a 1915(c) Medicaid Waiver program provides HCBS that support a culturally appropriate service delivery systemand is a trusted alternative that improves access and health care utilization for Tribal members who might otherwise go with out services.The program expands roles for Tribal departments, Tribal members, and provides opportunities for economic development for businesses that exist or may be developed; promotes positive health outcomes and well-being; and is a most viable avenue to deliver critically needed long term services and supports before life is lost or costly institutionalization is necessary.The Menominee Model of LTC has been shared with other Wisconsin Tribes and Tribes across the Nation and recommendations made to Tribes includes to view the Long Term Services and Supports (LTSS) in Indian Country…A Roadmap for Planning at CMS.gov
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In Summary
As the State of Wisconsin expands its Managed Care Model, Family Care, and Self Directed Supports Model, IRIS, the Menominee Indian Tribe exercises its status as a Sovereign Nation with the inherent right to self-governance to develop and implement a federal program that directly impacts the Tribe and our Tribalmembers.The Tribe togetherwith the State of Wisconsin are strong proponents of a new 1915 (c) waiver application for a Tribal Only Waiver option that is recently submitted to the Centers for Medicare and Medicaid Services for authorization and inclusion in the Wisconsin State Plan Amendment.CMS authorization of the new 1915 (c) waiver for Sovereign Tribal Nations to administer the Medicaid waiver program is essential to sustain the Menominee Model ofLong-Term Care
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TRIBAL OPPORTUNITY IN BUILDING LONG TERM CARE …