General Council briefed on Skookum cost-containment efforts

Like other governmental entities, the Confederated Tribes of Grand Ronde is analyzing ways to keep often double-digit increases in health care expenses from consuming more and more of its limited budget.

During the Dec. 2 General Council meeting held in the Tribal Community Center in Grand Ronde, Tribal Assistant Executive Director of Health Services Allyson Lecatsas briefed the membership on ways the Tribe has kept health care costs in check and plans to continue combating those increases, including asking Tribal members to apply for Medicaid and look at other insurance coverage accessible to them.

Lecatsas said during her more than 30-minute presentation that the ultimate goal of Skookum administrative changes planned for 2013 will be to take more of the burden of funding health care for Tribal members off the Tribe and moving it to Medicaid, a federal program that is administered by the states that is available for people with low incomes or are medically needy, or to other insurance, such as employer-sponsored plans. Native Americans are exempt from any cost sharing - co-pays -- in Medicaid.

But first, Lecatsas presented a history of Tribal health care.

Since federal funding through Indian Health Service and Contract Health Services is woefully insufficient to provide adequate health care for all Tribal members, the Tribe started paying premiums of Tribal members to have commercial health insurance through Oregon Dental Service in 1997.

In September 2004, the Tribe moved to a self-insured plan, which pays medical bills for Tribal members using gaming dollars. In 2009, the Tribe started using Shasta Administrative Services of Bend as its third party administrator for health care claims.

In 2010, a Tribal workgroup was formed with the goal of finding possible cost savings in Skookum.

Lecatsas said that Skookum was originally conceived to be the payor of last resort. In 1997, 58 percent of Tribal members were enrolled in Oregon Dental Service insurance, but now almost 100 percent of Tribal members are enrolled in Skookum, with 85 percent to 90 percent of them not having any other insurance coverage.

Because of this, the Tribe has seen health care costs consume an increasing portion of gaming dollars, from $3.4 million in 1997 to $22 million in 2007. An analysis commissioned by the Tribe in 2007 projected that Tribal health care costs were on a trajectory to exceed $29 million by 2010.

However, Lecatsas said, administrative changes made during the last four years have saved the Tribe $20 million and reduced annual health care expenses to $18.5 million in 2011.

But, she added, Skookum will not be sustainable at the current 8 percent to 10 percent rate of inflation seen annually in the health care industry.

Lecatsas said the Tribe will start in 2013 asking Tribal members to apply for Medicaid in their respective states. In Oregon, that would mean applying to the Oregon Health Plan unless a Tribal member can show proof that they are not eligible for Medicaid.

Lecatsas said a 2011 survey of Tribal members, which drew 2,760 responses, found that 60 percent of Tribal members did not have other health care coverage options besides Skookum. It also found that of those 1,648 Tribal members who do not have other health insurance options, 704 reported being unemployed.

In addition, Lecatsas said, of those who responded to the survey who reported income levels, only 32 percent earned enough money to not qualify for Medicaid coverage and 55 percent reported income levels at or below 133 percent of the federal poverty, which means they might qualify for Medicaid.

If Tribal members applied to Medicaid and were accepted, it would take a significant burden off Tribal dollars.

"We want to move Skookum back to being the payor of last resort," Lecatsas said. "The Tribe could be saving a tremendous amount of money to the health plan that we are paying unnecessarily just by making a few administrative changes. And, of course, this would be by making it mandatory that Tribal members who do not have other coverage either provide proof that their income is over the Medicaid eligibility or that they actually apply for Medicaid and get enrolled or be denied. … This will not affect the benefits you receive, but how we administer the plan."

Tribal members covered by the Oregon Health Plan would see Medicaid be the primary payor of their health care expenses with Skookum being secondary, paying only what Medicaid does not cover.

Lecatsas said Tribal members in 2013 will see Health Services implement Medicaid verification. Currently, she said, the Tribe is encouraging Tribal members to apply for Medicaid, but it is not mandatory.

Tribal members with questions about the Skookum health plan are encouraged to contact Lecatsas at 503-879-1359, Barbara Steere at 503-879-2487, Melody Baker at 503-879-2011, Tresa Mercier at 503-879-2008 or Jim Holmes at 503-879-2221.

In other action, Evelyn Seidel, Duane Wheeler, Gladys Hobbs, Louise Medeiros and Julie Duncan were nominated for three open seats on the Elders Committee. Votes will be accepted during the Elders Committee meeting from 10:30 a.m. to 12:30 p.m. Wednesday, Dec. 26, at the Elders' Activity Center and again during the Jan. 6 General Council meeting between 10 a.m. and noon in the Tribal Community Center.

Steven Soderberg, Linda LaChance and Cordelia Kneeland won the $50 door prizes and Felicia Torres won the $100 door prize. Kathryn Harrison, Margaret Provost, Seidel and Raymond Petite won earrings made and donated by Tribal Council member Jon A. George.

The next General Council meeting will be held at 11 a.m. Sunday, Jan. 6, in the Tribal Community Center.