General Council briefed on Tribal health plan again

CLACKAMAS -- Stressing the importance of the SOS - Save Our Skookum - effort, Tribal members received a briefing on the Tribe's efforts to control and reduce health care costs for the second time in four months at the March 3 General Council meeting held at the Monarch Hotel & Convention Center.

Tribal General Manager Mark Johnston said that the continuing effort to get Tribal members who may be eligible for Medicaid coverage from using Skookum as their primary payer is the first step in controlling escalating medical costs for the Tribe.

In 2012, Skookum, which uses Tribal dollars to pay Tribal member medical bills and is not an insurance plan, cost approximately $18 million, or about 25 percent of the entire Tribal governmental budget.

"As part of the secondary payer process, we've just begun to look at opportunities to get members enrolled in other coverage to reduce the primary coverage on Skookum by the membership," Johnston said.

Johnston said the largest portion of the $18 million annual health care cost comes from Tribal members who use Skookum as the primary payer.

One way to reduce Tribal costs without reducing Tribal member benefits is to get Tribal members who qualify for Medicaid to apply for the Oregon Health Plan, which would become the primary payer and Skookum would then become the secondary payer.

"So, essentially, we're asking Tribal members to do a little extra legwork with the hope of saving millions of dollars on the health plan without affecting the members' out-of-pocket expenses," Johnston said.

Johnston said the initial application for the Oregon Health Plan is only one page and that Tribal staff are available to help in submitting it. By applying, Tribal members would be placed on a "reservation list." If picked from that list, Tribal members would receive the more in-depth application for Medicaid.

"Our goal is to reduce the number of members who use Skookum as the primary payer and trying to get some other folks in front of your Tribal dollars," Johnston said.

Johnston said that Tribal Elders who live alone do not have to apply for Medicaid because the Elder pension puts them over the program's income limits. Members who are already on Medicaid do not need to apply.

However, a married Elder or Elder living with a child receiving the pension will need to have their income information verified to ensure they are not over Medicaid income limits.

Although the current push is to get qualified Tribal members on Medicaid, the next step will be to look at other money-saving opportunities, Johnston said.

"The next step will be looking at other opportunities for primary coverage," he said. "We have folks who may have access to work insurance, in which they could enroll their children and their spouse, and it may cost a couple hundred bucks a month. In those cases, we're going to look at opportunities to get the families enrolled in those plans and reimburse those members for those costs. So, again, it puts Skookum in the secondary position and not the primary."

Former Assistant Executive Director of Health Services Allyson Lecatsas made a similar presentation at the Dec. 2 General Council meeting held in Grand Ronde.

Tribal members with questions about the Skookum health plan should call Barbara Steere at 503-879-2487, Tresa Mercier at 503-879-2008 or Jim Holmes at 503-879-2221.

In other action, it was announced that the next General Council meeting will be held at 11 a.m. Sunday, April 7, in the Tribal Community Center.

Tribal Elder Kathryn Harrison and Tyrone and Kevin Simmons won the $50 door prizes and Audrey Mercier won the $100 door prize.

In addition, leather bags and necklaces created by Tribal Elder Dakota Whitecloud and jewelry made by Tribal Council member Jon A. George were raffled off.

The Portland Drum Group opened the General Council meeting with drumming. The group includes George, Greg Archuleta, Eric Bernando, Debi Anderson, Erin Bernando and Jordan Mercier. They received assistance from Kevin and Makai Simmons and Tribal Council member Chris Mercier.