Navajo Nation Creating Navajo Managed Care Organization

Navajo Nation Vice President Jonathan Nez and President Russell Begaye

Published September 19, 2017

WINDOW ROCK – The Office of the President and Vice President (OPVP) has been working on creating an entity that will offer Medicaid managed care services to Navajo tribal members, along with other Native American tribes, under New Mexico’s Centennial Care 2.0 Program.

Navajo Nation President Russell Begaye met with New Mexico state and federal government officials to begin the process of establishing a Navajo-owned managed care organization (MCO) as part of the Center for Medicare/Medicaid Services’ (CMS) 1115 demonstration waiver.

“Creating a Navajo MCO will change the healthcare landscape of the Navajo Nation,” President Begaye said. “It will provide Medicaid benefits, services and support that enhance our current IHS healthcare and P.L.638 healthcare. We hope to improve quality and preventative care by being able to track the health care history of each Navajo Medicaid patient throughout the course of their lives.”

The design of the Navajo MCO is based on a federal provision which acknowledges the sovereign right of American Indian tribes and Alaskan Natives to establish managed care services for their members.

Fee-for-service will remain an option for New Mexico Medicaid recipients. However, the Navajo MCO will be an option that takes into account the unique practical, financial and cultural needs of Native Americans.

In many situations, tribal members are referred to health care providers in cities that are hours away from their homes.  This results in millions of dollars in health care leaving the Navajo Nation that could be reinvested into improving health care systems for the Navajo people.

The Navajo MCO will be able to design specific value-added services that go above and beyond traditional fee-for-service Medicaid benefits. Value-added services will address Navajo Medicaid member needs like traditional healing, transportation, care coordination, home health care, community services and supports, telehealth and other benefits that will be designed with input from tribal leadership and the community. Future members will be able to speak Navajo-to-Navajo with MCO customer service and care coordinators. All Navajo MCO employees will be required to have training on the unique cultural and language needs of the Navajo Nation and its people.

The Navajo MCO will establish a value-based system that provides a dependable source of income for local health care facilities.  For this to work, the MCO aims to develop provider contracts with 638 tribal facilities, Indian Health Services, and Community Health Representatives. By doing this, the MCO will bring much-needed resources for these groups to improve their services to Navajo patients.

There are many benefits to a Navajo-owned MCO. The creation of the MCO will allow the Navajo Nation to use generated revenues for infrastructure, training and job creation.  The Navajo MCO will also yield opportunities for Navajo physicians and health care providers to return to the Navajo Nation.

The groundwork is being laid in terms of detailed planning, agreements and partnerships. The OPVP will provide the public further information on developments in establishing the managed care organization. The expected launch date for the Navajo MCO is Jan. 1, 2019 and it would match current New Mexico Medicaid managed care contract and implementation timelines.

“Primarily, we want to serve our tribal membership but we also want to be able to open it up to all Native Americans that would like to sign up with the Navajo MCO,” President Begaye said. “Many tribes are looking for alternatives in addressing the payment and delivery of health care. This is not moving to privatization but it’s making sure that our people are served right and come away with a positive experience when it comes to their healthcare. We are passionate about finding ways to bring this about.”

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