Published May 7, 2018
WASHINGTON — Navajo Nation President Russell Begaye is deeply concerned with recent statements made by the Trump Administration’s U.S. Department of Health and Human Services (HHS) that exempting American Indian and Alaskan Natives (AI/AN) from work requirements for Medicaid benefits could raise “civil rights issues.”
“Tribal nations are governments. We are political entities. We are not a race in the eyes of the federal government nor have we been throughout history,” President Begaye said. “Our citizens pay the price when laws and precedent are ignored or misinterpreted. This is especially concerning because it will limit sorely needed health care services for our people.”
On January 17, the Centers for Medicare & Medicaid Services (CMS) asserted in a Dear Tribal Leader letter that “civil rights issues” could prevent states from exempting AI/AN from Medicaid work requirements. But that blatantly ignores the sovereign status of Indian tribes as recognized in the U.S. Constitution and countless federal laws and policies over more than 200 years. Also, the U.S. Supreme Court has held the federal government’s relationship with American Indians is not race-based, but rather, a unique political status that upholds a government-to-government relationship with separate sovereigns.
President Russell Begaye, center, is concerned about HHS refusal to recognize tribes as sovereign nations.
The administration appears to also take a federalist approach in dealing with states, as well. Certain states, like Utah and Arizona, have already negotiated with tribes for individual state waiver exemptions for AI/AN Medicaid beneficiaries. However, CMS has stated it “will not guarantee to approve the negotiated exemptions” and can reject prior negotiations and state requests at its discretion.
“This unprecedented decision by HHS is very troubling and will harm Navajo citizens,” President Begaye said. “I am concerned that certain individuals at HHS are making misguided decisions that will have disastrous repercussions despite centuries of federal Indian policy. We expect HHS to consult with the Navajo Nation on proposed policy changes. I urge HHS leadership and Congress to step in and be a voice of reason to prevent the blatant disregard of well-established legal precedent and treaty negotiations. Eligibility issues should be addressed directly with tribal nations and through congressional channels, not through arbitrary interpretations by agency appointees and staff.”
After repeated requests for justification from tribal leaders, the HSS Office for Civil Rights maintains that it cannot convey its reasoning due to “attorney-client privilege protections.” Tribal leaders view this refusal to provide justification with great concern and disregard for explicit tribal consultation provisions.
President Begaye noted, “HHS leadership has not formally taken a position or given guidance on the reasoning behind these CMS staff-level, ‘civil rights’ concerns. I urge HHS leadership to uphold our government-to-government relationship, their federal trust responsibility and ratified treaties, especially the 150-year-old Navajo Treaty of 1868.”
Navajo Nation leadership will continue discussions on this matter and engage with both congressional and federal agency leaders.