Navajo Nation President Advocates for Tribal Exemption from Medicaid Work Requirement

Dr. Glorinda Segay told the Nation Indian Health Board that tribal leaders are responsible for speaking on behalf of their most vulnerable citizens in opposing the proposed work requirement mandate.

Published September 4, 2018

WASHINGTON — Navajo Nation President Russell Begaye continues to oppose the federal decision to impose mandatory work and community engagement requirements on American Indians and Alaskan Natives (AI/AN) who receive Medicaid.

Working in coordination with the Navajo Department of Health and national health organizations, President Begaye has advocated for a tribal exemption from the Trump administration’s proposed work requirements for AI/AN Medicaid recipients.

In a letter addressed to the Department of Health and Human Services (HHS) and the Centers of Medicare and Medicaid Services (CMS), President Begaye stated that imposing these requirements in the Section 1115 Demonstration Waiver undermines tribal sovereignty.

“HHS and CMS are contradicting prior state-tribal negotiations in which they created laws exempting AI/ANs from work requirements,” President Begaye said. “In May, Secretary Alex Azar said CMS would defer to the states’ individual decisions to mandate or exempt tribal work requirements.”

Navajo Nation President Russell Begaye

In July, CMS Senior Counselor Calder Lynch informed the CMS Tribal Technical Advisory Group (TTAG) that the Trump Administration would move to mandate Medicaid work requirements. Counsel further stated it’s unlikely that CMS would approve prior state exemptions for AI/ANs and that HHS is not considering alternatives.

“I request that HHS re-examine CMS’ statement and reconsider the Tribes’ numerous requests for an AI/AN exemption in addition to state decisions,” President Begaye said. “In particular, HHS needs to examine CMS’ approach in attempting to classify AI/ANs as a racial classification rather than a legally-defined political status. This violates Constitutional provisions and long-standing U.S. Supreme Court decisions.”

The imposition of mandated Medicaid work requirements for Native Americans goes against the federal government’s unique trust responsibility to AI/ANs and contradicts the purpose of the Indian Health Service (IHS). IHS is already chronically underfunded by 66 percent causing a complete lack of adequate healthcare across Indian Country.

The Navajo Nation met in Washington, D.C., on Tuesday, Aug. 28, with Native American organizations and tribal leaders to discuss the impacts of mandating Medicaid work requirements in Indian Country. Dr. Glorinda Segay, director of the Navajo Department of Health, said the issue threatens tribal sovereignty and enrollment.

“The underlying issue of this mandate is much broader for diminishing tribal sovereignty in Indian Country.” Dr. Segay said. “Indian Country needs to be more vocal, strategic and coordinated in moving to exempt all AI/ANs from these unprecedented Medicaid work requirements. Unemployment on the Navajo Nation is near 42 percent and many of our citizens sustain their livelihood through traditional employment like artisan work. This type of artisan work is unaccounted for under Medicaid guidelines to count as “work” to remain enrolled for healthcare.”

Segay encouraged the National Indian Health Board to push the work requirement issue to the forefront, a move that would force congressional leaders to engage with voters. According to Segay, nothing’s changed since July when CMS said the administration would push to mandate work requirements.

“We are speaking on behalf of our most vulnerable tribal members who live deep in rural areas—people who aren’t aware of the internal discussions of the Trump Administration and how it will impact citizens in Indian Country,” Dr. Segay stated. “Our citizens are the most vulnerable individuals who will be harmed through this implementation of work requirements.”

Vice President Jonathan Nez said tribal nations should act immediately before the requirements are mandated. He called for further government-to-government consultation between tribes and the Secretary of Interior.

“The main purpose of both TTAG and the Secretary’s Tribal Advisory Committee is for tribal leaders to provide advice and recommendations directly to the Secretary and CMS administrator as a part of the federal trust responsibility to tribal consultation,” Vice President Nez said. “We expect HHS and CMS to work directly with tribal nations to assist in the advancement of our healthcare system but we have yet to see these discussions move forward.”

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