Navajo Nation President Joe Shirley recently wrote to the State’s Medical Assistance Division (MAD) expressing his Tribe’s opposition to cuts in Tribal health, with Pueblo and Apache leaders voicing concerns as well.

By the statistics, requests from Shirley and other leaders make sense. American Indians continue to live sicker and die younger than other New Mexicans, a trend replicated throughout the United States. 2008 data from the New Mexico Department of Health shows that this population fares the worst amongst NM racial/ethnic groups in nine of the 20 health indicators measured, including homicide, motor vehicle deaths, and youth obesity. American Indians in our state are three times more likely to die from diabetes and alcohol than the best performing groups in these areas.

“We simply cannot take health care away from the most vulnerable. It is in all of our best interest to provide healthcare services to the level of the need for those services in our state,” Dr. Kristine Suozzi, Coordinator of the New Mexico Health Equity Working Group told The Independent.

Suozzi pointed to a recent letter from UNM economists to Governor Richardson, a warning that cutting income and services to those who need them will have a spiraling downward effect on our overall economy.

The funding of health care for American Indians continues to lag far behind the national average, roughly one-third of that spent per-capita by those with private insurance, and half of that spent on prisoners. While the Indian Health Service (IHS) provides much of the funds for on-reservation care, 17 percent of the IHS budget comes from third-party payers such as Medicaid. The majority of the Native population does not live on reservations, and for this group, Medicaid becomes an even larger source of healthcare coverage. In all, almost half of our state’s American Indians (43 percent) are on Medicaid, and 66 percent of this group are children.

Last September, when the MAD announced impending cuts to Medicaid, Tribal leaders and advocates, along with Medicaid supporters such as the New Mexico Center on Law and Poverty (NMCLP) began to strategize how to minimize these cuts, and more importantly, minimize the impact that such cuts would have on the vulnerable populations they serve.

“With the $4 to $1 match in federal funding, it would be fiscally irresponsible to forego funds that are critical to our economic recovery and thousands of jobs in the healthcare sector,” Sireesha Manne, a lawyer with the NMCLP told The Independent.

Manne is equally unimpressed with proposals to restructure Medicaid benefits.

”We’re looking at devastating cuts to healthcare coverage for people living in poverty. This will make the difference of whether a family member with a disability can continue to receive services at home, or whether a child can see the eye doctor or dentist,” Manne said.

One proposal, introduced in House and Senate Joint Memorials by Ray Begaye and John Pinto, respectively, requested the development of a program to establish Native Americans in a separate category of Medicaid eligibility with its own benefits package.

The bill invokes legal arguments, pointing out that under New Mexico’s State-Tribal Collaboration Act signed into law last year by Gov. Bill Richardson, Tribes must be given information regarding redesigns of programs such as Medicaid so that Tribal leaders an opportunity to give “important systemic input into the redesign.”

Regina Roanhorse of New Mexico Voices for Children said she saw these memorials as safeguards in a Medicaid restructuring process that has thus far not included Tribal leaders.

“These are important to ensure that when the state “re-designs” the services and coverage plans for Native Americans that we don’t see any drop in enrollment or cuts to services like prescription medication, transportation, dental, and vision,”  Roanhorse said.

Asked why there should be a separate category for American Indians, Roanhorse pointed out that New Mexico receives 100 percent of the funding for Medicaid services provided to tribal members at IHS facilities and the Tribe-run 638 programs.

“[It's] fiscally advantageous to the state, especially in this economic climate, to maximize Medicaid in the Native population,” she said.

The memorials also point out that the American Recovery and Reinvestment Act (ARRA) of 2009  requires states to consult with federally recognized tribes on any Medicaid plan amendments.

While there is no current consensus as to how to answer the Medicaid question, more Federal funds for the program would help both those trying to balance the budget and those advocating for the health of our Native communities.

Last week, Senator Bingaman announced he would join in introducing legislation on Capitol Hill that would help New Mexico and all other states pay for the increased costs of providing health care.