Eastern Shoshone Tribal Liaison Sara Robinson testified before the Wyoming Legislature’s Select Committee on Tribal Relations at the Joint Tribal Chambers in Fort Washakie on Tuesday. (Ernie Over photo) 

Part I of a series

(Fort Washakie, Wyo.) – The Wyoming Legislature’s Select Committee on Tribal Relations heard a plea from Wind River Reservation health advocates Tuesday morning for help in obtaining a Section 1115 Waiver in the Medicaid program. Eastern Shoshone Tribal Liaison Sara Robinson said the Wyoming Department of Health is prohibited from consulting with Tribal health officials on medicaid expansion efforts. That prohibition, she said, is blocking efforts to obtain a waiver which could allow reimbursements for adults up to 138 percent of the Federal Poverty Level who are also eligible for services at an Indian Health Services (IHS) facility. “Right now Director Tom Forslund is prohibited from talking to us. We want the ability for the Department of Health to communicate with us because we need to move forward as allies to obtain a waiver for this expansion,” she said.

According to Medicaid.gov, a Section 1115 Waiver allows states the flexibility to test new or existing approaches to financing and delivering Medicaid and the Children’s Health Insurance Program.

Robinson, and Wind River Indian Health Services CEO Richard Brannon both testified that the Federal Government only funds the IHS facilities up to 60 percent of its demonstrated need. “Congress expects the remaining 40 percent to come from third party reimbursements, through Medicare, Medicaid and private insurance,” they both said. Current reimbursements are barred for those who seek non-Western or traditional medicine, Robinson said.

A proposed fix that could allow the state to consult with the tribes is a draft bill (14LSO-0255.WI) that has not yet been sponsored for introduction.  Co-Chairman St. Sen. Cale Case of Lander said the proposed bill, in its current form, falls short of what the Tribes are asking.

Co-Chairman St. Rep. Patrick Goggles of Ethete said the legislation is needed because lawmakers in the last session prohibited the Governor and the Department of Health from any negotiation on Medicaid expansion.

St. Rep. Lloyd Larsen of Lander agreed and said any expansion now has to be approved by the legislature. “Prior to that the Tribes could come to the Department of Health, but now we have to hear it (at the legislature).”

“To be stewards of our responsibilities we need to understand the concept of what they (Tribes) are trying to do,” he said to the other Select Committee members. “If we do support this, there is a bunch of information that we still do not know. The Wyoming Department of Health had not been given any direction of what should be in the bill.” Larsen is also a member of the Wyoming House Labor, Health and Social Sciences committee, the legislative body that any health-related legislation would be funneled through.

Robinson said other successful Section 1115 waivers for other Tribal Nations came about through the states and tribes working together and then presenting the waiver application to the Centers for Medicare and Medicaid Services, known as CMS.

In Part II, County10.com will report on the medical challenges of the Reservation