New Federal Policy Could Help Close the Gap

On average, Native Americans in Wisconsin die 14 years sooner than whites! In 2014, the average age at death for Native Americans was just 63 years, compared to 77 years for white Wisconsinites.

Think about that.  Fourteen years is 5,110 days, or 122,640 hours!

Think about someone you know who died too soon because of a disease or an accident.  Imagine what they might have done or what you might have done together if they had had another month or another year. Now think about the difference that an additional 5,110 days could make.

A new Wisconsin Council on Children and Families (WCCF) report, “Closing Gaps in Native American Health,” looks at the disparities in health care and health outcomes between white Wisconsinites and Native Americans, and it summarizes a recent federal policy change that could help reduce the alarming gaps. Those health disparities include the following:

• The age-adjusted mortality rate was nearly 50% higher for Native Americans in Wisconsin in 2014 than for whites (1036 vs 702 deaths per 100,000 people).
• The 2014 diabetes mortality rate was nearly four times higher for Native Americans in our state than for whites.
• The infant mortality rate for Native American children in Wisconsin was 69% higher than the rate for white children during the period 2012 to 2014.

Under a Medicaid policy change announced in February, the federal government will pay the full cost of a broader range of Medicaid health care services for Native Americans. Up until this year, full federal funding was available for Medicaid services provided at Indian Health Service (IHS)/tribal clinics, but not for care that the same patients have to go somewhere else to receive. The new policy will also pay the full Medicaid costs of other care provided to Native Americans, if it is delivered by providers under contract with an IHS clinic and that clinic refers the Medicaid patient and continues to oversee their care.

The policy change could yield significant savings in the Medicaid budgets of states with substantial Native American populations. In South Dakota, for example, officials are exploring the possibility of using the savings to pay for the state share of costs for an expansion of Medicaid eligibility.

Sashi Gregory, WCCF’s health policy analyst, said it is too soon to know if there will be significant savings in Wisconsin, and she added that the extent of those savings is not the key question. “The much more important issue,” Gregory said, “is figuring out how best to take advantage of the new opportunity to fill gaps in health care services for Native Americans in Wisconsin, including things like mental health services and substance abuse treatment.”

State and tribal health officials in Wisconsin are in the early stages of determining how to best utilize the new opportunity to increase the federal share of health spending for Native Americans and improve access to care and care coordination.

Jerry Waukau, health administrator of the Menominee Indian Tribe of Wisconsin, said that tapping the full potential of the broader eligibility for 100 percent federal funding will not be a simple thing to accomplish because there are administrative challenges for tribal officials and the Wisconsin Department of Health Services to overcome.

“Despite those challenges, we’re optimistic that the policy change provides an avenue for removing some of the barriers to increasing access to care and improving health care outcomes for tribal members,” Waukau said.

Eliminating the enormous health disparities will require much more than implementation of the recent Medicaid policy change; Wisconsin will also have to alleviate poverty and mitigate other social determinants of health. In the meantime, improving access to quality health services is a very important place to start.

If state health officials, Indian Health Services, tribal clinics, and private providers work together to take advantage of the potential increase in federal funding, we can begin to close the unacceptable gap of 14 years between the lifespans of Native Americans and white Wisconsinites.

Jon Peacock