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NATIVE ELDERCAREGIVER CURRICULUMNECC: 3.2HEALTH CARE SYSTEM
Caring for Our Elders: Health Care System: Accessing Resources for Native Elders 3.2
Caring for Our Elders: Health Care System: Accessing Resources for Native Elders 3.2
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Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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“System” can be very confusing
Elders & Families have many questions about access Who to go to? Where to go? How to pay?
Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
3
Excuse me…Could you tell me how to access the health care system????
By Understanding a Piece at a Time…
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Health Care System: Overview
I.H.S. (Indian Health Service) Medical, public health nursing, dental care, pharmacy services
Hospital & Clinic access No nursing homes No defined system of long-term
care
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Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
Health Care System: OverviewI.H.S. (Indian Health Service) Available services vary depending on: Federal Budget Alternative servicesContract care partnersService Area
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Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Tribal CHR Program (Community Health Representatives) “Vital Link” between health care
system & community’s access to services
Services vary by Tribe: determined by Tribal leadership
Some CHR programs are very dedicated to eldercare services
Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Tribal CHR Program
Need to know each Tribe’s priorities for the CHR program in their community
Potential for CHR programs to improve health care access is an untapped resource !!Would be logical for CHRs to lead HCBS
Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
9
Other Tribal Health-Related Programs Access for all tribal members
Services vary Tribe to Tribe Administered by Tribe directly Variety of services dependent on
available funding sources
Health System Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
10
Contract Health Services Mechanism to
purchase health-care services
Services that cannot be provided by I.H.S. or Tribal facilities
Health System Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Contract Health Services Person must be referred by I.H.S. Eligibility is generally restricted to:
those living on or near their home reservations
students/dependents away at school Because of limitations on funding
Priorities given to “life-threatening” & “urgent” needs
Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
12
Diabetes Programs IHS Special Diabetes Program for Indians (SDPI)Administered by I.H.S. or Tribal Health Programs
Programs designed to be specific to local Tribal needs
Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Diabetes Programs I.H.S. I.H.S. Department of Diabetes Treatment & PreventionClinical guidelines & public health approaches
Research & training & technical support
Develop educational materials
Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
143)
MEDICARE & MEDICAID* *with appreciation to the following resources:1)Baldridge, Benson, Carlson & Redford:
2004 “Tribal Guide for Elder Care: A Primer on Long-Term Care Services & Financing for Indian Elders”
2)“Building Partnerships: CMS, States, Tribes & Aberdeen Area I.H.S.” 2009 CMS Medicare & Medicaid Training, Sioux Falls, SD June, 2009
3) Wallace, S.P., Satter, D.E., Zubiate, A. 2003 “Medicaid Home Care and Tribal Health Services”: A tool kit for developing new programs.
MEDICARE as Health Insurance
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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A few slides about “Medicare”…
Health Care System: Medicare
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare: FEDERAL program People 65 years and older People who are disabled Based on a work history of the
individual (or the individual’s spouse) that entitles them to Social Security benefits
Health Care System: Medicare
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare: Special “eligibility” If not 65 years old yet & need services?
For knowing about special eligibility, it is best to visit with: Contract Health (CHS) Contract Health Services at IHS
IHS works with insurance eligibility and reimbursement issues full-time!
Easy to visit with CHS in own community
Health Care System: Medicare
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare PART A Covers: Hospitals for in-patient care
Including I.H.S. hospitals Skilled Nursing homes Home Health Care Hospice Care Blood transfusions
Health Care System: Medicare
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare PART B Covers: Outpatient medical/surgical services
Medical supplies Diagnostic tests Outpatient therapies
Health Care System: Medicare
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare PART B Covers: (cont’d)
Hospital and clinics (including I.H.S.) for health care services from: Doctors, nurse-midwives, clinical
social workers, clinical psychologists, registered dieticians, physical therapists & occupational therapists
Health Care System: Medicare
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare PART B Services (cont’d)
Part B can also cover: Outpatient Mental Health Some Preventive Services Other medical services
Health Care System: Medicare
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare PART C A form of “managed care”
insurance plan Not really applicable to Tribal communities
Health Care System: Medicare
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare PART D Prescription Drug
Coverage Available to all people with
Medicare eligibility IHS is approved as a
prescription drug providerElders can get their medications from IHS
Health Care System: Medicare
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare Regulations for Home Health:
Must require “skilled” care in the home professional nurse, therapist skills, etc.
Must be “homebound”, but can go to:religious servicesan adult day care programclinic or hospital
Health Care System: Medicare
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare for Home Health Will NOT be provided permanently Will NOT cover Personal care services
Unless part of the “skilled care” package for a limited period of time only
May cover medical supplies & equipment Will cover Hospice Care under Part A
Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare: Federal program Standardized services are available across the nation according to national eligibility regulations
Medicaid: A Federal-State program But is State administered Eligibility is determined by states Services are determined by states
Health Care System: Medicaid
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicaid: STATE-ADMINISTERED program…
SO, Services & eligibility vary
from State to State
“could you say that again?”
Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicare & Medicaid are both government funded health-related programs
Medicare is FEDERAL Program Same services across
the nation in every state
Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicaid is STATE –ADMINISTERED Program… so, Services vary from “state to state”
Eligibility is determined “state to state”
“thanks for the clarification!”
Health Care System: Medicaid
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicaid Usually is the “Payer of last resort”
But in Indian Country, I.H.S. is usually the “payer of last resort”
IHS will pay for services after all other insurance options have been utilized for health care payment Including CMS* payment
*Center for Medicare & Medicaid Services
Health Care System: Medicaid
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicaid: Eligibility for ELDERLY Based on financial need
Not based on work-history Elders 65 years of age & older Elders who are disabled Elders on Social Security Income (SSI)
automatically are eligible for Medicaid
Health Care System: Medicaid
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicaid Eligibility for Elders (continued): Elder must have extremely
low amount of assetsVaries from state to stateDon’t have to count the
elder’s home, car, clothing, household goods, burial plot
Health Care System: Medicaid
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicaid Pays for nursing home care
The elder’s resources have to be extremely limited they can keep their home, car, belongings
Health Care System: Medicaid
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicaid… (continued) Can ask the “estate” for some “pay-
back” after a person passes away…
BUT Medicaid will NOT take Tribal land or
income from Tribal land or items with spiritual or cultural significance to the Indian community
Health Care System: Medicaid
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Medicaid… (continued) Home Health Care Options under
Medicaid Will pay for “personal care” if elder is eligible
Bathing, dressing, cooking, cleaning Different from Medicare… more “non-medical”
type of services in the home Each State has its own mechanism for Personal Care Services through Medicaid Some states are very generous with elder benefits
for Home & Community-Based Services (HCBS)
Health Care System: Can feel confusing!
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Health Care System
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Challenge is to learn to navigate all of these agencies and services !
It can be done… Work with the “people”
who are in the system… A “system” is only as good
as its people! Essential to Build partnerships!
Can Find the Way to Resources!
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Know the PEOPLE For every program, find the
“key person” to “unlock the network resources” !
Use the RESOURCES MANY AVAILABLE! Websites, literature, Toll free phone numbers,
etc.
Understanding a Piece at a Time
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Health Care System: Medicare
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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QUICK REVIEW ! MedicareA “standard” federal
programPart A: Hospital insurancePart B: Medical insurancePart C: Medicare Advantage Part D: Prescription Drugs
Health Care System: Medicaid
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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QUICK REVIEW ! MedicaidFederal-State Health Care Program, but…Services & eligibility determined “state by state”Need to find out what is available for elderly in EACH state
Health Care System
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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Resource people can be the “guides through the maze”: Contract Health Services staff at IHS
Extremely knowledgeable of CMS funding resources, eligibility requirements, deductibles, monthly premiums, etc.
County Social Service Programs Particularly well-informed about
Medicaid funding & eligibility
Health Care System: Overview
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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“Thanks very much…”
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders
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