WINDOW ROCK

“We’re really excited about this this opportunity because it puts the health-care effort in Navajo hands so we, as Navajo people, through an assertion of sovereignty, are able to run a managed care organization,” said Naat’aanii Development Corp. Board Chairman Manley Begay at a New Mexico Human Services Department tribal consultation last month.

“It allows to do things the Navajo way,” said Begay. “It allows us to put Navajo culture in health care. We don’t want someone else to do it for us. We want to be running the show. We want to be calling the shots.”

On Friday, Nov. 15, at 1 p.m. there will be a Naabik’iyati’ Committee work session at Twin Arrows to review plans for the proposed Indian Managed Care Entity partnership between Naat’aanii Development Corp., Molina Healthcare and the New Mexico Human Services Department, that is poised to deliver Medicaid to Navajo.

Speaker Seth Damon said that the work session will gather everyone involved with the project to address any outstanding questions.

It follows a public tribal consultation in Gallup last month between HSD, Council and the president’s office, where officials from NDC and Molina shared plans for the IMCE rollout.

Many questions came up, including whether there needed to be additional state-tribal government-to-government consultation and what role each of the three partners would play.

“The number one priority in this entire matter is protecting the health care for our Navajo people,” said President Jonathan Nez in an Oct. 30 statement. “We are evaluating the partnership between Molina Health Care and Naat’aanii Development Corporation. It’s unclear when or if a contract may be signed until we gain more information and a clearer perspective.”

The IMCE project officially got its start under the leadership of President Russell Begaye in 2018 when New Mexico received approval by the Centers for Medicaid Services to start a pilot program for an IMCE with the Nation.

“We believe transparency and freedom of choice is key in this process,” said Nez. “As we move forward, we expect Molina Health Care and Naat’aanii Development Corporation to be forthcoming with detailed information that outlines how and who exactly will manage and oversee the health care benefits.

“We also expect the state of New Mexico to honor its government-to-government consultation obligations – this needs to happen before we consider any further action,” he said.

NDC’s interim CEO, Robert Joe, emphasized in an interview last week that the agreement with HSD is not between the state and the Navajo Nation, but directly with NDC, owned by the Nation.

“It’s not a direct agreement with the tribe,” said Joe.

“The Section 17 (NDC) is separate, stand-alone, and only tangentially tied to Navajo Nation,” explained Chairman Begay.

Support for project

NDC’s proposed IMCE has official support that includes Council’s Health Education and Human Services Committee, the Diné Hataalii Association, and First Nations Community Healthsource, and more is forthcoming, said Joe.

“As a HEHSC committee, it is our fiduciary duty to look out for the well-being of our Navajo people,” said Vice-Chair Charlaine Tso. “This took time to investigate, consider, and approve. We need to focus on opportunities that will reinvest in our tribe, and provide jobs. This will do all the above.”

Begaye had touted that the NDC IMCE would be the first of its kind in the country and suggested the potential revenues could bring in billions of dollars to the Navajo economy.

“Its something good for the people and good for the nation,” said Joe. “Opportunities like this do not come by that often.”

In his presentation at the state-tribal consultation in Gallup, HSD Cabinet Secretary Dr. David Scrase said that the proposed IMCE could generate up to $470 million in annual payments to the Navajo nation if 70,000 people enrolled.

“We are hoping that this effort will achieve that balance of providing great access to services that are of high quality while doing at a cost that we can afford and is sustainable,” said Scrase.

Scrase, who is a practicing physician, said the program would prioritize prevention and wellness, case management and care coordination, and customize programming to mitigate health disparities by addressing individual and community needs on Navajo.

“We actually have an opportunity to fashion a plan that focuses on some of the top health risks that include heart disease, cancer, diabetes, dementia and liver disease,” he said.

Request for Information outdated

In February of 2018, the Navajo Nation submitted a response to a request for information from HSD regarding the proposed Navajo IMCE.

The 318-page document, signed by former President Begaye, details plans for how the Navajo IMCE project would be structured and administered. It lists NDC as the company that would run the IMCE along with a health care company named Agilon Health Inc. and includes a list of executives who would be hired.

However, since then NDC has move forward and replaced Agilon with Molina Healthcare, but there has been no official update to the 2018 RFI submission.

Joe said that from what he understood the “legal team from the state and Molina and our side, we all agree, there’s no need to go and do another update (to the RFI).”

“It’s already done,” said Joe “We’ve already satisfied the requirements.”

He says there is an internal business plan being finalized for the new partnership with Molina, but that can’t be shared publicly yet.

“It’s competition sensitive,” said Joe.

However, when Scrase was asked if HSD will be issuing a new RFI, he responded by saying, “As a result of the collaborative process between President Nez, NDC, Molina and HSD, all the concerns will be addressed. HSD has not yet decided whether to have NDC redo the RFI. We are waiting for a tribal decision to move forward.”

Delegate Carl Slater said that he hopes that Nez will open a line of communication to the Council about his communications on behalf of the Nation regarding “this historic opportunity to assert sovereignty and self-determination.”

He said HEHSC is currently drafting legislation to support the NDC-Molina proposal.

“Our support as a committee is unequivocal,” said Slater. “We are happy to meet with the president, governor, and HHS secretary to address this opportunity in a unified, transparent manner.”

‘… do our research’

“It is quite important that the state of New Mexico take a very close look at any entity that’s going to do business with the Navajo Nation government,” said Deputy Chief of Staff Milton Bluehouse, who spoke on behalf of Nez at the Oct. 9 consultation.

Bluehouse emphasized that the government-to-government relationship is a “sacred obligation” there to protect Navajo people’s health and resources.

“When we talk about health care, we’re not talking about 470 million dollars. That’s why people are excited about it,” said Bluehouse. “What we’re really talking about is improving Navajo people’s health, and giving them the quality of care in a timely manner.”

Bluehouse said that it is also critically important that consultation occur with Navajo Nations federal partners, such as IHS and ’638 contracted health facilities, with Nez and the Council at the table.

“I would certainly hope that the Navajo Nation Council and the various committees have taken a look at this voluminous document and have asked the very same 17 questions,” said Bluehouse.

Bluehouse stressed that the answers to the questions are very important. He added that since the Oct. 9 meeting when he requested updated answers to the “17 questions” from NDC, he has not yet received them even though the president’s office was told they would be provided weeks ago.

“We’re going to provide them some updates, but we’re not required to,” Joe said about providing the information.

The question remains how much information is a Section 17 such as NDC required to share with the Nation without comprising potential business deals and legal agreements?

“It is upon us to do our research to make sure we don’t race headlong into a situation where two to three nears from now, we’ve got 50-70,000 Navajo people on the receiving end a bad decision,” said Bluehouse.

How enrollment will work?

It is estimated that of the approximately 100,000 Navajos who live in New Mexico 75,000 could be eligible for the Navajo IMCE Medicaid program.

To qualify, participants will need to be a member of a federally recognized tribe or married to one, live on the Navajo Nation, and meet federal residency and income requirements.

Once enrolled, IMCE members would be have access to a provider network that includes Molina’s as well as services they already use such as IHS, and tribal and urban Indian health care providers.

Joe said the primary purpose of the Oct. 9 tribal consultation was not to approve the project but instead to discuss the two options for enrolling Navajos in Medicaid in order to move the project forward.

Scrase explained that “passive” enrollment would offer automatic enrollment by zip code on Navajo, with the option for enrollees to opt out afterwards. “Active” enrollment would require applicants to apply individually for benefits through a Medicaid enrollment specialist.

All parties involved with the partnership recommend the more efficient passive enrollment option and it is open to debate whether active enrollment would even be economically feasible.

However, passive enrollment presents other questions such as do individuals have a right to say they don’t want to be automatically enrolled?

Also, Medicaid is guided by strict federal regulations that require enrollees to share their personal data, which some people don’t want to do.

Speaker Seth Damon, who was not present at the Oct. 9 consultation, said that he wondered if the Navajo people should be engaged first with community hearings about the critical enrollment question.

Partner roles

Carolyn Ingram, a senior vice president at Molina, said the IMCE program will be tailored to Navajo and will encompass cultural and language preferences and support traditional healing models.

In her report she clarified that HSD will have the authority over New Mexico’s Medicaid program Centennial Care (2.0), and will “monitor compliance with contractual requirements.”

NDC, the owner of the IMCE contract will “provide direction and strategy,” “lead relationship efforts,” and provide customer care.

Meanwhile, Molina Healthcare will be a subcontractor to NDC that will “conduct health plan operations,” offer a provider network, and handle “claims payments, data reporting, and quality and provider services.”

Ingram said that through Molina’s existing network, members will have access to primary and specialty care providers across New Mexico, Arizona, Utah and Texas.

“We want people to get care where they are used to getting care,” she said. “This gives Navajo Nation opportunity to create something that can span over several different states to make it seamless.”

Joe confirmed that while Molina will handle the more technical aspects of the operation, NDC will manage administrative functions, including government affairs, marketing and public relations.

He estimates that the combined staff to run the IMCE will total approximately 200 employees.

“Everything depends on the enrollment decision,” said Joe, which will determine the number of members and thus the amount of revenues.

“That is the pivotal point,” he said.