Could Indian reservations seek Medicaid expansion on their own?

Native American reservations are considered sovereign nations, which may give them an opportunity to expand Medicaid coverage despite the stance of the state where they are located, reported WyoFile.

Two tribes in Wyoming are asking the state Legislature to approve a demonstration project with the Centers for Medicare & Medicaid Services that would cover their members. Wyoming, one of the most conservatives states in the union, is not only against expanding the Medicaid program as part of the Affordable Care Act but does not plan to police whether the ACA is followed in other aspects. Moreover, under a recently enacted state law, Wyoming lawmakers would have to approve any waiver application that includes an expansion of coverage.

A federal waiver could cover as many as 5,000 Native Americans in Wyoming who are members of the Northern Arapaho and Eastern Shoshone tribes. They are among the state's poorest residents, and could comprise nearly a third of the Wyoming residents who would be eligible for Medicaid expansion under the ACA.

"The tribes deserve to be heard," Wyoming Rep. Elaine Harvey told WyoFile. "I'm listening. I would be open to a demonstration project."

Harvey and many other Wyoming officials are opponents of the ACA, which would cover up to 17,000 residents. However, they have noted that reservation residents often have extreme difficulty accessing care."The question is how to increase access to third-party payers who can provide coverage to community members," Patrick Goggles, head of the Wyoming Housing Authority, told WyoFile.

Native American communities are generally supportive of using waivers to expand Medicaid, according to research conducted by the Tribal Health Reform Resource Center.

To learn more:
- read the WyoFile article
- check out the Tribal Health Reform white paper (.pdf)

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