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OCR Page 1 of 80JUN. 17. 1997 10:29AM
CRIHB
NO.766
P.1/1
CALIFORNIA RURAL INDIAN HEALTH BOARD, INC.
1451 River Park Dr., Suite 220
Sacramento, CA 95815
(916) 929-9761
Fax (916) 929-7246
FAX MEMORANDUM
TO:
Ms. Lynn Cutler
Intergovernmental Affairs
White House
202/456-2889
FROM:
Barbara Beller Barbara Beller
Tribal Government Resource Specialist
SUBJECT:
House Budget Reconciliation Bill/Medicaid
DATE:
June 17, 1997
I am writing on behalf of 33 tribes and 12 tribal health programs in California to alert the
Administration on proposed language contained in the House Budget Reconciliation Bill
that would be devastating to tribes and tribal health programs nation wide.
Provisions include mandatory enrollment in managed care. It would authorize states to
require all Medicaid beneficiaries to enroll in a managed care organization that serves
only Medicaid eligible individuals. These organizations would not be required to
contract with tribes or Indian Health Service facilities. States would not be required to
provide care that has been culturally appropriate within the Indian health system.
The language would also phase out payments to federally qualified health centers over
the next five years, giving the states the option to set FQHC payments. The managed
care organizations (Medicaid) would not be required to contract with FQHC'
Lastly, the bill would establish a block grant to the states to provide health coverage to
uninsured low-income children. It would be in the form of an entitlement to the states
with no protections for Indian children and tribes. There would not be set asides for
tribes and funding for tribal child health would be at the discretion of each state.
Additionally, states could use their block grants for health insurance or direct purchase of
service from providers. Again, the states would be authorized to exclude IHS and tribal
health programs by geographical area.
It is my understanding the bill will be taken up in the Senate Finance Committee in the
next couple of days. We are asking the Administration to keep a watchful eye should
these provisions make their way to the President's desk. We are of course taking the
appropriate actions with committee members and will request Senator Nighthorse
Campbells intervention on behalf of tribes.
Any additional information you could provide to me on this matter would be appreciated.
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