Exploring the Feasibility of a Navajo Nation Medicaid Agency

Last updated Sep 27, 2018 | Published on Sep 13, 2018

Econometrica relied on secondary data and site visits to examine several issues.

State Medicaid administration has additional complexity when Tribal lands cross State lines. The Navajo Nation extends across three States, creating challenges for Medicaid beneficiaries and healthcare providers on Navajo lands.

The Navajo Nation advocated for the creation of a Navajo Nation Medicaid agency to reduce this complexity. The Navajo Nation’s boundaries extend across Arizona, New Mexico, and Utah, meaning residents of Navajo lands may be eligible for Medicaid programs in those States, depending on where they live. The Indian Health Care Improvement Act mandated the Secretary of the U.S. Department of Health & Human Services to study the financial and operational implications of the creation of a Medicaid agency for the Navajo Nation, affected States, and the Federal Government.

On the Navajo Nation Feasibility Study, awarded to Econometrica under the Small Business Research and Demonstration (SBRAD) indefinite delivery, indefinite quantity (IDIQ) contract, we assessed the feasibility of establishing a Navajo Nation Medicaid agency.

The study addressed several issues related to the feasibility of a Navajo Nation Medicaid agency. These included startup requirements and costs, requirements and costs of ongoing operations, cost implications for the Navajo Nation and the Federal Government, legal and regulatory issues, and the impacts on the three States currently serving Navajo Nation residents. The study also addressed potential models that could serve as a basis for a plan to design, implement, and operate a Navajo Nation Medicaid agency.

A new agency would provide consistent eligibility rules and benefit packages, provider participation and requirements standards, and claims submission processes for all residents of the Navajo Nation. In addition, a Navajo Nation Medicaid agency would be able to tailor Medicaid to increase cultural appropriateness and responsiveness to Navajo traditions, which, in turn, could improve healthcare use, preventive behaviors, and positive health outcomes.

The methodology for the study included analysis of secondary data and site visits. We used data from a variety of sources, including:

  • 2010 Census data.
  • Data from the States of Arizona, New Mexico, and Utah.
  • 2010 Federal Medical Assistance Percentage rates for each State.
  • A Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary report on 2010 spending.
  • Medicaid budgets and program spending for several small population States and U.S. territories.

We also conducted site visits and discussions with Navajo Nation leadership and the state Medicaid agencies of New Mexico, Arizona, and Utah. Through these discussions, we gathered information to structure the cost estimates, develop the assumptions used to produce the estimates, and understand the impact a Navajo Nation Medicaid agency would have on the affected states’ Medicaid systems. CMS used our Final Report on these topics to develop the Report to Congress on the potential costs and implications of a Navajo Nation Medicaid agency.

About Econometrica:
Founded in 1998, Econometrica is a research and management organization in Bethesda, MD, established to provide public- and private-sector clients with customized program support services. Econometrica works with multiple agencies to provide high-quality, cost-effective analyses, modeling, and economic evaluations. The company consistently receives exceptional scores from its clients and believes in three principles: technical capabilities, happy customers, and business development.

The study addressed several issues related to the feasibility of a Navajo Nation Medicaid agency. These included startup requirements and costs, requirements and costs of ongoing operations, cost implications for the Navajo Nation and the Federal Government, legal and regulatory issues, and the impacts on the three States currently serving Navajo Nation residents.

See our report here

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