Copyright © 2000 NLThomas
All Rights Reserved

Pictured Left to right - Anne Roberts, executive director, Oklahoma Health Care Authority, Pam Baumert, patient benefits advocate (PBA), CN AMO Community Clinic, Salina; Regina Christie, CN Health Service PBA program director; Nancy Smith, PBA, CN Redbird Smith Health Center, Sallisaw; Dr. Anna Mitchell, Medicaid Operations Director, Oklahoma Health Care Authority

TAHLEQUAH, OK - Cherokee Nation employees were recently honored for increasing enrollment in SoonerCare, Oklahoma’s version of public health insurance, which includes Medicaid and the Child Health Insurance Program (CHIP). The Oklahoma Covering Kids Partnership presented an award to the patient benefits staff of the Cherokee Rural Health Network, acknowledging their work in collaborating with local offices of the Department of Human Services.

The award congratulates the CRHN staff for helping to increase operating revenue for the federally funded facilities, and acknowledges the specialized skills required to enroll Native American patients in state-administered programs.

According to Mim Dixon, executive director of the Cherokee Nation Health Service, I.H.S. funded facilities have been designated as "payers of last resort," when other resources are available to patients.

"This basically means that we are obligated to collect revenues from any third-party payer for which a patient may be eligible," Dixon said. Third party payers include Medicaid, Medicare and private insurance.

The U.S. Congress funds much of the care provided through the Cherokee Rural Health Network. That funding amounts to roughly $600 annually per patient, compared to $3,000 per patient for Medicaid. According to Hickory Starr, service unit director for the W.W. Hastings Hospital in Tahlequah, it just makes sense to collect reimbursements from Medicaid, Medicare and private insurance for eligible patients.

"Every change that occurs in the regulation of health care funding on a national level presents a challenge to providers," said Starr. "We must not only change the way we think and do business, but we must educate our patients and the public at large on the rights and responsibilities of beneficiaries. We cannot continue to think and operate as the old I.H.S. We must do business like the rest of the health care industry I am very proud of the staff for finding ways to help our patients that also helps the hospital," Starr said.

Denise Exendine, Hastings business office manager, said the hospital has increased its Medicaid collections by $3.5 million since implementing its patient benefits program in Fiscal Year 1997.

"It is so exciting to see that collaboration among hospital staff, the Cherokee Nation and the Department of Human Services has made it possible for us to serve so many people in our community," Exendine said. "Simply by taking the time to explain benefits and assist in completing paperwork, they not only help patients pay for care, but they also help the hospital and clinics continue operating with very limited federal funding." Exendine said once patients are enrolled in a third-party program, that program will reimburse any authorized health care provider, including those to whom referrals must be made when necessary services are not offered at a tribal or I.H.S. facility.

Last year, the tribal health service initiated a program to increase the number of patients enrolled in SoonerCare and other third-party benefits. According to program manager, Regina Christie, the program’s staff already worked in the clinics and was familiar with the patients. The program kicked off by mailing out over twelve thousand SoonerCare applications.

"One of the biggest challenges we have is to explain the importance of SoonerCare benefits to our Indian patients in a way that clearly demonstrates it does not replace their right to obtain health care from a tribal or I.H.S. facility; it merely helps that facility pay for the cost of providing care," Christie said.

The Cherokee Rural Health Network refers to facilities funded through the U.S.P.H.S./Indian Health Service (I.H.S.) located at Tahlequah, Stilwell, Sallisaw, Salina, Jay, Nowata, and Muskogee. The I.H.S. operates the W.W. Hastings Hospital at Tahlequah, and the tribe operates outpatient clinics in the other six sites. The group received the award as a result of increased enrollment in SoonerCare, Oklahoma’s version of public health insurance, which includes Medicaid and the Child Health Insurance Program (CHIP).

The Oklahoma Covering Kids Partnership is a cooperative of the Oklahoma Institute for Child Advocacy, the Oklahoma State Department of Health, the Oklahoma Primary Care Association, the Oklahoma Health Care Authority and the Oklahoma Department of Human Services Caring Program for Children. The group sponsored a two-day networking seminar in September where the award was presented to the Cherokee Rural Health Network staff.