Tribal Health set to make Medicaid determinations
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ST. IGNATIUS — Confederated Salish and Kootenai Tribal Health (CSKTH) is now set to make Medicaid eligibility determinations, and perform functions related to the eligibility process, in an effort to enroll individuals applying for Medicaid in a more timely and convenient process.
This new authority delegates responsibility to Tribal Health to act in a manner similar to other state public assistance offices throughout Montana.
“With expanded Medicaid in Montana, there is an opportunity to provide increased healthcare access so that no one is left without healthcare coverage,” said Joe Durglo, Tribal Health Business Office Executive Director. “This new authority allows for Tribal Health to make a determination on an individual’s application for Medicaid— allowing for more expediency and convenience for applicants.”
Montana’s Department of Public Health and Human Services (DPHHS) is the single state agency to administer the Medicaid program in Montana. Under this new agreement with the state, CSKTH is designated as a local public agency on behalf of DPHHS, accepting oversight authority and supervision to the same extent that other local agencies are obligated to administer Medicaid eligibility under the State Plan.
Kelly Pierre has been announced as the new Tribal Health Medicaid Eligibility Lead, providing direction to personnel known as Medicaid Eligibility Technicians, and who will be making determinations in Tribal Health Centers. (See inset)
Montana Medicaid is income-based health care coverage for qualifying Montanans and is run by DPHHS (Montana Department of Public Health and Human Services). Healthy Montana Kids Plus (HMK Plus) is income-based health coverage for children in Montana and is also run by DPHHS. The State of Montana pays a small portion of the cost of Medicaid and HMK Plus and the federal government pays the rest. Medicaid and HMK Plus do not pay money directly to beneficiaries. Instead, payments for health care services are sent directly to health care providers. If Medicaid and HMK Plus pay for health care services, it must be medically necessary. Services must be provided by a health care provider who is a Montana Medicaid or HMK Plus provider and services must be Medicaid or HMK Plus covered services.
In addition to providing Medicaid eligibility determinations, Confederated Salish and Kootenai Tribal Health provides comprehensive health services at centers across the Flathead Reservation, including: medical, behavioral health, dental, optical, audiology/speech, community health, physical therapy and pharmacy.
