April 16, 2014
Enthusiasm and Partnerships Overcome the Vastness of Alaska for Healthcare Enrollment (National Minority Health Month)
By: Rebecca Owl Morgan

In recognition of National Minority Health Month, the Diverse Elders Coalition is featuring stories relevant to the health disparities and health issues affecting diverse older adults during April. A new story will be shared every Wednesday with additional posts shared throughout the month. Be sure to visit diverseelders.org regularly during the month of April.

The Alaska Native Tribal Health Consortium (ANTHC) has a bold vision: to ensure that Alaska Native people are the healthiest people in the world. By working to ensure that all Alaska Native and American Indians in Alaska have health insurance, the ANTHC is helping to eliminate long entrenched health disparities. ANTHC was formed almost 20 years ago as a nonprofit health organization that offers quality health care services for all Alaska Natives and American Indians.

Monique Martin - ANTHC Healthcare Navigator

Monique Martin – ANTHC Healthcare Navigator

Recently, the National Indian Council on Aging (NICOA) spoke with Monique Martin, a dedicated healthcare navigator for ANTHC. Growing up in Southeast Alaska gave Monique insight on the best ways to communicate with Alaska Native/American Indian elders across the state. She has traveled the land, teaching about the Affordable Care Act, enrolling and sharing what she knows.

Partnerships were formed with other organizations that had a shared vision to help in tackling the task. The United Way of Anchorage, AARP, Alaska Primary Care Association and the Anchorage Neighborhood Health Center all came together to spread the word about the Affordable Care Act.

Monique said that when they started there was a general lack of information and citizens were seeking a source for reliable, unbiased information. ANTHC has become that source with a content-rich website that has an authentic “Alaska feel”. To make sure the educational materials had that crucial “Alaska feel” they made everything as Alaska Native specific as possible. They took generic PowerPoint slides and took out anything that did not apply to Alaska. They added pictures that reflected the people they were speaking with. They stuck with plain language. For example, instead of the phrase “shared responsibility”; they used the term “tax penalty”. The result was that the message felt like it was coming from your neighbor, someone you know. Personalizing the message makes it more real and more believable.

Alaska Natives have a unique status and have formed regional and village corporations of which they are shareholders. By working with these corporations (see explanation below: What is the Alaska Native Claims Settlement?) Monique was able to spread the word using this existing network. The materials they developed were shared and placed in newsletters, posted online, promoted by other health organizations and announced at monthly meetings and presentations.

To overcome their lack of resources they used a train the trainer approach. When they trained a group in Kodiak, they made sure to focus on training people in Kodiak who would then carry on with the trainings. The local knowledge of the trainer helps to tailor the training to the concerns specific to that region. The people receiving training would see a member of their community, a trusted person explaining these sometimes confusing concepts. The webinars they offered have trained over 4,000 people. The tribes were very involved, some received Health Resources and Services Administration (HRSA) grants to do outreach and education.

Monique laughed as she said that “After a time, the process of outreach took on a life of its own”.

Alaska is made up of many groups gathered under the term Alaska Native. There are around 140, 000 AN/AI people living in the state, comprising over 20% of the population. A short list of tribal groups includes: Athabaskans, Eyak, Tlingit, Haida, Tsimshian, Eskimo (including Iñupiat, Yup’ik and Sugpiag) and Aleut. But Alaska is also home to many American Indians. So instead of the usual abbreviation American Indian/Alaska Native (AI/AN), they reverse the order to become Alaska Native/American Indian (AN/AI). Monique mentioned that it is best to be as specific as possible when referring to tribes in Alaska. People are proud of their heritage and prefer not to be lumped together.

At informational meetings AN/AI elders tended to follow a pattern that she found endearing. Their first question was: What do I need to do to be in compliance with ACA? Once they received a clear answer their next questions invariably focused on the rest of their family. They were very concerned that no one was left out and everyone could be cared for. Monique made sure that elders and others understood about the special provisions for AN/AIs, including monthly open enrollment. This is an important message: Open enrollment continues for all AN/AIs who are members of federally recognized tribes or Alaska Native Corporations. So enrollment efforts will continue for ANTHC and their partners.

To enroll, AN/AI elders need to document that they are members in a federally recognized tribe or Alaska Native Corporation. Most have some form of verification: either a tribal enrollment card, enrollment in an Alaska Native corporation, or have a Certificate of Degree of Indian or Alaska Native Blood (CDIB) from the Bureau of Indian Affairs.

Monique encountered some unique barriers to enrolling AN/AI elders. For example, the sheer size of the state makes reaching every community difficult. Some places are only accessible by plane or at certain times of the year. The open enrollment period fell between October to March and winter weather can derail the best laid plans with storms and icy roads. Internet access is very spotty. And the well-loved ANTHC health care system made it hard to convince people that they needed to do anything. The ANTHC has established itself as a gathering place and a trusted location in Anchorage. When people are in town they go to the hospital and have breakfast, they look to see who is in the hospital and visit and share a smile and laugh with them. These sorts of strong neighborly, cultural connections help a patient who may be going through a tough procedure. So Alaska Natives didn’t quite see the need to adopt the new improvements offered in the ACA since they are already very satisfied with their care. But the new changes are an opportunity for improved funding and would bring in more money to an underfunded system.

Alaska governor Sean Parnell chose not to expand Medicaid. This decision has led to a Medicaid gap. As many as 32,000 Alaskans fall into this gap where they make too much money to qualify for Medicaid or don’t qualify for other reasons. Many assume that the Indian Health System (IHS) is paying 100% of their medical costs and that is not the case. The IHS system is funded for only 50% of funding actually needed. The IHS also doesn’t cover travel expenses but Medicaid does. If an elder has complex health care needs, for example an organ transplant, they will be transported to Seattle and insurance would help cover these travel costs. When it is possible to bill 3rd party insurance like Medicaid, Medicare, retirement or private insurance it helps to build a more robust tribal health system. Monique said that ANTHC has a great relationship with the local IHS, they work together well. ANTHC stays connected with national groups and works with advisory groups within IHS and CMS on how to best serve AN/AI people.

Now that the general open enrollment deadline is over they want to continue their efforts to enroll documented AN/AIs with a media campaign and to reach out to even more rural elder Alaskans. They may seek permission to broadcast over CB radio to those in areas with no radio, internet or other forms of communication. They will continue to educate and enroll. Some tribes are looking at purchasing insurance on the marketplace for their members. ANTHC is actively working to expand Medicaid in Alaska. Check out what they are doing to empower Alaskans to take charge of their health by clicking the logo below.


What is the Alaska Native Claims Settlement?

In December 1971, Congress enacted the Alaska Native Claims Settlement Act (ANCSA), a historic measure intended to resolve the long-standing issue of aboriginal land claims in Alaska. ANCSA had another purpose, to create a mechanism for economic development in Alaska, particularly in rural areas. It was Congress’s intent that Alaska Native people, the shareholders of private corporations created by the Act, would guide this development.

Under the 1971 Act, Congress created the 12 regional corporations and more than 200 village corporations. A 13th corporation, based in Seattle, Washington, also was formed. Both land and cash were involved in the settlement. The corporations were formed to receive approximately 45 million acres of land transferred from federal to private ownership and to manage investment of $962 million appropriated by Congress as the cash part of the settlement. An exception to this is that the 13th corporation received no land.

From the Bristol Bay Native Corporation website, http://bbnc.net/index.php/our-land/ancsa

Rebecca Owl Morgan is a Project Coordinator at the National Indian Council on Aging, Inc. (NICOA). The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.


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