Medicaid pumps outside money into poor Indian health system

OKLAHOMA CITY (AP) _ If it weren't for Medicaid, Billie Pumpkin's 16-year-old son probably would not have been eligible for surgery when he tore cartilage in his knee last fall. <br/><br/>Ridge

Monday, August 23rd 2004, 6:05 am

By: News On 6

OKLAHOMA CITY (AP) _ If it weren't for Medicaid, Billie Pumpkin's 16-year-old son probably would not have been eligible for surgery when he tore cartilage in his knee last fall.

Ridge Sanders was treated for his football injury at the Cherokee Nation's W.W. Hastings Hospital in Tahlequah. SoonerCare, which administers Medicaid, paid for a picture of the inside of Sanders' knee. Three weeks later, he had surgery.

The family, members of the Cherokee tribe, could have asked for federal health care money distributed to the Cherokee Nation, but that money gets allocated by priority. ``Life or limb'' medical problems get treated first; everyone else needing a procedure goes on a waiting list.

Sanders probably would have been denied surgery because his injury wasn't serious enough, Pumpkin said. With Medicaid, he got the treatment he needed, quickly.

In the cash-strapped, overburdened American Indian health care system, Medicaid is an extra source of funding. Oklahoma officials are working to enroll more Indians in Medicaid to give them access to better health care and to save the Indian clinics money.

Federal funding for clinics in this region is about half the national average, despite Oklahoma having the second-largest Indian population, behind California. The funding formula, based on factors such as life expectancy and poverty, doesn't consider population, said Chris Walker, a senior health official for the Cherokee Nation.

Indian Health Service, in the U.S. Department of Health and Human Services, provides an average of $900 per Indian for health care in Oklahoma, Kansas and Texas. The national average is $1,600 to $1,900 per tribal member, said Steve Barse, an Oklahoma spokesman for IHS.

The funding level limits the number of clinics that tribes can build and number of doctors they can hire, Walker said.

Patients commonly wait months for appointments at Indian clinics.

``The issue in Oklahoma is access,'' Walker said.

Medical workers at Hastings Hospital see about 600 patients a day, he said. Plus, many Indian clinics in Oklahoma only have enough space for one doctor and one or two examination rooms.

When eligible Indians enroll in Medicaid, they have access to other medical clinics, not just the overwhelmed Indian clinics.

``We think we have a really good system here and that we could benefit our Indian Medicaid recipients by improving their access to health care facilities,'' said Trevlyn Terry, manager of Indian Health Services for the Oklahoma Health Care Authority, the state Medicaid agency.

About one in six Oklahoma Indians is enrolled in Medicaid. Terry did not know how many Indians were eligible.

One benefit for patients on Medicaid is a wider selection of medicine than they would get from the federal government through tribal clinics, she said.

But individual Indians often don't see the benefits to using Medicaid because much of their medical care is paid by the federal or state government, Terry said.

Oklahoma Medicaid officials want to sign up Indians for the federal assistance because it's their right as U.S. citizens, Terry said.

And when Indians use Medicaid at tribal clinics, it saves the state money.

The federal and Oklahoma governments pay about $28 million a year for Medicaid services for Oklahoma Indians, Terry said.

The state could save every penny of its share if Oklahoma Indians exclusively used tribal clinics.

If Indians use the clinics, the federal government pays 100 percent of the cost. If they go to non-Indian hospitals, the state picks up 30 percent of the tab.

``It's not like we're trying to discourage anyone from going to the provider they want,'' said Debra Isham, tribal liaison with the health care authority.

In fact, many Indians don't need to be convinced to use tribal clinics, despite the long waits and hassles over funding.

For Pumpkin, it's less of a hassle to always use Hastings Hospital. Then, she doesn't have to fill out paperwork to change her primary care provider every time she steps outside the Indian health care system.

Her two sons were born at Hastings Hospital, and their doctor knows the family's medical history.

Walker and Isham described patients as extremely satisfied with Indian clinics, except for the long waits.

``I think some people are more comfortable going to the clinics,'' Isham said, ``because that's where they've always gone.''