native American Health Programs Face Uncertainty amid potential Medicaid Cuts
Table of Contents
- 1. native American Health Programs Face Uncertainty amid potential Medicaid Cuts
- 2. The Looming Threat to Tribal Healthcare
- 3. Medicaid’s Vital Role in Indian Country
- 4. Disparities and the Fight for Access
- 5. Political Crosscurrents and Potential Exemptions
- 6. State-Level Concerns and Shifting Costs
- 7. Financial Realities and the Path Forward
- 8. what specific actions can be taken to mitigate the negative impacts of Medicaid cuts on Native American healthcare access and outcomes?
- 9. Interview: Medicaid Cuts and the Future of Native American Health
March 19, 2025
Tribal leaders and health officials across the United States are expressing deep concern as Congress considers significant reductions in federal Medicaid funding. These cuts could severely impact healthcare services for Native American communities, which heavily rely on Medicaid to address chronic underfunding from the Indian Health Service (IHS) and to combat persistent health disparities.
The Looming Threat to Tribal Healthcare
As the U.S. Congress debates perhaps sweeping cuts to the federal Medicaid budget, healthcare providers serving Native American populations are preparing for the worst. The Oneida Community Health Center near Green bay, Wisconsin, serves as a stark exmaple. With over 40% of its 15,000 patients enrolled in Medicaid, the center faces a dire future if the proposed cuts are enacted.
Debra Danforth, director of the Oneida Complete Health Division and a citizen of the Oneida Nation, emphasizes the potential devastation: “It would be a tremendous hit.” The facility provides a wide array of essential services,including ambulatory care,internal medicine,family practice,and obstetrics,to the oneida Nation’s approximately 17,000 members. The center’s “open-door policy,” extending care to members of any federally recognized tribe, underscores its critical role in the region.
Danforth’s concerns are echoed by tribal health officials nationwide, who fear that Medicaid cuts will inevitably lead to service reductions and compromised care for Native Americans.
Medicaid’s Vital Role in Indian Country
The relationship between Native American communities and Medicaid is unique and deeply intertwined. Medicaid serves as a crucial supplement to the chronically underfunded Indian Health Service (IHS), the federal agency tasked with providing healthcare to Native Americans. Medicaid has historically accounted for about two-thirds of third-party revenue for tribal health providers, providing much-needed financial stability and enabling facilities to cover operational costs.
Beyond direct funding, Medicaid and the Children’s Health Insurance Program (CHIP) provide insurance coverage to over a million Native Americans, allowing them to access healthcare outside of tribal facilities without incurring crippling medical debt. This is notably vital for specialized care and services not readily available within the IHS system.
“Medicaid is one of the ways in which the federal government meets its trust and treaty obligations to provide health care to us,”
Liz Malerba, director of policy and legislative affairs for the United South and Eastern Tribes Sovereignty Protection Fund
Malerba, a citizen of the Mohegan Tribe, asserts that any disruption to Medicaid constitutes “an abrogation of that responsibility.”
Disparities and the Fight for Access
Native American tribes face immense challenges in providing adequate healthcare to their populations, which grapple with severe health disparities and a high prevalence of chronic illnesses. In some western states, life expectancy for Native Americans is just 64 years, considerably lower then any other demographic group in the U.S.
Despite these challenges, many tribes have made significant strides in recent years to expand access to care by adding health services and providers, largely thanks to Medicaid reimbursements. For example, five urban Indian organizations in Montana experienced funding growth of nearly $3 million over the past two fiscal years.According to Lisa James, director of development for the Montana Consortium for Urban Indian health, this increased revenue has been “instrumental” in allowing clinics to add previously unavailable services, such as behavioral health, and to expand operating hours and staffing.
These Montana clinics, located in Missoula, helena, Butte, Great falls, and Billings, serve 30,000 individuals, including non-Native Americans. they offer a comprehensive range of services, including primary care, dental care, disease prevention, health education, and substance use prevention. Medicaid cuts would force these organizations to curtail services and limit their ability to address persistent health disparities.
according to data from the Kaiser Family foundation (KFF) from 2017 to 2021, American Indian and Alaska Native people under 65 are more likely to be uninsured than their White counterparts. Though, 30% rely on Medicaid, compared to just 15% of White individuals. Furthermore, over 40% of American Indian and Alaska Native children are enrolled in Medicaid or CHIP.
A January report from the Georgetown Center for Children and Families further highlights Medicaid’s importance in Native American communities. The report found that the share of residents enrolled in Medicaid was significantly higher in counties with a ample Native American presence, with about 50% of children in those areas enrolled in Medicaid.
| demographic | Medicaid/CHIP Enrollment Rate |
|---|---|
| American Indian/Alaska Native Children | Over 40% |
| Children in Native Areas (Small Town/Rural) | About 50% |
Political Crosscurrents and Potential Exemptions
The political landscape surrounding Medicaid cuts is complex and uncertain. The federal government has previously granted exemptions to tribes from certain executive orders. As a notable example,in late February,the Department of Health and Human Services (HHS) clarified that tribal health programs would not be affected by an executive order terminating diversity,equity,and inclusion (DEI) government programs. However,the Indian Health Service is expected to discontinue DEI hiring efforts established under an Obama-era rule.
HHS Secretary Robert F. Kennedy Jr. further demonstrated a commitment to Native American healthcare by rescinding the layoffs of over 900 IHS employees in February, just hours after termination notices were issued. During his Senate confirmation hearings, kennedy pledged to appoint a Native American as an assistant HHS secretary. The National Indian Health Board, a non-profit advocacy group based in Washington, D.C.,has endorsed elevating the IHS director to assistant secretary of HHS.
Despite these positive developments, concerns remain that exemptions alone may not be sufficient to protect native American communities from the broader impact of Medicaid cuts.
“Just because Native americans are exempt doesn’t mean that they won’t feel the impact of cuts that are made throughout the rest of the program,”
Jessica Schubel, a senior health care official in Joe Biden’s White House
State-Level Concerns and Shifting Costs
State leaders are also voicing concerns about federal Medicaid cuts, warning that they could shift significant costs onto state budgets. Without sustained federal funding, which can cover over 70% of Medicaid costs, state lawmakers may be forced to make tough decisions, such as tightening eligibility requirements, which could disproportionately impact Native Americans.
Tribal leaders emphasize that state governments do not have the same treaty obligations to Native american communities as the federal government. Moreover, the nature of tribal interactions with Medicaid varies significantly depending on the specific state program.
Adding to the uncertainty, President Donald Trump has made seemingly contradictory statements regarding Medicaid cuts.While stating in a February Fox News interview that Medicaid and Medicare would be spared, he together expressed strong support for a House budget resolution that would likely necessitate medicaid cuts.
This budget proposal, approved by the House in late February, mandates spending cuts to offset tax breaks. The House Committee on Energy and Commerce, which oversees Medicaid and Medicare spending, has been instructed to slash $880 billion over the next decade. The prospect of these cuts has drawn fierce opposition from national and state organizations, given that Medicaid and CHIP provide insurance to approximately 79 million people.
| Category | Details |
|---|---|
| House Budget Resolution | Requires $880 billion in cuts over the next decade. |
| Potential impact | Could affect 79 million Medicaid/CHIP recipients. |
Financial Realities and the Path Forward
The federal government currently reimburses IHS and tribal health facilities 100% of billed costs for American Indian and Alaska Native patients, effectively shielding state budgets. However, this arrangement may be imperiled by the proposed cuts.
Tribal leaders argue that Medicaid is already a stopgap measure,and any further reductions would force them to operate with even fewer resources. As Winn Davis, congressional relations director for the National Indian Health Board, explains, “When you’re talking about somewhere between 30% to 60% of a facility’s budget is made up by Medicaid dollars, that’s a very difficult hole to try and backfill.”
Davis also points out that Congress is not required to consult with tribes during the budget process, limiting their ability to influence decisions that directly affect their communities. Tribes can only engage with the Centers for Medicare & Medicaid Services (CMS) and state agencies after changes have already been made.
The financial impact of the proposed cuts is particularly concerning given that federal spending on Native American health programs constitutes a relatively small portion of the overall Medicaid budget. The IHS projects billing Medicaid for approximately $1.3 billion this fiscal year, less than half of 1% of total federal medicaid spending.
“We are saving more lives,”
Liz Malerba, director of policy and legislative affairs for the United South and Eastern Tribes Sovereignty Protection Fund
Malerba emphasizes the positive impact of Medicaid in tribal healthcare: “It brings us closer to a level of 21st century care that we should all have access to but don’t always.”
what specific actions can be taken to mitigate the negative impacts of Medicaid cuts on Native American healthcare access and outcomes?
Interview: Medicaid Cuts and the Future of Native American Health
Archyde News: Thank you for joining us today, Dr. Anya Sharma. Could you start by outlining the potential impact of proposed Medicaid cuts on Native American health programs?
Dr. Sharma: Certainly. As Congress considers meaningful cuts to Medicaid, the repercussions for Native American communities could be devastating. Medicaid is essential, acting as a financial lifeline for many tribal health facilities, supplementing the often-underfunded Indian Health Service (IHS). Cuts would inevitably lead to reduced services and compromised care, considering the existing health disparities faced by these communities.
Archyde News: With approximately 30% of Native Americans relying on Medicaid compared to 15% of White individuals, how critical is Medicaid in bridging this healthcare gap?
Dr. Sharma: Medicaid’s role is absolutely critical. It’s not just about funding; it provides crucial insurance coverage, enabling access to care both within and outside of tribal facilities. This access is vital for specialized services, and it addresses the significant health inequities these communities face, like the lower life expectancy rates in some areas.
Archyde News: We understand that tribal health facilities already operate with limited resources. How would these cuts exacerbate the situation?
Dr. Sharma: Many facilities heavily depend on Medicaid reimbursement, with Medicaid comprising a significant portion of their budget. These funds cover operational costs, staff salaries, and expansion of services.reductions would meen fewer resources to meet existing needs, let alone address the growing demand for services. Clinics are working to improve their focus on issues such as health education and substance use prevention.
Archyde News: There are discussions about potential exemptions. Could these effectively shield Native American communities from the broader impact of these cuts?
Dr. Sharma: Exemptions are helpful, but likely insufficient. Even if tribal programs are exempt, cuts within other parts of the Medicaid program can still influence the health of the native populations , as resources are finite.Additionally, tribal leaders are concerned about being consulted during the budget process, so they can be caught off guard. Federal funding shields state budgets but the potential cuts could affect the 79 million recipients of Medcaid and CHIP.
Archyde News: Looking ahead, what are the most pressing concerns, especially concerning these cuts and the long-term impacts on access to healthcare for Native Americans?
Dr. Sharma: The most pressing concern is the erosion of progress made in recent years to increase access to healthcare. We could see a reversal of gains in addressing health disparities. It’s not just about the immediate financial impact; it’s about the long-term health and well-being of Native American communities.How can we ensure that these communities don’t bear the burden and are able to continue to access care they need? This is going to take serious planning and cooperation.
Archyde News: Dr. Sharma, thank you for your insights. It’s a crucial topic that demands attention. We welcome readers’ thoughts and comments on this very critically important issue.
