Besides likely costing some of their citizens health coverage, new federal policy making Oklahoma tribes subject to Medicaid work requirements has broad financial implications.
In April, the Trump administration contended tribes are a race, not sovereign governments, making an exemption for them from work requirements illegal preferential treatment. The change in policy means tribes will have to follow Oklahoma's proposed work requirements if they are approved by the federal government.
Tribal officials brought their concerns to lawmakers in Washington during House Appropriations Subcommittee on Interior hearings this week.
The Muscogee Creek Nation is set to open a new health clinic in McIntosh County in July and is counting on Medicaid funding to operate it. While the state's Medicaid reimbursement is around 40 percent, tribes get a 100 percent pass-through of funds.
Principal Chief James Floyd said the unemployment rate in McIntosh County is around 10 percent.
"We’re going to be crippled in that county and that new facility with resources from the outset due to the fact that we’re going to find citizens reluctant to apply for Medicaid with a work requirement when there’s no work there in that county," Floyd said.
The Cherokee Nation has already calculated the financial impact to the tribe for providing more uncompensated health care.
"In 2017, Medicaid patient visits totaled more than 94,000 at our facilities. Without Medicaid reimbursement, we would lose as much as $46 million this year alone," said Principal Chief Bill John Baker.
Oklahoma U.S. Rep. Tom Cole indicated he’d like to see the policy reconsidered.
"I’m not against work restrictions. I actually favor them. But not at the expense of tribal sovereignty, and let’s sit down and let the tribes work out what works best for them. They can make that decision," Cole said.
Several states crafting Medicaid work requirements included provisions to exempt tribes. Oklahoma did not.
