Balancing Coordinated Care with Tribal Sovereignty: Lesson’s from Oregon’s Medicaid Reform

摘要

The purpose of this case study is to examine the efforts made by the legislature and the Oregon Health Authority (OHA) to involve Oregon’s nine federally recognized tribes in the implementation of the revised Oregon Health Plan. We identified eight key informants, consisting of four tribal representatives and four state representatives, for interviews. Additionally, we identified the contact person from each newly-established Medicaid delivery network to determine if they had included the tribe(s) or planned to include the tribe(s) in their network. The OHA made some steps to ensure the inclusion of tribes in the planning and implementation process, but were challenged with the rapid implementation timeframe. Formal linkages between the tribes and Medicaid delivery networks were not developed. The federally recognized tribes of Oregon and their respective members had legitimate concerns about the revised Oregon Health Plan and how they might affect access to health care services and provider reimbursements. As other states expand Medicaid based on changes resulting from the Patient Protection and Affordable Care Act, the needs of American Indians and Alaska Natives must be included in the planning process.