Medicaid Waiver Could Ease Serious Health Disparities On Wind River Reservation

May 8, 2015

The Fort Washakie health clinic is the oldest IHS facility in the U.S. Originally built in 1884, it is a patchwork of additions. The funding could help replace it.
Credit Melodie Edwards

This year, while Wyoming lawmakers were voting down Medicaid Expansion in the state, they also approved a Medicaid Waiver for the state’s two tribes, potentially pumping some $16 million of aid into the reservation’s health system. The health crisis on the Wind River Reservation is now at critical levels, but tripling the amount that the tribe’s receive for health care could help.

In March, Northern Arapaho member Cherokee Brown’s daughter brought her a tooth. She didn’t think much about it. Kids lose teeth.

“Her baby teeth were falling out and when she showed me, I just thought it looked like another tooth, one of the big teeth on top,” Brown says. “Really, what she was showing me were fragments of her back tooth.”

So Brown took her to the dentist at the free Fort Washakie Indian Health clinic. She was told her child needed emergency dental surgery but that she couldn’t get an appointment with the dentist for a month.

“He’s only there every Wednesday,” she says. “So I understand why they said we can’t see your daughter for a month. It was to the day, a month that I had to wait because that’s how booked out he was.”

Northern Arapaho member Cherokee Brown is Vice Chair of the Wind River Native Advocacy Center and the mother of six.
Credit Melodie Edwards

Brown couldn’t wait. The tooth was now seriously infected. So she took her child to a Lander dentist, shelling out $168 to get the antibiotics her child needed to sit out the month-long wait for surgery at Indian Health Services. And she says, everyone she knows has an IHS horror story like hers. It’s this lack of staff and space that convinced both tribes to work together to apply for a Medicaid Waiver, which gives states money for 5-year innovative health care projects. But, according to Eastern Shoshone Health Director Catherine Keene, for Wyoming’s tribes, there was a problem.

“We had to make sure that what we talked about did not mention anything having to do with Medicaid Expansion.” She says they had to explain to legislators that there would be zero cost to the state but they’d still get federal dollars to make the reservation healthier.

Health disparities on the reservation are badly out of whack. In Wyoming, obesity, diabetes, and mental illness rates are twice as high for tribal members as their white counterparts. And alcoholism rates are five times as high. 

Former director of Indian Northern Arapaho Councilman Richard Brannen was the director of Indian Health Services for many years. He says many Native American health issues stem from what he calls historical trauma from the experience of genocide. He says that kind of trauma requires a totally new approach.  That’s why he says they’ll use the money to do something he calls whole person care.

Our ancestors looked at these treaties as sacred. They were written and they looked at them as sacred words. They said, if you give up all your land, all of your minerals, your gold, your wealth, your water, we will put you on this reservation and we will provide health care as one of the what they call trust responsibilities that the federal government promised.

“We’re looking at a totally integrated health care system, which doesn’t just involve the clinics. It involves the whole community,” Brannen says. “The key is the patient owns their own health care. They're responsible for their health care. Part of it is respecting them and saying what do you need to make yourself whole again.”

Shoshone health director Keene adds that it’s about getting health care into people's homes and schools and daily lives. “Like one of our tribal sweats. You're doing therapy in those sweats. And it's being able to account for some of those that aren't done in a regular clinic exam room.”

The next step will be to get the federal government to approve the waiver. Keene is optimistic that will happen.

“If we can do stuff up front which is preventative, then it saves federal dollars in the end,” she says. “We’re just shifting the money from down the road and putting the money up front so they don’t get sick.”

But there's another reason the tribes are confident the project will get approved: the federal government is responsible by treaty for Native American health care.

“Our ancestors looked at these treaties as sacred. They were written and they looked at them as sacred words,” Brannen says. “They said, if you give up all your land, all of your minerals, your gold, your wealth, your water, we will put you on this reservation and we will provide health care as one of the what they call trust responsibilities that the federal government promised.”

Richard Brannen says by treaty the federal government is responsible for native health care. Representative Lloyd Larsen of Lander says it was this argument that convinced Wyoming lawmakers to approve the Governor's supplemental budget that included the waiver.

“[It’s] a trust responsibility to take care of these folks that are our neighbors and our citizens of our state. And they haven't done it. We said we need to try to help that. But it shouldn't cost the state. The state shouldn't have to subsidize the federal government's responsibility.”

Larsen says Wyoming is the first state without Medicaid expansion to offer its tribes a Medicaid Waiver like this, and may end up being a model for the 23 other states that haven’t passed expansion. The tribes hope to get approval and start receiving Medicaid funding sometime next year.