The Impact of Potential Medicaid Cuts on Native American Health Centers

A Looming Crisis for Native American Health Care

As Congress considers significant cuts to federal Medicaid funding, health centers serving Native American communities are bracing for a potential disaster. These centers, such as the Oneida Community Health Center near Green Bay, Wisconsin, rely heavily on Medicaid to provide essential health services to their patients. Over 40% of the 15,000 patients served by the Oneida Community Health Center are enrolled in Medicaid, making any cuts to the program a direct threat to their care. Debra Danforth, the director of the Oneida Comprehensive Health Division and a citizen of the Oneida Nation, emphasized the devastating impact of such cuts, stating, "It would be a tremendous hit." The facility provides critical services, including ambulatory care, internal medicine, family practice, and obstetrics, to the Oneida Nation’s 17,000 people. However, Medicaid cuts would force these health centers to reduce services, leaving many without access to the care they desperately need.

Medicaid as a Lifeline: A Unique Relationship

Medicaid plays a unique and vital role in Native American communities, helping to fill the chronic funding gaps left by the Indian Health Service (IHS), the federal agency responsible for providing health care to Native Americans. Medicaid has accounted for about two-thirds of third-party revenue for tribal health providers, offering financial stability and enabling facilities to cover operational costs. Over a million Native Americans rely on Medicaid or the Children’s Health Insurance Program (CHIP) to access care outside of tribal health facilities without incurring significant medical debt. Tribal leaders are urging Congress to exempt tribes from Medicaid cuts, arguing that such cuts would violate the federal government’s trust and treaty obligations to provide health care to Native Americans. Liz Malerba, a citizen of the Mohegan Tribe and director of policy and legislative affairs for the United South and Eastern Tribes Sovereignty Protection Fund, stated, "Medicaid is one of the ways in which the federal government meets its trust and treaty obligations to provide health care to us. So we view any disruption or cut to Medicaid as an abrogation of that responsibility."

Recent Progress at Risk: Expanding Care in Native Communities

Despite the challenges they face, some Native American communities have made strides in expanding access to health care in recent years, thanks in part to Medicaid reimbursements. For example, in Montana, five urban Indian organizations saw funding growth of nearly $3 million over the last two fiscal years, enabling clinics to add critical services such as behavioral health care. These clinics, located in Missoula, Helena, Butte, Great Falls, and Billings, serve 30,000 people, including many who are not Native American or enrolled in a tribe. However, Medicaid cuts would force these clinics to reduce services, undermining efforts to address the severe health disparities faced by Native Americans. American Indian and Alaska Native people under age 65 are more likely to be uninsured than their White counterparts, and 30% rely on Medicaid, compared to 15% of White people in the same age group. Moreover, over 40% of Native American children are enrolled in Medicaid or CHIP, making any cuts to these programs particularly harmful to families.

Federal Actions and State Responses: A Mixed Bag

While the federal government has taken some steps to protect tribal health programs, such as exempting them from certain executive orders, these measures fall short of addressing the broader threat posed by Medicaid cuts. For instance, the Department of Health and Human Services clarified that tribal health programs would not be affected by an executive order terminating diversity, equity, and inclusion initiatives. However, the Indian Health Service is expected to discontinue diversity and inclusion hiring efforts established under an Obama-era rule. Meanwhile, HHS Secretary Robert F. Kennedy Jr. rescinded the layoffs of over 900 IHS employees just hours after they received termination notices. While these actions provide some relief, they do not address the larger issue of Medicaid funding cuts, which would have a disproportionately harmful impact on Native American communities. Jessica Schubel, a senior health care official in the Biden administration, warned that exemptions alone are insufficient, stating, "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."

The Budget Battle: A Threat to Tribal Health

The budget proposal approved by the House in late February intensified concerns about the future of Medicaid. The proposal requires lawmakers to cut spending to offset tax breaks, with the House Committee on Energy and Commerce instructed to slash $880 billion from Medicaid and Medicare over the next decade. These cuts would have a devastating impact on the 79 million people who rely on Medicaid and CHIP for health insurance. Tribal leaders emphasize that Medicaid is not just a source of funding but a lifeline for Native American communities, which already face significant health disparities and inadequate access to care. Winn Davis, congressional relations director for the National Indian Health Board, noted that Medicaid dollars often make up 30% to 60% of a facility’s budget, making it nearly impossible to backfill such a shortfall. Furthermore, Congress is not required to consult tribes during the budget process, leaving Native American communities with little say in decisions that directly affect their health care.

A Call to Protect Tribal Health: The Fight Ahead

As the budget battle continues, tribal leaders and health advocates are urging Congress to spare Medicaid from cuts and uphold the federal government’s responsibility to provide health care to Native Americans. Liz Malerba emphasized the importance of Medicaid in saving lives and bringing tribal health care closer to 21st-century standards. "We are saving more lives," she said. "It brings us closer to a level of 21st-century care that we should all have access to but don’t always." The fight to protect Medicaid is not just about preserving funding; it is about ensuring that Native American communities have access to the care they need to address the severe health disparities they face. As the debate over Medicaid’s future unfolds, the stakes could not be higher for Native American health centers and the communities they serve.