Spilyay Tym oo, W arm Springs, Oregon
February 5, 2014
Medical insurance coverage available
to everyone through Affordable Care Act
Elina Langnese
Supervisor, W'.S.
Managed Care Program
W ith the new Medicaid
Expansion program increas
ing medical coverage, almost
everyone in Warm Springs
would m ost likely be consid
ered eligible for Medicaid.
Managed Care is requir
ing everyone apply for Med
icaid at this time.
M anaged Care can re
quire our patients to apply,
as the Medicaid Plans are a
free service with no charge
to the patient.
The only people not af
fected by this requirem ent
would be patients with pri
vate insurance, other than
Shasta, and those patients
eligible for Medicare at age
65, a n d /o r patients receiv
ing disability through Social
Security.
I f you apply and you
an d /o r any family member
are denied, the denial must
be brought to Managed
Care for processing.
temative resource if there is
reason to believe th at you
may be eligible for alternative
resources. In many cases the
alternate resource is Medic
aid, often known as the O r
egon Health Plan. Once on
Medicaid, you are required to
renew your application at in
tervals determined by Med
icaid.
This will be positive be
cause:
•Patients can seek outside
health care if you have (open
card) coverage through D -
Map
•Patients can seek outside
healthcare if they have Pa
cific Source Managed Care
Plans, where they would need
to see a provider in the-Pa
cific Source N etw ork (a list
would be provided to the pa
tient by Pacific Source).
• This will extend M an
aged Care dollars to m ore
patients over a longer period
o f time.
If people don’t apply,
the downside is:
for the visit.
•If patients are seen in the
emergency room and have
not signed up for Medicaid,
where they would have been
eligible, M anaged Care can
deny their visits and the pa
tients would be responsible
for all costs related to that
visit.
• When, referrals from an
IHS provider come through
M anaged Care, w e-let the
vendor know the insurance
status o f our patients. But
patients are still required to
bring their insurance ID to
the vendor for their visit.
• I f there is no insurance
identified and the patient does
not show an insurance card,
vendors are beginning to re
quire fees prior to seeing bur
Warm Springs patients.
• It is best to take a copy
o f your referral to your ap
pointm ent and present it to
the vendor.
• I f you have n ot followed
up to apply fo r M edicaid,
even if your IH S provider
referred you out, M anaged
Care will not cover the cost
Who can help you?
M anaged Care, the IHS
B u sin ess O ffice, an d th e
Warm Springs Library have
“assisters” who will walk you
through the Medicaid appli
cation and then they will mail
it off.
Time frame:
T h ere has b een such a
large volume o f applications
going through that it is taking
a very long time to obtain a
response from. Medicaid.
What will happen if you
are receiving medical care
beginning in January, 2014
prior to knowing your Med
icaid status?
We require documentation
th a t you have applied for
O H P and your application
has been sent in, as the ef
fective date will retro back to
January 1, 2014.
You m ay receive State
m ents from Vendors, as we
will hold claims, just bring the
statements in for processing
and we will notify the vendors
o f their status:
Page 5.
Health equity meeting Thursday
T h e C en tral O regon
Health Equity Task Force
will host an information-
gathering event this Thurs
day, Feb. 6, at the Living
H ope Church in Madras;
The meeting will begin at
5 p.m.
. T h e p u rp o s e o f the
meeting is to gain informa
tion on potential health
care inequities in the re
gion. Health care workers
can then focus on correct-
ing any potential inequities.
The Let’s Talk Diversity "
Coalition encourages tribal -
m em bers to attend, said I
E m m a Sm ith, C oalition
member.
“We would like people
to share stories o f how
medical services could be
handled m ore ap p ro p ri
ately for patients, and any
problem s they may have
had at any medical center,”
Smith said.
Let’s Talk Diversity meting
T he L et’s Talk Diversity
Coalition is represented by 24
local and regional organiza
tions in Jefferson County.
Its focus 'is on the aware
ness and understanding o f
different cultures. By doing
so, the C oalition m em bers
strive to effectively commu
nicate and interact w ith all
members o f our community.
The Coalition works to en
courage racial, cultural and
ethnic diversity that values
family lifestyles. This includes
supporting cultural resources
and promoting health and eco
nomic equity for everyone. 1
The Coalition mission is to '
develop a sustainable process
o f C ultural co m p eten cy
th ro u g h inclusive engage
ment by creating accountabil
ity for. equitable outcomes. .
The Let’s Talk Diversity 1
Coalition will hold its regu
lar meeting this afternoon, *
Wednesday, Feb. 5, front *
12:30 to 3 p.m. at the Health
Department in Madras.
Federal rule: You .are
required by federal regula
tions (CFR 42; Ch. 1; Subpt.
36.23,F) to apply for an al-
Questions and
concerns?
If you have a
question or a con
cern about the new
health insurance
law, please contact
Managed Care di
rectly and they will
discuss everything
with you. You can
reach
Managed
Care by calling 541-
553-4948, or call
the clinic at 541-
553-1196.
Culture &
Heritage offers
youth education
programs
Does, your child need help
with math? Math is made fun
and easy at the E ducation
building.
Ittitam asha (counting) is
from 4-5 on M onday and
Tuesdays, and Thursdays and
F ridays. T h e p ro g ra m is
brought .to you by the Warm
Springs Culture and Heritage
D epartm ent.
T h e re w ill be N ativ e
American games and projects,
and tutoring lead by certified
teacher E sther Kalama, as
s is te d by Jam es Sam.
Ittitamasha features beading,
weaving, artistry, and assis
tance with school work. For
in fo rm a tio n call 541-553-
3290.
Cover Oregon is a marketplace
for Tribal communities to find health
insurance and financial help to pay for it.
Kiksht
There are Kiksht language
classes at the Education build
ing Tuesday evenings from 5-
6:30, lead by Pam Cardenas,
assisted by Valerie Switzler.
Ask for free assistance
o
W arm
Springs
Vocational Rehabili
tation has orientations
every M onday at 3
p.m. at their office in
th e in d u s tria l park.
O rientations are also
held on Tuesdays at 3
p.m. at the Community
Counseling Center.
541 553 1196
I CERTIFIED
COMMUNITY
I PARTNER