14 DECEMBER 1,2012
Smoke Signals
Frequently asked questions regarding
requirement of application of Medicaid
Cancer awareness lunch
Many Tribal members rcixl the article in Smoke Signals regarding an
administrative change that will he occurring on the Skookum Health
Program. As a result, many questions have come up and we would like
to provide you with answers.
Q: What is the point of making members apply for Oregon Health
Plan, Medicaid or other state coverage?
A: To save Tribal dollars; if you are eligible for a state plan, this would
become primary and pay claims before Skookum, which saves Tribal
funds.
Q: I have Contract Health Services (CHS); do I still need to ap
ply? A: Yes, if you do not have a primary insurance coverage. Skookum is
not insurance and is not considered primary coverage.
Q: If I have a primary insurance, do I have to apply?
A: No, not at this time. It will only affect Tribal members using Skoo
kum as their only coverage.
Q: If I am an Elder receiving the Tribal Elder pension, do I have
to apply?
A: No, not if your income is over the Medicaid-eligible income (133
percent of federal poverty level). Please check with your state to see if
the Tribal Elder pension is counted as income, as this may be different
in each state.
Q: How do I apply for Medicaid?
A: Many states have an online application and eligibility information
or you can call the Department of Human Services in your state. We will
be able to assist Tribal members in this process of applying.
Q: Am I required to pay for insurance through my employer?
A: We encourage Tribal members with alternate resources, such as
employer-sponsored insurance, to enroll in those plans and use Skookum
as a secondary coverage to pay for any balances that are patient respon
sibility. But, at this time, you aren't required to enroll in your employer
plan if there is an associated premium that you must pay.
Q: When will this new policy go into effect?
A: We will be implementing this new policy sometime in 2013; we will
send more information regarding the change.
Q: Will there be Tribal staff available to answer my ques
tions? A: Yes, this is what we are working toward.
Q: Will Tribal members who are also employees at the Tribe,
Spirit Mountain Casino or Grand Ronde Station be required to
apply for Medicaid?
A: Yes, unless they are enrolled in the employee health plan.
Q: When I apply for my state's Medicaid or other health cover
age, will it have an effect on our current benefits?
A: If you are not accepted after applying, your Skookum benefits will
remain the same. If you are accepted after applying, you are enhancing
your benefits. The state Medicaid will be primary and Skookum secondary.
Skookum will pick up balances if and when there are any from covered
Medicaid services, thus leaving you with little to no out of pocket. If it's
not a Medicaid-covered service, nothing changes. Skookum pays like it
always has. Less out of pocket is a big deal for members outside the six
county service area.
Q: What information can be submitted to the Skookum Health
Program if I don't qualify for the state coverage?
A: We are working on this process, but some type of income verification,
such as a pay stub or tax information showing you are over the income
limits, would be acceptable and a denial from Medicaid will always be
accepted.
Q: Has there been an audit letter sent out to Tribal members,
and if so, when?
A: No, there has not been any letter or questionnaire sent to Tribal
members.
Q: Isn't my Skookum Health Program benefits an insurance?
A: No, Skookum is not an insurance plan; therefore, it is not considered
to be insurance by definition. You should not reference Skookum as insur
ance; it is not. It is a benefit you receive from the Tribe because you are
an enrolled Tribal member.
Q: What happens if I do not comply?
A: Your claims will be held in "pending" status at Shasta and not paid
until you fulfill your obligation. Once it is confirmed that you have fulfilled
your obhgation, we will instruct Shasta to process and pay your claims.
Q: How do I contact my state Medicaid office?
A: We will have a comprehensive list of contact information for all
states made available.
Q: What if one of my doctors is not part of the Oregon Health
Plan or other state Medicaid plan?
A: You should still sign up and use the Medicaid plan whenever possible.
Your Skookum program will still be in place and can cover your visits
with the nonparticipating provider or anything not covered by Medicaid
with pre-authorization from Skookum.
Q: Does Tribal Council know you're doing this to the member
ship? A: This action was authorized by Tribal Council.
Q: I might be getting a job soon; if I do, should I drop my Med
icaid? A: Keep your Medicaid until you have new coverage in effect and notify
Medicaid of your change in status. B
Photos by Michelle Alaimo
Tribal Elder Kathryn Harrison, left, is handed a door prize by Candi
Buswall, Grand Ronde Health & Wellness Center administration
secretary, after she won it at the Cancer Survivor CelebrationCancer
Awareness luncheon at the Elders' Activity Center on Wednesday,
Nov. 14. The event also included lunch, informational materials and
recognition of cancer survivors in attendance.
Ton! Mountain, left, Survivor Programs manager for Susan G. Komen :
for the Cure, talks with Tribal Elders violet Folden, middle, and Louise
Medeiros during the Cancer Survivor CelebrationCancer Awareness
luncheon at the Elders' Activity Center on Wednesday, Nov. 14.
Mountain is a breast cancer survivor and was working an information
table for Susan G. Komen for the Cure. She also was a guest speaker at
the event.
Testing and admissions fee assistance
Enrolled Tribal members can request assistance with test fees (i.e. GRE,
SAT, LSAT, ACT) and admissions application fees.
Contact Higher Education for more information at 1-800-422-0232, ext.
2275. D
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The Confederated Tribes of Grand Ronde - Adult Education GED Classroom
Thursday, December 6, 2012
Noon - 3:00pm
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Instructor: Julie Logan
Confederated Tribes of Grand Ronde Tribal Member
NORTHWEST INDIAN CpTcOLLEGE
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Continuing Education Units available through Northwest Indian College -units offered by request
Cat) SOS-S79-22S2 to sign up
Limit of 12 people - first come, Mrst serve - Federally Recognized Tribal members will have preference