14 DECEMBER 15, 2012
Smoke Signals
Frequently asked questions regarding
requirement of application of Medicaid
Many Tribal members rend the article in Smoke Signals regarding an
administrative change that will be 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. Hut, 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 obligation, 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.
Happy Birthday
Rhonda Fraser
We remember you when..-
but we love you now.
Dad, Mom, Mitch, Shelley,
Kayla, Jolly, Bubba, Lexy
and Lucy and the rest
of our crazy family.
Happy 1 7th Birthday
Kiana Leno
Dec. 11th
i Hi
Love, all your family & friends.
CONGRATULATIONS
TALIAI
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Km uf
Mm
1 st place in a writing contest at
Willamina Elementary School.
Grandma Kelly & Papa Martin,
and all of your family are very
proud of you, and love
you very much!
Keep reaching for the stars Talial
Happy Birthday
Tammy
Dec. 23rd
Y hi M
Smoke Signals file photo
Love, your goddaughter
Kiana.
Confederated Tribes of Grand Ronde
Youth Education Department
2012-13 Winter
Middle & High School Programs
For CTGR Tribal youth in grades 6-12
9ijJf0'Jj- Community Project
m
Health Project starts
V
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irr- Girls Lock-In
yOecepibar 14 - Incentive Program Reward f t
January 7-C Roller Skating Party -py
jFhr rv 11- Flshlntt Trio Punamiser tT.
February 25- " KW Plold iflp . .
'March 11-. , . TL'amook Cheese Patt-y attefl
Lijl pioneer Museum Field J, i "'ST. J
'3 - Holiness Dajj with PievpJoh i
March 25-27- Spring Break Camp ' 1
Man
No-School Days with a $5 fee: ,
: January 2-3
January 4 T..
" ' January 18
January 28
March 11
March 22
No-School Days with NO $5 fee:
January 7
February 11
February 25
March 25-27
Incentive Program:
7-12 Grade points per class A 7 points B 5 points C 3 points ( 1
School Attendance: .25 points earned everyday without unexcused tardy or absence.
Community Service: Take part in a preapproved community project and earn 2 points for every hour
served. The maximum community service points that can be earned is 80 points. Students must con
tact lead staff before taking part in community service project. There will also be service projects of
fered.through the Youth Education Department. Please contact Chris Bailey or Matt Zimbrick for to
sign up for a future community service project.
Your Journey Details '
January- - Report Cards Come Out (0118)
February- i Community Project TBD
. . ...( Snow Trip . '
March- Community Project TBD
(1fi ftn-y Typy (p) .5j3.-79-21fll far, mar lir'rw'