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Smoke Signals
JANUARY 1,2013
Grand Ronde Tribal
Housing Authority
Frequently asked questions regarding
requirement of application of Medicaid
Many Tribal members read the article in Smoke Signals regarding an
udminiHtrative change that will bo occurring on the Skookum Health
Program. As a result, many questions have come up and we would like
to provide you with answers.
(J: 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 Medica id-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. O
Applications being accepted
Jan. 2 for grandfamily housing
A grandfamily is defined as: A family, whose head or spouse is
Elder, containing minor children in the legal long-term custody
or guardianship of the Elder. A grandfamily shall not include any
other adults under the age of 55 (including the parent(s) of the
minor children).
If your family fits this definition, qualifies as low income and you
are interested in moving into our new grandfamily units, which
are part of Elders' Housing Phase II, we will start accepting ap
plications on Jan. 2.
You can pick up your application at the Grand Ronde Tribal
Housing Authority offices at 28450 Tyee Road, Grand Ronde, Ore.,
97347. If you cannot come into the offices to pick up your applica
tion you may call the front desk at 503-879-2401 and an application
will be mailed to you.
Make sure you specifically request the application for "grand
family housing."
Applications will be handled on a first-come, first-serve basis
starting Jan. 2. It is important that applicants provide all requested
documentation at the time they submit the application.
If you have any questions, you may contact Leon Ramos or Debo
rah Kroeker at Grand Ronde Tribal Housing, 503-879-2401. We
look forward to working with you.
Down Payment Assistance Program
The Grand Ronde Tribal Housing Authority (GRTHA) has 2013
Down Payment Assistance available for applicants with moderate
to low incomes. Although the budget for Tribally funded Down
Payment Assistance has been committed for 2013, HUD funds may
be available for qualified Tribal applicants whose gross household
income either meets, or is less than the guidelines below:
Family sizeGross income
1 $39,900
2 $45,600
3 $51,300
4 $56,950
5 $61,550
6 $66,100
7 $70,650
8 $75,200
Please call Nancy Holmes, Homeownership Coordinator, at 503-879-2445
to pre-qualify for HUD funded assistance.
Intervention
Services to be provided to babies &
moms-to-be:
Checkups
Cleanings, if applicable
Injection-free fillings, if needed and
appropriate
Cavity prevention treatment
Age-appropriate goodie bags
Raffle ticket for one of two blankets
to be raffled every six months
Confederated Tribes
of Grand Ronde
Dental Clinic
Pregnant women
and babies under 2
Tribal members: pregnant women or
0-2 year olds (teeth or no teeth!)
who come in for a scheduled dental
checkup or other appointment will
be entered in a
raffle for a baby
Pendleton
Blanket!
To schedule call:
503-879-2020
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