Ready for Reform!

Port Gamble S’Klallam Tribe

Washington State on the pleasant side of the Puget Sound on the Kitsap Peninsula with treaty rights stretching to the Olympic Peninsula, the Pacific Ocean and Canada

Kerstin Powell, Business Office Manager

2. Outreach, Eligibility and Enrollment Port Gamble S’Klallam Tribe Medicaid and Food Stamp Eligibility Pilot Project

Port Gamble S’Klallam History

The Port Gamble S’Klallam Reservation is comprised of 1,341 acres, located on the northern end of the Kitsap Peninsula within Kitsap county of Washington State.

The Tribe has over 1,045 enrolled tribal members of which approximately 350 are children (under age 18).

About ½ live on the reservation. The majority of the rest live near the reservation.

BackgroundThe Tribe began discussions about eligibility determinations over 10 years ago. (Project was proposed to then Governor Locke in year 2000)

The Tribe has been fortunate to have continued leadership that just didn’t give up through years of being ignored and discouraged

The Tribe has a history of great success in providing many new services that enhance the quality of life of its members such as;

Tribal TANF since October 1, 1998Child Support since 2000Tribal Foster Care since 2004

How/processIt wasn’t until 2007 that the discussions between the State and the Tribe began to formulate into something that seemed it could become a reality.

We began meeting regularly with State staff about the necessary steps for the Tribe to begin Eligibility determinations.

The State had to apply for a waiver to FNS to allow the Tribe to determine food stamp eligibility.

An Intergovernmental Agreement was signed on May 11, 2009.

A five year pilot project started.

No grants or monetary assistance received form the State for this pilot

The tribe budgeted for two FTE to run the program

Tribal Staff were required to attend training 2-3 days per week for approximately 3 to 4 months while still performing their other work duties.

It takes less time, about 6 to 8 weeks depending on the trainer’s schedule, if you can concentrate on just the training and not perform other job duties at the same time although it can be overwhelming

Three health business office staff trained on the medical

Three Children and Families/TANF staff trained on food stamps and medical eligibility

Training & Cost

It is very helpful to have a designated trainer right at your facility and for ongoing assistance

Costs include eligibility staff, computers, IT staff time to get access to all state programs

We requested that an experienced support staff from the State be available to us a few days per week to assist staff as necessary

After beginning training in Augusts 2009, on November 1, 2009 staff started determining eligibility for Family, Pregnancy and Children’s Medical

In January 2010 staff started determining eligibility for Food Stamps and issuing EBT cards.

Training & Cost Continued…

Eligibility Staff

The Children and Families Department has two Tribal TANF staff that determine eligibility and provide other social services while a third person is designated just for eligibility

Of the three in the Health business office, one is currently doing medical eligibility with a supervisor and one back up staff

Benefits to Tribal Members

Tribal members can apply for and receive basic food benefits and medical coverage right here on the reservation saving a round trip of 70 miles to the local CSO (The tribe serves all Native Americans in the zip codes closest to the reservation)

Tribal members can immediately replace a lost EBT card so they may access their benefits right away and not have to wait for a ride to Bremerton

More tribal members apply for benefits because they are comfortable coming to tribal staff

Low income families can access food stamps, medical and Tribal TANF all at the same time

Benefits to Tribal Members

More families can provide healthy food for their children

Families can get medical coverage right away when coming to the Tribal Clinic which lowers the Tribe’s costs

The local DSHS CSO (Community Services Office) case manages any Non-Natives

How it helps

The tribe is eligible to receive match dollars at 50% for Medicaid and 75% for Food Stamps

Increased and faster access to Medicaid and Food Stamps for tribal members

The tribal clinic can collect the Encounter Rate for Medicaid eligible visits that they in the past were not able to (waiting for the client to apply for Medicaid and eligibility to be processed by the State, eligibility not being backdated to cover prior medical care)

How it helps continued…

Savings of Contract Health Services dollars with increased and faster eligibility for Medicaid

Pregnant women applying for Medicaid sooner

Tribe will have an opportunity to help tribal members have a Medical child support order established before the State does

Important Considerations

It is important to train staff that expect to stay around for quite some time

Those determining eligibility need to have excellent computer skills

Must be detail oriented with good follow through especially to get backup documentation

It is not just determining eligibility but working the case for mid-certs, and eligibility reviews, and getting more documentation, and cleaning up audits which is very labor intensive at first

Tribal staff do not have the various levels of experienced workers you find in a CSO so they immediately get very complicated cases that a new financial worker in a state office would not see for perhaps a year.

Audits

In the first year foodstamps and medical are 100% audited

After the first year the foodstamps will still be audited monthly by the state’s process review panel after which those cases will be audited by the Feds just like every CSO

Who to contactDoug Porter, Assistant Secretary, Health and Recovery Services Administration, 360-725-1867

Jolene Sullivan, Port Gamble S’Klallam Tribe,360-297-9636

Colleen Cawston, Indian Policy Support Services Director, DSHS, (360) 902-7816

Rebecca Henrie, Project Coordinator, ESA, DSHS360-725-4615