Hospital on Nebraska reservation remains without key certificationNeighboring tribal chairman: IHS 'failed us, killed our people'
By Kevin Abourezk
@Kevin_Abourezk WINNEBAGO, Nebraska -- The Winnebago Tribe is moving forward with plans to take over the troubled Indian Health Service hospital on its reservation. The tribe recently hosted an informational forum for citizens to educate them about the process of self-governance, the method by which the tribe plans to manage the Omaha-Winnebago Hospital. The goal is to complete the takeover by July 1. “The tribe has taken great care in each step because we want this to be the best turnaround, the top-notch health care facility for all those Native Americans that choose to walk through that door and have their health care delivered,” said Victoria Kitcheyan, a council member whose aunt died after being sent to the facility. The effort, though, is seeing some resistance. The Winnebago Tribe shares the hospital with the neighboring Omaha Tribe, whose leaders have raised questions about the initiative. “I feel that IHS has failed us, has killed our people, has not fulfilled their obligations to the people,” Omaha Chairman Michael Wolfe said. “Now they’re bailing out, and they’re just happy and tickled pink that Winnebago wants to take this hospital over. They broke it. Why should the Winnebago want to come and fix it?” “And if it fails again, who are they going to blame?" Wolfe said. "They’re going to blame all Indian people.”
Leaders of the Winnebago Tribe feel they have no other choice. They voted last November to pursue self-governance after failing to see improvements at the hospital. The Centers for Medicare and Medicaid Services terminated the facility's certification in July 2015 due to serious lapses in patient care. The hospital, already suffering from inadequate funding, can no longer bill Medicare and Medicaid for services. The IHS has been unable to say when it might regain certification. “Maybe it’s time to try something else,” Myra Munson, an attorney who is helping the tribe with its efforts, said at the January 25 forum. After serving as a commissioner of the Alaska Department of Health and Social Services, Munson has helped numerous tribes with self-governance and self-determination initiatives over the last three decades. “You’re in very good company all over the country,” Munson said.
The move to self-governance – as set forth by Title V of the Indian Self-Determination and Education Assistance Act of 1975 – allows tribes to assume control over health care funding and programs that the IHS would otherwise provide. A tribe must enter into a compact, as well as a funding agreement, with the federal government that sets forth the terms of their nation-to-nation relationship. Title I of the federal law also allows tribes to assume through a process known as self-determination. Under that process, a tribe enters into a contract with IHS to manage certain programs but the IHS retains control over funding for those programs. Across Indian Country, nearly 225 tribes have entered into self-determination contracts with the agency. More than 350 tribes take part in self-governance, with two tribes in Michigan having completed their moves in December. The Great Plains Area, a region that includes Nebraska, North Dakota, South Dakota and Iowa, is somewhat different. The Spirit Lake Nation is currently the only tribe in the area with a self-governance compact. At the Omaha-Winnebago Hospital, Munson said the Winnebago Tribe and the Omaha Tribe would need to agree to move forward with self-governance if they wanted to offer all of the same programs with the same level of funding. But she said the process could still move forward with just one tribe on board. “The money can be divided and the program can be divided so that both tribes are fairly treated,” she said. “The Winnebago Tribe is not willing to or interesting in doing anything that undermines another tribe.” Despite raising questions, leaders of the Omaha Tribe are still negotiating with Winnebago and IHS officials. But Alan Harlan, the Omaha treasurer, doesn’t like the idea of the federal government trying to dictate any decisions for his people. “The IHS seems to be on the side of the Winnebago Tribe so we have to meet with both of them, the government and the Winnebago Tribe, to come to a reasonable agreement to this,” he said. “I hope we can. I don’t want to see us grow apart. I want to see us grow together.”
Munson said it will take at least a year for the Winnebago Tribe to regain certification for the hospital once it takes it over. Until then, the tribe won’t have access to Medicare and Medicaid for inpatient and emergency departments. The tribe will be able to continue to access Medicaid for other types of services, she said. The tribe already has begun advertising for new positions that will be needed to begin the process of recertification, including for an executive director, hospital administrator, a contract specialist and a human resources staff specialist. According to Munson, a tribally-operated hospital has never been decertified, as self-governance offers many protections to tribes. Munson also offered numerous facts about the self-governance process at the recent Winnebago forum. Among them: · The tribe won’t see a reduction in funding for the programs it will take over. Indeed, most tribes that complete self-governance see increased health funding as they aren’t required to pay as much in administrative costs as IHS does. · Under self-governance, the tribe would continue to receive funding for its hospital, even if it fails to reach a funding agreement with IHS one year. That’s very much unlike tribes with self-determination contracts. Those tribes remain under the whim of IHS, at least as far as funding. “IHS must continue to fund you exactly as it would have had you continued your funding agreement, including any increases,” Munson said. “It takes away the ability of IHS to manipulate or to pressure tribes.” · Self-governance tribes tend to have more health experts working for them than other tribes that rely on IHS for expertise on health care policy. · Tribes that complete self-governance never risk conceding any sovereignty through the process. “Nothing that would arise out of the exercise of self-determination and self-governance leads to that result,” Munson said. · The move to self-governance doesn’t prevent federal employees from working for the tribe. In fact, the Winnebago Tribe plans to offer contracts to all of the hospital’s current federal employees. “It is absolutely essential for good programs to have stability in their health care staff,” Munson said. She said the hospital has had 13 different acting or permanent CEOs over the past three years. “The lack of consistent leadership, the lack of vision has impaired the ability to recruit people and get them commit to be here.” She said she’s hopeful the tribe will be able to change that, by providing consistent leadership to the hospital’s staff and by offering salaries that are competitive with private market rates. · The move to self-governance also doesn’t mean the tribal council will take direct control of the hospital, deciding who to hire and fire. Munson said efforts are underway to ensure some separation of powers between the hospital’s leadership and the tribe’s. · It will be important for the tribe to consider training programs for aspiring health professionals, since it currently doesn’t have enough trained health professionals to adequately staff the hospital. Munson said a health consortium in Alaska has even considered starting a college to train health professionals to staff its programs. · The tribe doesn’t plan to change its patient eligibility guidelines. “Anyone who’s getting care at the hospital today who wants to continue to can count on the fact that they will be able to afterwards,” Munson said. Jim Snow, a Winnebago council member, said the move to self-governance will provide the tribe much greater power to control its own health programs. “We’re trying to provide quality care for our tribal members and anyone that comes into our hospital,” he said. More information on the Winnebago Tribe’s move to self-governance can be found online at: winnebagotribe.com/index.php/government/winnebago-hospital-self-governance. Related Stories:
Winnebago Tribe asserts self-determination in hopes of fixing troubled hospital (November 15, 2017)