Saint Regis Mohawk Tribe Supports House Letter Opposing Medicaid Work Requirements for Tribal Members

May 21, 2018

AKWESASNE, NY — The Saint Regis Mohawk Tribe (“SRMT” or “Tribe”) applauds 56 members of the House Native American Caucus for opposing the Center for Medicare and Medicaid Service’s (“CMS”) recent reclassification of Native Americans and Alaska Natives as a racial group for purposes of receiving Medicaid.

In a letter dated Onerahtohkó:wa/May 11, 2018; House members highlighted the unprecedented change in CMS policy; which “sweeps aside decades of Supreme Court jurisprudence, numerous statutes, and long-established Executive Branch policies governing the relationship between sovereign tribal governments and the Department of Health and Human Services (“HHS”). The letter goes on to read, “In addition to threatening tribal sovereignty, this shortsighted and ill informed decision will have the added effect of reducing funds available to the Indian Health Service (“IHS") — in effect, undermining Congress’s intent in enacting Section 1911 of the Social Security Act to authorize IHS reimbursements under Medicaid.”

The House’s effort comes in response to a Tsiothohrkó:wa/January 11, 2018 letter to state Medicaid directors, which authorized states to establish and implement their own work requirements without accommodations for federally recognized tribes. Tribal governments were directly informed on Tsiothohrkó:wa/January 17, 2018 that CMS would not approve a waiver that contained a tribal exemption because of civil rights concerns. Though New York State has made the reasonable decision to not impose the work requirement, the Tribe supported the letter as efforts to classify Native Americans as a ‘racial group’ is alarming for all of Indian Country.

“This is a dangerous change in policy for many tribes around the country,” said Tribal Chief Beverly Cook, a family nurse practitioner and Nashville Area Representative for the National Indian Health Board. Chief Cook added, “Because the IHS continues to be chronically underfunded and incapable of addressing our disproportionally high rates of diabetes, chronic ailments, and cancer; Medicaid assists us in providing basic healthcare services to our members. The loss of these funds would cripple our already limited ability to address the health concerns of Mohawk people.”

In 2017, SRMT provided healthcare services to 14,456 tribal patients and collected $1.3 million in Medicaid. With a total health care budget of $22.3 million last year, the loss of this revenue would force SRMT to choose between providing priority-level Purchased Referred Care referrals and other important services or diverting revenue away from other efforts the Tribe is undertaking; such as increasing employment opportunities, developing the much needed infrastructure in the North Country, and mitigating the impacts of Superfund Sites located adjacent and upstream from where the Tribe draws its drinking water.

“By adding barriers for Native Americans in accessing the Medicaid program, the federal government would be actively choosing to violate its federal trust responsibility,” stated Tribal Chief Eric Thompson. Chief Thompson noted, “We, as two nations, did not enter into legally binding treaty agreements where we exchanged hundreds of thousands of acres of land for the federal government to deliver Mohawk people chronically inadequate healthcare services because the federal government abruptly decides that tribes are not governments.”

“We would like to thank Congressman Tom Cole (R-OK) and Congresswoman Betty McCollum (D-MN), Co-Chairs of the House Native American Caucus, our own representative, Congresswoman Stefanik (R-NY), and other members of Congress who signed on to the House Native American Caucus letter,” stated Tribal Chief Michael Conners. Chief Conners concluded, “We appreciate and sincerely value Congress’ efforts to join forces with tribal leaders and representatives from around the country to retract CMS’s harmful proposal. Together, we will continue fighting for improved access to reliable healthcare for Indian Country.”

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The Saint Regis Mohawk Tribal Council is the duly elected and federally recognized government of the Saint Regis Mohawk People.