*Services available include

*Medical

*Lab/X-ray

*Dental

*Mental Health

*Chemical Dependency

*Diabetes Education

*Contract Health

*Nutrition

*Community Health Representative

*Transportations to and from visits

*Native women's wellness, including Mobile mammography.

*Special Diabetes program for Indians (SDPI)

Key to our BH program success has been the development of Integrated care within our Wellness Center.

We have weekly/monthly meetings with our Medical providers as a team to discuss/coordinate care of Medical and BH clients.

Sign-ups began in October, immediately following Linda’s certification as Tribal Assister.

Our program sponsors Shoalwater Bay Tribal Members who are:Eligible for Contract Health ServicesOver 138% of federal poverty levelDo not qualify for other, alternate resources

The amount sponsored will be the premium remaining after tax credits are applied. The first priority has been to sign up CHS members who were previously sponsored on Basic Health and would lose that coverage on January 1st. It is expected that all of these will qualify for Apple Health as part of the Medicaid Expansion group.

Of these 13 individuals:11 have been successfully enrolled, and qualify for Apple Health effective January 1st

2 are pending completion of the application process. There are 6 CHS members who did not previously qualify for an alternate resource, due to income. Of these:5 will be eligible for sponsorship through the Washington Health plan Finder1 is pending new insurance through their employer

With the Tribal sponsorship program available and completion of the application process (by March 31st), 100% of CHS members would potentially qualify for an alternate resource. This will greatly alleviate the burden on the CHS program and on the individuals & families.

Some frustrations Linda has encountered:

  Downtime and crashes in the beginning of the plan finder.Technical information on how to use the plan finder was lacking but Lou and Sheryl were a huge help.

Requirement of email addresses for clients that may not have email access and having to set up children w emails. Some parents do not like the idea of there child's information being in “Cyber space”.

DSHS renewals are falling through the cracks.  Knowing there was an issue in January with data not transferring to healthplan finder properly, believe there may be other system glitches as well: Trouble with one client in particular where they signed her up for apple health and included her daughter, but she kept getting letters that the renewal was incomplete.  This was due to the system putting an erroneous end date on her renewal (January 1900).  Family members can have different renewal dates for their Apple health wondering if these will be aligned later, or can they be?  That’s going to make the process more cumbersome.  Another issue is that all of our clients so far have been put into plans.  These are the basic health folks and they are largely being assigned to the same plans they were on, but we understood, as Native Americans, they would be exempt. A related issue is that no one had ID cards in January from their plans.  Most had the State’s ProviderOne card, but had no knowledge that they had been assigned to a plan and no ID card. We had 2 patients have trouble getting meds and another who’s doctor delayed a (non-emergent) referral. And one surgery delayed until the network issue was addressed.

One aspect of this problem, that is difficult (or impossible) to address, is the panic in the provider community over all the insurance changes.  Probably not much anyone can do, but maybe worth noting.

* Recruitment & Retention

* Daily personnel issues

* Referral distance of all clients and transportation to appointments.

* Redirecting patients towards a healthier medical/lifestyle options.

* Dealing with difficult patients. Uncompromising, demanding patients make it hard to do your job as well as you would like.

* “No-Showing” for appointments tribal and non tribal patients.

* Specialty providers are getting more particular of the clients they are taking when it comes to “No show” appointments.

* Insurance companies and the paperwork they generate.

* Compliance for our patients who not only deserve excellent care but also have access to such services yet they refuse standard care (such as: Labs, mammograms, DM education, Nutrition counseling).

* Trying to help some patients that don’t understand that health care is a partnership and we can’t bestow health on anyone who doesn’t work with us to real their goals.

* Patience and persistence.

* Having multiple jobs rolled into one. Grants are more difficult that some people think. Grants tend to create more work for the employees.

* Knowing that those Native Americans who we can’t help will end up going without proper health care.

* Funding to do all the things that need done for our tribal members. Not ever having enough money to help all Native Americans who request health care services from the tribe.

* Long term health compliance.

* Patient compliance.

* Advising patients that there teeth are not savable.

* Some patients don’t understand the necessity of good oral health.

* Trying to explain that certain procedures can not be done due to insurance limitations or tribal CHS dollar limitations.

* Knowing that a patient who needs dental care, however they don’t have the financial ability to take care of there dental needs. This affects a lot of our Direct care clients that we have to refer out for Specialty dental care.

* Dealing with difficult clients who have “poor” boundaries.

* Transportation barriers

* Continual “No Show” appointments

*Working with the RSN’s

* Red tape to get clients admitted for CD and MH stays.

2 AHAB Sirens at Shoalwater Bay Reservation Insures coverage for all of Tokeland Other Warning Systems: NAWAS 24/7 warning NOAA Radios in all Tribal Buildings Telephonic Warning System

Elders homes are flaggedNOAA weather radios in most homes and all Tribal Buildings