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Recognizing that many Native Americans have limited faith in Western medicine, Molina Healthcare created a Traditional Medicine Benefit that gives Native Americans with Molina’s Medicaid coverage in New Mexico a stipend to spend on traditional care. The health plan has a similar program in Utah.
Molina wanted to honor Native American culture and traditional healing as a way to stay healthy holistically, says Shelly Begay, Native American Affairs manager for Molina in New Mexico. "A number of Native Americans have strong ties to their traditional culture and appreciate having this benefit to help out with the cost of services rendered by traditional healers," she says.
Molina consulted a number of Native American tribal leaders and learned that Native Americans often go to traditional healers for consultation or treatment because they don’t feel comfortable going to see a Western doctor and some may not agree to see a doctor without the blessing of their traditional healer. "It was suggested that the health plan provide a benefit that allows Native Americans to tap into traditional healers to complement the use of Western medicine," Begay says. Molina’s staff met with tribal leaders and community members in New Mexico and visited reservations in remote rural areas to get ideas on how the program should work.
Native Americans have a lot of economic and environmental challenges when it comes to accessing healthcare, Begay says. "We have 23 established identified tribes in New Mexico and many of their members have poor health outcomes that are made worse because of their social environment."
Molina established the Traditional Medicine Benefit as a complement to its Western medicine benefits. Members may apply for a stipend of up to $200 that they can use for traditional healing treatments such as herbal treatments or a purifying sweat lodge ceremony with a spiritual healer. The health plan implemented a similar benefit in Utah in 2011.
"We encourage our members to use traditional healing in coordination with Western medicine and preventive services. This way they receive holistic healing as well as physical treatment. We have made it clear that in no way do we want to interfere with the role of traditional healers," Begay says.
All members of Centennial Care, New Mexico’s Medicaid program, are assigned a care coordinator. The care coordinators review the members’ medical history and conduct an assessment of gaps in preventive care and other healthcare needs. Then they contact the members and work with them to obtain the care they need. If the members don’t have a primary care provider, the care managers help them find one.
The care coordinators are well versed in social service organizations and health education programs in the community. They can help members identify resources in the community and help them overcome the barriers to obtaining medical care. For instance, many reservations are located an hour or more from the nearest medical facility and the members need help with transportation to see a provider.
"Care coordinators also refer members for the services they need, such as programs to help them stop smoking, and diabetes education programs," she says. They also help members access other benefit programs that provide financial assistance for medication, housing, or utilities.
Some of the care coordinators are Native Americans and live in the communities they serve. The entire team has been through cultural competency training and are familiar with Native American practices and beliefs. "Our staff respects our members’ cultural practices and honor them," she says.
The members who receive the Traditional Medicine Benefit stipend are responsible for choosing what services they want and for making arrangements to receive them. "We don’t ask intrusive questions about what the benefit is used for, but we do encourage them to tell their primary care providers about any herbal remedies they may be using or other traditional treatment they have received," she says.
One of the goals of the program is to make sure members are aware of all the benefits that Molina offers. "We have an integrated staff from all disciplines that can help connect them with the care and services they need," Begay says.
Many Native Americans continue to receive health care at Indian Health Services, where they can get physical health and behavioral health services and fill their prescriptions at the pharmacy. "Indian Health Services and Tribal Clinics are part of our network, and we encourage our members to continue to utilize services at their local service units. The care coordinators assist members with seeking out services in their communities," Begay says.
New Mexico has a high poverty rate and many individuals could be eligible for Medicaid but have not signed up or don’t know how to sign up. "New Mexico has expanded its Medicaid program to cover individuals ages 19 through 64. Many young individuals feel like they don’t need insurance. We are educating a lot of people about benefits and encouraging them to enroll in Medicaid," she says.
"The purpose of the program is to make sure our members have better health outcomes and at the same time help individuals take charge of their overall health with the assistance of the care managers. We focus on making sure our members have the right resources and know how to access them," Begay says.