IA2 Staff Pens Article on Potential Promise of Urban Indian Health Programs for SMPs

November 26, 2014

IA2 staff Dave Baldridge and Jolie Crowder co-authored an article in The Sentinel, published by the National Consumer Protection Technical Resource Center, about urban Indian health programs as a promising means for reaching Indian elders by the U.S. Administration for Community Living’s Senior Medicare Patrol (SMP) program. A program designed to educate and empower seniors in the fight against health care fraud- promoting a message of prevention, protection, detection and reporting by Medicare beneficiaries.

An excerpt from the article:

According to the 2010 Census, 71 percent of all American Indian/Alaska Natives (AI/ANs) live in urban areas. The remaining 30 percent live on reservations, trust lands, or bordering rural areas. This is a dramatic demographic shift from 1970, when only 39 percent of AI/ANs lived in urban areas. Currently, urban Indian health indicators underscore the shared challenges of urban Indians and their nonurban counterparts.

Compared with the general population, urban Indians have:

  • 38 percent higher rates of accidental deaths
  • 54 percent higher rates of diabetes
  • 126 percent higher rates of liver disease and cirrhosis
  • 178 percent higher rates of alcohol-related deaths

Indicators of economic stability (or the lack thereof) are also particularly stark for urban Indians.

  • The poverty rate of urban Indians is 20.3 percent, compared with 12.7 percent for the general urban population.
  • The unemployment rate of urban Indians is 1.7 times higher than that of non-Indians in urban areas.
  • Urban Indians are three times more likely to be homeless than non-Indians.

To help meet the health care needs of urban Indians, the Indian Health Service (IHS) Urban Indian Health Program (UIHP) supports contracts and grants to 34 urban health programs funded under Title V of the Indian Health Care Improvement Act. Approximately 45 percent of Urban Health programs receive Medicaid reimbursement as Federally Qualified Health Centers (FQHCs). Others receive fees for service under Medicaid for allowable services such as behavioral services and transportation. Those designated as FQHCs provide services to Indians and non-Indians.

UIHPs are located in 19 states supporting individuals in approximately 100 U.S. counties in which more than 1.2 million AI/ANs reside, according to the 2010 U.S. Census. Approximately 150,000 American Indians use Title V programs for health care services. These populations are not generally able to access hospitals, health clinics, or contract health services administered by IHS and tribal health programs because they either do not meet HIS eligibility criteria or reside outside of IHS and tribal service areas.

Since 1972, IHS has gradually increased its support for health-related activities in off-reservation settings, aimed at assisting the rapidly growing urban AI/AN population. However, the federal funding level for Title V programs is estimated at 22 percent of the projected need for primary care services, with only one percent of HIS federal dollars reaching urban Indian centers.

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