PRESENTED BY: • Dave Baldridge, Executive Director, International Association

for Indigenous Aging• Sherrie Varner, Medicare Policy Analyst, Choctaw Nation

• Jolie Crowder, Project Manager, International Association for Indigenous Aging

Protect Yourself, Your Family and Your TribeMedicare offers peace of mind and protection for elders

This grant was supported in part by a grant (No. 90SM0012) from the Administration on Aging (AoA), Administration for Community Living (ACL), U.S. Department of Health and Human Services (DHHS). Grantees carrying out projects under government sponsorship are encouraged to express

freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official AoA, ACL, or DHHS policy.

Today we will talk about…

• Who is an Indian?

• Demographic snapshot of American Indian and Alaska Native (AIAN) Elders

• Overview of Indian health care

• Medicare fraud and abuse in Indian Country

• Conducting outreach

• Test drive the new outreach toolkit

According to the 1976 Indian Health Care Improvement Act…

An Indian is anyone who is a member of a ‘recognized’ tribe, with no mention of blood quantum. An individual may be considered Indian if he or she

belongs to a tribe, band, or group that has been terminated since 1940, regardless of whether or not the individual lives on or near a reservation. Another category includes those members of tribes which are recognized

now—or may be recognized in the future—by the state in which they reside. In addition, anyone who is a descendent, in the first or second degree, of any

one of these individuals also qualifies. Eskimos, Aleuts, and other Alaska Natives are considered Indians. Anyone considered by the Secretary of the

Interior to be Indian for any purpose qualifies. And finally, anyone who is determined to be Indian under regulations promulgated by the Secretary of

Health and Human Services also is considered to be Indian.

Who is an Indian?

Q: A:

566 federally recognized tribes

250 languages actively spoken

324 federally recognized reservations

617 legal and statistical AIAN areas according to Census Bureau

Ethnically and culturally diverse

Recognition as an Indian requires:• Recognition by the tribe• Evidenced by tribal membership, showing descendency from parents,

grandparents or other ancestors

Indian Country (Alaska reserves this phrase for the lower 48!):• All lands within the limits of any Indian reservation, Indian communities within

the borders of the U.S., and Indian allotments, federal trust lands held for AIAN tribes

• Not a unified country• Many distinctive nations, tribes, communities with political, geographic,

demographic, economic and cultural differences

More about Indians…

In exchange for land and to compensate for forced removal from homelands, U.S. government promised

through law, treaties and pledges to support and protect AIAN people

• Long established political relationship between the U.S. government and AIANs

• Tribes have status as sovereign nations (authority to govern themselves)

Federal Trust Responsibility

Demographic Snapshot• 5.2 million AIANs in 2010

• Increase of 39% from last Census

• Fastest growing population, twice that of the total U.S. pop

• 1.9 million receive services from Indian Health Service (IHS), agency of Dept. of Health & Human Services

• 450,000 65+ AIAN

• By 2060, will quadruple, 2 x faster than total U.S. 65+ population

Alaska Natives differ from Indians in the lower 48. No “Indian

Country” tribal members. Alaska Natives are known as Customer-Owners; they both own the tribal health corporation AND they are

consumers of the services.

• 60% live in non-rural areas; only 22% live on reservation lands or trusts• 50% AIAN alone, 50% multi-racial (multi-race is growing fast)• Women comprise 56%

Health care coverage:• 96% have Medicare• 24% have Medicaid• 77% do NOT list IHS as a source of health care

Comparison of AIAN 65 + to overall 65 U.S. Population

More Facts About AIAN Elders

AIAN 65+ All U.S. 65+ Proportion of the population 9% 14%At or below poverty 16% 10%Didn’t complete high school 27% 19%Describe health as fair or poor 39% 27%Hospitalization rate 33% 15%Diabetes 30% 22%

• Lower median age: die younger• Higher rates of stroke, heart attack, coronary heart disease and depressionLimitations in activities of daily living are more common: • 1/3 report trouble walking – nearly 2 x that of the total U.S. population, • 3 x more AIAN (or higher) report problems with: eating, using the toilet,

dressing getting of bed, and bathing/showering. 3 – 4 x higher rates of reported barriers to care:• long wait for appointments, • long wait in a waiting room, • no transportation, • cost of care, • office not being open when they could get there.

Health Disparities

AIANs rank at, or near the bottom, of nearly every social, health, and economic indicator.

Population by County

Geography • 566 federally recognized Indian “Nations”: tribes, bands, nations, pueblos, Rancherias, Native villages

• 229 of these located in Alaska

• Tribes spread across 35 states

• Those who live on reservations are often geographically isolated

• Migration to urban areas represents most significant demographic shift in U.S. history

• European settlers invaded lands, military intrusions, massacres of tribal villages, forcible removal, broke treaties

• When not in war, forced attempts to acculturate and eliminate Indian culture and religion

• Children removed from communities and taken to boarding schools and foster homes starting late 19th century– major boarding schools closed in 1980s/1990s

• 1950s and 1960s federal government legislation to terminate obligations to Indian tribes resulted in policies and programs designed for assimilation

• 1952 BIA Urban Indian Relocation Program – active recruitment of Indians; Relocation offices in Chicago, Denver, Los Angeles, San Francisco, San Jose, St. Louis, Cincinnati, Cleveland and Denver

• Estimated 750,000 migrated to cities between 1950 and 1980 • Fought to retain tribal cultures, but not completely successfully• Majority no longer live on reservations and have blended with mainstream• Broad variation in beliefs and practices• This loss of culture has had significant and lasting impact and can be tied to

disparities that exist today

Impact of Acculturation

Urban Indians

13

• As of 2010 Census, 71% of all AIAN live off reservation

• 1976 Indian Health Care Improvement Act – created title V which targets funding for health programs in urban areas

• Title V (urban Indian health programs) receive < 1% of Indian Health Service (IHS) budget

• Urban Indians share same health and socioeconomic disparities as reservation counterparts

Overview of Indian Health Care

• Indian health care is not simply an extension of mainstream health system• Federal government entered into close to 400 treaties between 1778 and

1871 – medical care as partial compensation for land and other resources• Indian health care is considered by many as a pre-paid right• Legal basis for federal health care:

• U.S. Constitution commerce clause• Snyder Act of 1921• Johnson O’Malley Act of 1934• Transfer Act of 1954• Indian Sanitation and Facilities Services Act of 1959• Indian Self-Determination and Education Assistance Act of 1975• Indian Health Care Improvement Act of 1976• Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986• Indian Child Protection and Family Violence Prevention Act of 1990• Indian Health Care Improvement Act of 1976, as amended by the Affordable Care Act in 2010

Federal Responsibility to Provide Health Care

Federal Side of Indian Health

IHS Indian Health

HRSA

CMS

ACL

SAMHSA

ACF

CDC

• I= Indian Health Service (IHS). Agency within the US Department of Health and Human Services responsible for providing health services to AIANs predominantly located on or near Indian reservations in 35 states

• T= Tribes and tribal organizations or 638 programs. Have authority to operate hospitals and clinics, under the Indian Self-Determination Education and Assistance Act

• U= Urban Indian organizations. Operate health clinics in urban centers under title V of the Indian Health Care Improvement Act

These programs are often referred to as I/T/Us – IHS, Tribal providers and Urban Indian health care providers

Indian Health Care System – I/T/U

Who Can receive Indian health care services?

Is of Indian and/or Alaska Native descent as evidenced by one or more of the following factors: • Is regarded by the community in

which he lives as an Indian OR Alaska Native;

• Is a member, enrolled or otherwise, of an Indian or Alaska Native Tribe or Group under Federal supervision;

• Resides on tax-exempt land or owns restricted property;

• Actively participates in tribal affairs; • Any other reasonable factor

indicative of Indian descent; or

Is an Indian of Canadian or Mexican origin, recognized by any Indian tribe or group as a member of an Indian community served by the Indian Health program; or

Is a non-Indian woman pregnant with an eligible Indian's child for the duration of her pregnancy through post partum (usually 6 weeks); or

Is a non-Indian member of an eligible Indian's household and the medical officer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.

Proof of Eligibility for Services

• Anyone with a Certificate of Degree of Indian or Alaska Native Blood (CDIB) can use an IHS facility

• Some I/T/Us may use a tribal card or a descendency letter as evidence of eligibility

• Info recorded in the PRS [Patient Registration System] is used to determine individual eligibility for IHS direct care services and Contract Health Services. Requires documentation from the BIA [Bureau of Indian Affairs] concerning individual tribal affiliation and membership status

IA2 International Association for Indigenous Aging

Indian Health Service (IHS)• Provides care to 2.2 million AIAN

• Directly operates hospitals, health centers, school health and health stations

• Oversees Contract Health Services (CHS)

• Unlike Medicare, not an entitlement program; not health insurance

• IHS appropriations typically run out mid-year – results in rationing of care

• CMS program funding supplements revenue stream

• Use a public health model – medical care, preventive care, health education and sanitation

Map of IHS Service Areas

IA2 International Association for Indigenous Aging

This map created at https://mapapp.ihs.gov/mox6/

Map of IHS Facilities

IA2 International Association for Indigenous Aging

This map created at https://mapapp.ihs.gov/mox6/

Map of IHS Service Areas & Facilities

CHS is a fund that is used:• Where no direct care facility exists• Direct care facility is incapable of providing emergency or needed specialty care• Direct care facility has too heavy a medical workload• Supplements alternate resources (i.e., Medicare or private insurance)

• If health services can’t be provided in a direct care facility, Indian patients are referred out to private and public sector providers

• Authorization of services is dependent on appropriations and medical priorities, most referrals for life threatening illnesses or emergencies

• Not an entitlement program• Even with referral funding for care not always available• IHS is the payor of last resort for contract health services, notwithstanding

any Federal, State or local law or regulation to the contrary

Contract Health Services

CHS Is Complex & Has Boundaries

• Example: Choctaw Nation of Oklahoma includes 10 ½ counties in Southeastern Oklahoma BUT serves 8 counties for CHS

• If patient lives in the 8 counties, they could qualify for CHS if qualifications met

• If patient lives in TX, AR or outside the 8 counties, doesn’t qualify for CHS, but may benefit from direct care services provided by health care facilities in the 8 counties

IA2 International Association for Indigenous Aging

Indian Self-Determination and Education Assistance Act allows tribes to contract or compact with IHS to operate programs IHS would otherwise provide

Known as 638 programs or facilities

Tribes and tribal organizations operate about 50% of the Indian health system

Provide care in:• Hospitals• Health centers• School health centers• Health stations (including 166 Alaska Native village clinics)

Tribal programs bill Medicare, Medicaid, CHIP and private insurance

Tribal Health Care

Urban Indian Health Programs

Title V of Indian Health Care Improvement Act (IHCIA) established Urban Indian Health Organizations

Centers participate in Medicare, Medicaid and CHIP and bill at fee-for-service or Federally Qualified Health Center (FQHC) rates

34 urban Indian clinics operate 41 sites throughout the country

About 149,000 Indians served

15 clinics are FQHCs and serve Indians and non-Indians

Funding is 22% of the projected need for primary care services (alone)

Less than 1% of IHS funding goes to urban Indian health centers

18 cities identified as having an urban Indian population large enough to support a program

Services vary by clinic: dental services, comprehensive primary care services, substance abuse (outpatient and inpatient services), behavioral health services, immunizations, HIV activities, health promotion and disease prevention, and referral services to other health programs, i.e., WIC, Social Services, Medicaid, Maternal Child Health, etc.

IA2 International Association for Indigenous Aging

Annual per capita health expenditures fall below level for every other federal medical program and standard

Vast majority of funding is for primary care

FY 2015 budget request of $4.27 billion = .4% of the overall Dept. of Health and Human Services budget

Only 60% of funding needed

Misperception that Indian casinos provide enough funds for health care-- only ½ of tribes have casinos, 39 casinos account for 66% of revenues, profits aren’t shared between tribes

Even with 3rd party collections (e.g., Medicare), care is rationed system because funding runs out early in the year

I/T/U Funding

Medicare & the I/T/U System

+

=

• I/T/U can bill Medicare – I/T/U is payor of last resort• Medicare funding can be used to offset I/T/U expenses without reduced

appropriations• Medicare covers some services not available through I/T/U• Medicare and Medicaid reimbursements to IHS exceed $1 billion• 12 IHS Areas - 11% - 19% of IHS Active User costs are paid by Medicare

fee-for-service payments• Medicare revenues at IHS service units vary from 15-65% of operating

budgets (not including all tribal facilities that receive reimbursement)

Medicare & the I/T/U System

30

• Between 385,000 and 446,000 AIAN with Medicare

• Enrollment by state varies – 6% - 15% (white states = data wasn’t analyzed)

• 96% of all 65+ AIAN enrolled in Medicare

• 90% of those enrolled in Medicare have Part A and part BPercentage of AI/ANs Enrolled in Medicare by State

Barriers for AIAN Medicare Enrollment

•Belief that IHS will cover all medical needs

•Belief they are entitled to care and shouldn’t have to fill out paperwork to get it

•Confusion about the system and terminology– “I’ve never had insurance before”• Understanding insurance, coverage, deductibles, co-pays, Parts of Medicare, Part D

prescription drug Tier methods

•Don’t know how to enroll• Enrollment is primarily done on-line for Part D• Internet access limitations• Difficult to decide which plan is the best for the patient’s medical needs

•Cost - Part B premiums, penalties for late enrollment; Part D premiums and choices

•Not eligible because of work history

IA2 International Association for Indigenous Aging

Why Have Medicare + I/T/U?Benefits the System

•Indian Health Service, Tribes and Urban health care facilities/clinics can bill Medicare

•I/T/U pays last

•3rd party revenue enables I/T/Us to provide additional health services to AI/ANs-- new services and improved quality of care

Benefits Elders

•I/T/U:

isn’t insurance, doesn’t cover all services, equipment

may run out of funding before year end

prescription formularies may be limited

•Medicare can help pay for any approved services used outside of the IHS system

32

Services Not Always Covered by I/T/U

Skilled Nursing Facility Care (Part A)

Hospice Care (Part A)

Dialysis (Part B)

Acute In-patient Mental Health Programs (Part A)

Mental Health services outside of the IHS System (Part B)

Certain DME such as beds, scooters, lifts (Part B)

IA2 International Association for Indigenous Aging

Medicare Advantage & I/T/U

•Not a large number enrolled (11% vs. 27% all others)•Often no contracts with MA plans•Payment to the I/T/U could be paid at regular

reimbursement or paid at a lesser “out of network” amount

•Often I/T/U receives $0 reimbursement from MA plans as they are not acknowledged as a provider in the plan

•Patients are often confused about MA plan enrollment/eligibility and don’t realize they have left “traditional” Medicare

IA2 International Association for Indigenous Aging 34

Medicare Administrative Contractor for IHS - Novitas Solutions, Inc. (formerly Trailblazer Health Enterprises, LLC).

Fiscal intermediary for CHS program and 11 tribal programs - Blue Cross and Blue Shield of New Mexico

Tribes, federally qualified health centers, rural health centers, and other non-IHS entities may have other fiscal intermediaries or carriers • can use the Medicare Administrative Contractor designated for their state for

Medicare claims, or • can elect to file claims through Novitas.

I/T/U Billing Entities

Systems vary from one tribe to the next

Each I/T/U has staff (often referred to as Benefit Coordinators) that assist patients with:

• Medicare and Medicaid questions and assistance with enrollment• Private insurance questions• Affordable Care Act Marketplace questions and assistance with enrollment• Veterans Affairs health benefits• And many other health-insurance related questions and assistance

Tribal health consortium and/or Indian health boards:• May be a consortium of Tribes that provides service• Indian Health Boards advocate for direction and priorities and liaison with

local, state and federal government on policy

Learn the Tribal Health Systems in Your State

AIAN Resources: CMS

CMS Division of Tribal Affairs, located in Baltimore, serves as a liaison between the Agency and Tribal communities

CMS Regional office- Native American Contact (NAC) available to provide technical assistance on CMS programs to I/T/Us

For more information, go to:• http://

www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Outreach-and-Education-Resources.html

IA2 International Association for Indigenous Aging

Other Health Care Resources

Indian Health Service: www.ihs.gov

Indian Health Manual (IHM): http://www.ihs.gov/IHM/

Indian Health Care Improvement Act: http://www.ihs.gov/ihcia/

Bringing Better Health Care to Indian Communities Publication ID 11368-N:

https://www.medicare.gov/Pubs/pdf/11368_N.pdf

Marketplace info: www.healthcare.gov/tribal

Local or IHS Area policies and procedures or a specific tribe or tribal entities’ policies & procedures.

IA2 International Association for Indigenous Aging

Medicare Fraud & Abuse in Indian Country

Why is it so difficult to quantify Medicare fraud for AIAN seniors?

• Medicare, Census, IHS don’t accurately identify all AIANs

• Medicare, Census, IHS data systems not linked

• I/T/U health care system and billing is complex

• IHS estimates don’t capture data collected by tribes

• No concrete way to measure fraud, errors, abuse

Q: A:

Is there less fraud in Indian country?

Nobody knows!

• May be some cultural insulation or geographical isolation in some tribal communities to fraud and abuse scams

• Fewer incentives to commit fraud because I/T/U reimbursements are complex and funding is limited

Q: A:

What are the barriers to fraud detection and reporting?

• Distrust of government• Reluctance to report friends,

family, tribe members• Fear of retribution• Limited literacy• Limited access to information• Limited technological access• Lack of Medicare knowledge• Lack of interest in health care

billing• MSNs are suppressed for I/T/U

services

Q: A:

OIG is responsible for oversight

Between 2001-2010 opened 288 investigations involving IHS

118 investigations led to criminal prosecutions

OIG identified 5 key vulnerabilities:• Employee misconduct• Drug diversion by employees, providers and beneficiaries• Tribal enrollment fraud • Fraud related to 638 programs• Medicare or Medicaid reimbursement fraud

Oversight & Fraud in Indian Country

Real Cases: Health care fraud & abuse in Indian Country

• South Dakota Man Charged With Pharmacy Fraud

• Montana Clinic Psychologist Guilty of Bribery and Tax Fraud

• Montana Home Health Care Agency Owners Indicted on Conspiracy to Commit Health Care Fraud, Money Laundering and Identity Theft

• Tribal Governor Convicted of 29 Counts of Fraud in Substance Abuse and HIV Prevention Programs

Conducting Outreach with AIAN Communities

• Lack of understanding about Medicare within communities• Bad history of outsiders working with AIAN communities• Requires cultural sensitivity and acknowledgement of the

diversity that exists between the various tribes

Despite the challenges they face, Native communities usually offer great strength and resiliency.

Family and community factors—including spirituality, traditional practices, and other cultural strengths—can and do offer opportunities to maximize the

health and well-being of AI/ANs.

Incorporating these factors will make programs and interventions more culturally relevant and successful.

Challenges to Conducting Outreach

Recognize that historical events and relationships with the federal government have created mistrust

Plan for collaborative, long-term relationship building

Work towards building effective partnerships and relationships built on trust

Learn how each tribe’s community members view the world from their cultural lens--especially regarding health

Acknowledge the importance of culture in planning and throughout the course of the project

Recognize resource constraints

Seek guidance and experience from within the community

Partner with trusted community organizations to help gain entry

Recognize that health literacy is disproportionately burdensome on the AIAN population

Overcoming Challenges

Confidentiality is critical--small communities, relatives, friends or acquaintances work in health care clinics or hospitals.

• Establish trust and elicit support from tribal leaders• Identify or recruit a tribal community member to serve as an

advocate for the project• Conduct a needs assessment• Meet communities where they are--don’t assume what worked in

the mainstream will work with a tribe• Fund or support community-based organizations with a proven track

record• Identify and form collaborations with tribal departments and non-

tribal agencies work on health and social issues• Challenge misconceptions about the cultural values of AIAN

communities

Tips for Conducting Outreach

Non-Natives NativesDemonstrating learning early; seeking to please Gaining respect through silence and observation at an early age

Speaking to many people who give perspective to life; not needing to talk to those whom one is close to; companionship

Conversing at length with those whom one is close to; watching and giving respect to those whom one does not know well

Valuing conversation as a way to get to know others

Valuing observation as a way of getting to know others

Learning through trial and error Children listening and learning; not answering questions or demonstrating skills unless they know the answer or are adept at the skill

Expecting to demonstrate knowledge Difficult meeting expectations of non-Natives due to their way of learning

“Putting your best foot forward.” Presenting positive self-image and high hopes for the future. Interpreting Natives who are not boasting or speaking of the future as lacking self-confidence.

Not accepting boasts, nor speaking of the future

Communicating rapidly Thinking before answering, leading to longer pauses

Requiring closure for courtesy Not requiring closure (e.g., may hang up at the end of a telephone conversation without saying good-bye)

Preferring direct messages Preferring indirect messages

Communication Differences

Remember: Keep it simple. You don’t want to derail your project plans by being overly ambitious. Forging new relationships with AI/AN

communities takes time and a hands-on effort.

1. Develop a purpose

2. Conduct a quick assessment (see the assessment form in the toolkit)

3. Identify your audience – beneficiaries, family, tribal leadership, health boards, title VI directors, clinic staff, urban Indian health centers, etc.

4. Customize the SMP message to the needs of the community, health care system that serves them, and the local billing process.

Develop an Outreach Plan

• Address general lack of understanding and awareness within AIAN communities about Medicare – go armed with Medicare knowledge and resources or bring a partner with you who can fulfill this role

• Emphasize Medicare as insurance and the direct connection to the benefits to them individually as well as to their tribe

• Personalize the implications of fraud and scams to them individually – find examples of fraud or scams from the community

• Simplify the message and use plain language• Consider minimizing references to federal government programs in some

communities, because of their lack of trust or other negative perceptions• Consider methods that are typically less formal (talking circles vs. PowerPoint

presentations)• Invite community members to review materials and incorporate feedback

before distributing within the community or conducting a presentation

Tips for SMP Messaging

Media only – perhaps good for SMPs with no track record of tribal relationships• Mail or deliver fact sheets• Create video resources for clinic waiting rooms• Customize materials for media outlets and social media tribes specific to the tribeGrassroots Outreach• Identify workshop and presentation opportunities and conferences and events

• Area Indian Health Board Conferences• Tribal health or non-health related conferences• Tribal health fairs or local events• Title VI elder nutrition program events• Tribal senior and elder center events

Direct Approach• Identify and partner with a tribal health advocates--tribal health center director,

community health representative, etc.• Approach Urban Indian Health Center to discuss partnership opportunities

Conference or Workshop• Depending upon # of tribal communities in the state consider a conference specifically

for AIAN advocates or invite AIAN staff to your regular conference

Outreach Methods

• Connection with tribal elders can be challenging as an outsider• Building relationships takes time and consistency• 18 months of integration grant funding was not enough to get

established• Elders can be slow to comprehend anti-fraud messages due to

complexity • Elders have many Medicare questions• It can be difficult to recruit volunteers because of tribal

commitments• There may be a limited need to translate materials: elders rely on

oral, not written, messages (Check with the community) • Turnover in tribal staff is frequent and can cause project restarts• Tribal events tend to be more informal then regular presentations,

and have shorter planning cycles

SMP Lessons Learned from Outreach

Rural and isolated locations mean a lag behind in internet access

But, AIANs adopt social media at some of the fastest rates

One study found:• 94% of tribes have a website• 84% of AIAN use internet several times a day• 44% have social networking sites• 92% own a cell phone

Lack of internet access has expedited use of cell phones – many move to mobile internet using cell phones

Radio is still an effective medium – AIAN elders remain the least wired within AIAN age groups

Mobile Indian Country

Test Drive the Toolkit

Toolkit Resources

• Resource Manual

• Newsletter article templates

• Tri-fold brochure

• PowerPoint - same content 2 versions

• 6 fact sheets

• Outreach assessment form

• Regional profiles of AIAN populations

• Profiles of 10 largest tribes

• Consistent look and feel

• Theme: Medicare Matters

It’s long!

It’s comprehensive

Used a lot of Headings and Subheadings

Use the Table of Contents to pick where you want to go and supplement the info you need

Navigating the Manual

Newsletter Articles & Fact SheetsNEWSLETTER ARTICLES

• Medicare Open Enrollment Scams• Medicare Matters to Our Elders

and Families• Medicare Identity Theft• Medicare Matters – Health Care

Providers

FACT SHEETS ~ 6TH GRADE LEVEL• Medicare Basics for AI/AN Elders• Medical Identity Theft for Indian Elders• Home Health Care Fraud for AI/AN

Elders• Medical Equipment Fraud for Indian

Elders• What is Medicare Fraud? For AI/AN

Elders• Protecting Elders from Fraud in

Community Settings (For Professionals)

Outreach Assessment Form

Where to access• SMP Resource Library• IA2 Website:http://iasquared.org/wordpress2/what-we-do/current-projects/smp-american-indian-and-alaska-native-integration-project-2/

Promotion• NCUIH• NIHB• CMS LTSS Working Group• Title VI Directors• LTC Ombudsman• Leadership

Council on Aging• More…

Do you have entities in your state who might find the info or any resources useful? If yes, please share!

Where to Find the Toolkit & Promotion

Thank You…

• Blake Harper, Kauffman & Associates, Inc. • Nancy Aldrich & William F. Benson, Health

Benefits ABCs, LLC• Carolyn Holmes, Holmes Research &

Consulting, LLC• Sherrie Varner, Medicare Policy

Analyst/Marketplace Certified Application Counselor, Choctaw Nation of Oklahoma