[Congressional Record Volume 147, Number 164 (Friday, November 30, 2001)]
[Senate]
[Pages S12260-S12261]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Campbell, and Ms. Cantwell):
  S. 1753. A bill to amend title XIX of the Social Security Act to 
include medical assistance furnished through

[[Page S12261]]

an urban Indian health program operated by an urban Indian organization 
pursuant to a grant or contract with the Indian Health Service under 
title V of the Indian Health Care improvement Act in the 100 percent 
Federal medical assistance percentage applicable to the Indian Health 
Service; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, the legislation I am introducing today 
with Senators Campbell and Cantwell entitled the ``Urban Indian Health 
Medicaid Amendments Act of 2001'' would raise the Medicaid matching 
rate to 100 percent for Medicaid-covered services provided to Medicaid-
eligible American Indians and Alaska Natives at urban Indian health 
programs.
  The legislation eliminates the discrepancy in current law that 
provides for a higher matching rate to states for care delivered in an 
non-urban outpatient facility operated by the Indian Health Service, or 
IHS, or by a tribe or a tribal organization under contract with IHS 
compared to the lower matching rate to an urban Indian program funded 
by the IHS to deliver services to Medicaid-eligible Native Americans 
residing in urban areas.
  The bill would not alter current policy toward facilities operated by 
the IHS or by tribes or tribal organizations. As under current law, the 
Federal Government would continue to pay 100 percent of the cost of 
treating Medicaid-eligible American Indian or Alaska Natives at an IHS 
hospital or tribal clinic. Similarly, the bill would not alter the 
amounts paid to IHS hospitals or tribal clinics for treating Medicaid 
patients.
  Instead, the bill simply extends the 100 percent federal matching 
rate to the costs of treatment of Medicaid-eligible Native Americans in 
urban Indian health programs and corrects the inconsistency in 
treatment under current Medicaid law.
  The urban Indian health program was first authorized in 1976 in Title 
V of the ``Indian Health Care Improvement Act.'' According to a report 
entitled ``Urban Indian Health'' by the Kaiser Family Foundation that 
was released this month, ``The purpose of the Title V program is to 
make outpatient health services accessible to urban Indians, either 
directly or by referral. These services are provided through non-profit 
organizations, controlled by urban Indians, that receive funds under 
contract with the IHS.''
  In fact, the Federal Government, through the IHS, currently funds 36 
urban Indian health programs in 20 states: Arizona, 3; California, 8; 
Colorado, 1; Illinois, 1; Kansas, 1; Massachusetts, 1; Michigan, 1; 
Minnesota, 1; Montana, 5; Nebraska, 1; Nevada, 1; New Mexico, 1; New 
York, 1; Oklahoma, 2; Oregon, 1; South Dakota, 1; Texas, 1; Utah, 1; 
Washington, 2; and Wisconsin, 2.
  These programs are nonprofit organizations that provide outpatient 
primary care services, and in some cases, just referral services, to 
urban Indians, many of whom are eligible for Medicaid. In FY 2001, 
Congress appropriated $29.9 million, or just 1 percent of the Indian 
Health Service budget, in discretionary funding to these programs. 
These programs are expected to supplement this direct funding with 
revenues from third party payers, such as private insurance and 
Medicaid.

  Urban Indian health programs may participate as providers in their 
state's Medicaid program and receive payment for services covered by 
Medicaid that are furnished to Medicaid-eligible urban Indians. 
Whatever amount the state pays the urban Indian program for a Medicaid 
patient visit, the Federal Government will match the State's 
expenditure at the State's regular Federal Medicaid matching rate, or 
FMAP.
  In contrast, if an American Indian or Alaska Native who is eligible 
for Medicaid receives primary care services covered by Medicaid at an 
outpatient facility operated by the IHS or by a tribe or a tribal 
organization under contract with the IHS, the Federal Government will 
pay 100 percent of the cost of the service.
  The policy rationale for this enhanced matching rate is that because 
Indian health is a Federal responsibility, states should not have to 
share in the costs of providing Medicaid services to Native American 
beneficiaries receiving care through facilities operated directly by 
the Federal Government's IHS or by tribes or tribal organizations on 
behalf of the IHS. This same rationale applies to Medicaid-covered 
services provided by urban Indian programs funded by the IHS to deliver 
services to Medicaid-eligible Native Americans residing in urban areas. 
Unfortunately, the Medicaid statute does not reflect this policy. This 
legislation would address this inequity.
  Moreover, as a report by the Kaiser Family Foundation entitled 
``Urban Indian Health'' released this month adds, ``Extension of this 
100 percent matching rate to services provided by Title V providers to 
Medicaid-eligible urban Indians may give State Medicaid programs an 
incentive to treat these `safety net' clinics more favorably in both a 
fee-for-service and managed care context.''
  The proposal would simply amend the third sentence in section 1905(b) 
of the Social Security Act to read as follows (new language in italic):

       Notwithstanding the first sentence of this section, the 
     Federal medical assistance percentage shall be 100 per centum 
     with respect to amounts expended as medical assistance for 
     services which are received through an Indian Health Service 
     facility or program whether operated by the Indian Health 
     Service or by an Indian tribe or tribal organization or by an 
     urban Indian health program (as defined in section 4 of the 
     Indian Health Care Improvement Act).

  The amendment would be effective for Medicaid services furnished on 
or after October 1, 2001. Under this language, the enhanced 100 percent 
matching rate would apply only to services furnished directly 
``through'' an urban Indian health program, not by referral. Note that 
the amendment would not determine the particular amount the state 
Medicaid program pays an urban Indian health program for a particular 
service, such as a patient visit. The language only affects the Federal 
Government's share of that payment amount.
  Despite the fact that recent Census figures indicate that 57 percent 
of the 2.5 million people that identify themselves solely as American 
Indian and Alaska Native live in metropolitan areas, including 17,444 
in Albuquerque, New Mexico, the IHS budget only provides 1 percent of 
its funding to urban Indian health programs. We should and must begin 
to take steps to eliminate such dramatic discrepancies.
  As a result, within the Medicaid program, just as the Federal 
Government reimburses States 100 percent for the costs of services 
delivered to Native American beneficiaries receiving care through 
facilities operated directly by the Federal Government's IHS or by 
tribes or tribal organizations on behalf of the IHS, the same should 
apply to urban Indian health programs. This simple, yet important bill 
will eliminate the disparity and I urge its swift passage.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1753

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Urban Indian Health Medicaid 
     Amendments Act of 2001''.

     SEC. 2. INCLUSION OF MEDICAL ASSISTANCE FURNISHED THROUGH AN 
                   URBAN INDIAN HEALTH PROGRAM IN 100 PERCENT 
                   FMAP.

       (a) In General.--The third sentence of section 1905(b) of 
     the Social Security Act (42 U.S.C. 1396d(b)) is amended--
       (1) by inserting ``or program'' after ``facility'';
       (2) by striking ``or by'' and inserting ``, by''; and
       (3) by inserting ``, or by an urban Indian organization 
     pursuant to a grant or contract with the Indian Health 
     Service under title V of the Indian Health Care Improvement 
     Act'' before the period.
       (b) Effective Date.--The amendments made by subsection (a) 
     take effect on October 1, 2002.
                                 ______