By Melissa Davlin, Idaho Reports
In today’s Medicaid expansion debate, expect to hear more questions about why the work requirement proposal exempts members of American Indian tribes.
The issue came up in the March 21 House floor debate on expansion, with both Reps. Fred Wood and Mat Erpelding expressing concern over House Bill 277 exempting tribal members from proposed work requirements. (Though the Senate Health and Welfare Committee held 277 in committee, the Senate as a whole reconstructed it in amendments to Senate Bill 1204, which the House is amending Thursday.)
So why is the exemption in the bill? It comes down to tribal sovereignty. A 1974 Supreme Court decision, Morton v Mancari, recognizes tribes as separate political entities.
In other words, the exemption isn’t based on one’s ancestry or race. Rather, an enrollee would be exempt from work requirements only if they are a member of a federally recognized tribe. So if someone has American Indian ancestry, but they aren’t a tribal member, they would still be subject to those work requirements.
Arizona set the precedent by adding exemptions into its Medicaid work requirements for tribal members last year. In January, the Centers for Medicare and Medicaid Services approved the request, after initially saying it believed the exemption would violate equal protection laws.
According to the Associated Press, Maine and Wisconsin allow tribal members to satisfy requirements by working in tribal work programs, and Maine also exempts tribal members from paying premiums.
In an April 3 joint letter to members of the House, representatives from Idaho’s five federally recognized tribes supported the inclusion of the exemption in Senate Bill 1204, and hinted at a lawsuit if the exemption is removed by lawmakers. “American Indian and Alaska Native populations are treated distinctly under the Affordable Care Act (ACA), which makes it appropriate for states who implement ACA programs to mirror that treatment,” the letter says. “As counsel for the tribes, we view the tribal exemption as a significant legal issue and one we would very much like to avoid if possible.”
