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Jason Smalley:

To Whom It May Concern:

I write on behalf of Citizen Potawatomi Nation and Citizen Potawatomi Nation Health Services to provide an official response regarding the Oklahoma Health Care Authority's (OHCA) proposed changes to Oklahoma Medicaid and Children's Health Insurance Program eligibility policies under Public Law 119-21 in its State Plan Amendments. As you know, this federal law grants specific exemptions to American Indian and Alaska Native (Al/AN) members, including exemptions from six-month renewals and work requirements. We call on OHCA to operationalize these statutory protections clearly, consistently, and without administrative barriers.

Verification of Al/ AN Status and Recognition Processes

OHCA must maintain its ongoing process for recognition of Al/AN members through established agency processes to ensure members receive their lawful exemptions. This should include providing applicants the right to use self-attestation when completing benefit applications. Additionally, OHCA must accept claims filed by Indian Health Service (IHS), Tribal, and Urban Indian (1/T/U) facilities to verify this status given staff at these facilities screen members under rigorous Indian Health Service eligibility criteria prior to service delivery.

Alignment with Centers for Medicare & Medicaid Services Guidance

We further call on OHCA to follow Centers for Medicare & Medicaid Services-issued guidance that explicitly directs state agencies not to require reverification of Al/ AN status once established. Requiring repeated documentation creates unnecessary administrative burdens and increases procedural disenrollments. OHCA must record verified Al/AN status permanently across all renewal cycles.

Correction of Demographic Errors from Observational Selection

Application assisters, eligibility workers, or hospital staff sometimes complete applications without asking applicants about Tribal status. Unfortunately, there is a history of these individuals selecting a race category based solely on their visual observation. OHCA must allow Al/AN members to correct these errors immediately upon discovery. The correction must automatically apply all Al/AN exemptions-including those from work requirements and six-month renewals-without forcing the member through an appeal process. 

Retroactive Eligibility for the Adult Expansion Group

Reducing retroactive eligibility from three months to 30 days for the Adult Expansion group creates severe financial strain, consequently increasing uncompensated care costs for Indian Health Service facilities and Tribal Health Programs across Oklahoma. We urge OHCA to preserve the existing three-month retroactive coverage window to protect safety-net providers and vulnerable health care recipients, many of whom live and are treated in rural Oklahoma communities without adequate access to alternative medical facilities.

As elected leaders charged with overseeing our own Tribal healthcare system, we appreciate the challenges that OHCA officials are facing in implementing Oklahoma Medicaid and Children's Health Insurance Program eligibility policies under Public Law 119-21. Given Oklahoma's unique status as home to 39 Tribal nations, many with health systems serving significant numbers of Oklahomans, we believe your attention to, and incorporation of these Tribal priorities will be a net benefit to our state. We look forward to seeing OHCA incorporate these protections into its final State Plan Amendments.

Do not hesitate to contact our office if we can provide further guidance on these matters.

Sincerely,

Jason Smalley

Vice Chairman

OHCA Response:

OHCA appreciates Citizen Potawatomi Nation’s comments. OHCA will implement the federal protections for American Indian and Alaska Native members, including the exemptions from community engagement requirements and six-month renewals.

Consistent with CMS guidance, OHCA will use reliable information available to the agency to verify qualifying AI/AN status and will not require reverification once that status has been established. CMS guidance also permits states to enroll based on attestation and verify exclusion status post-enrollment when appropriate.   

OHCA also appreciates the concerns raised regarding retroactive eligibility. However, the reduction in retroactive eligibility for the adult expansion group is required by federal law and is not a state option. OHCA therefore cannot retain the existing three-month retroactive eligibility period for this population.

Thank you for your comments and continued partnership.