South Dakota to Advance Federal Employee Medicare Program

Last year, the South Dakota congressional delegation successfully pushed forward federal legislation that will allow more than 100 tribal-controlled schools across the country to participate in the Federal Employee Medicare Program (FEHB ). The Office of Personnel Management (OPM) is working to get the word out, and we hope this short update provides useful information for newly eligible entities and other groups interested in efforts to expand eligibility. tribal as part of the FEHB program.

According to the Congressional Research Service, the FEHB program is the largest employer-sponsored health insurance program in the country, providing health care benefits to about 85 percent of federal government employees and 90 percent of federal retirees. Under the program, the federal government and the employee or retiree share the cost of health insurance, with the federal government typically contributing 72% of the weighted average premium of all plans, but no more than 75% of the cost. premium of a given plan. The OPM administers the program.

Many tribal employers have been eligible to participate in the FEHB program since 2012. The Patient Protection and Affordable Care Act (Pub. L. 111-148), enacted in 2010, established that an Indian tribe or tribal organization running programs under the Indian Self-Determination and Educational Aid Act (ISDEAA), or an urban Indian organization running programs under Title V of the Indian Healthcare Improvement Act , could participate in the FEHB program.

In 2011 and 2012, the OPM held consultations with Indian tribes and other stakeholders on the new program, and in May 2012, tribal employers began purchasing FEHB coverage, rights and benefits for their workers. employees. Under the Tribal Employer Program, the tribal employer is required to pay at least the government’s share of the premium, and the registrant pays the remaining share. Tribal employers are allowed to purchase coverage only for employees and their dependents, and coverage is not available for retirees.

The Tribal School Federal Insurance Parity Act, introduced at the 115th Congress, aimed to extend the benefits of the FEHB program to employees of schools controlled by tribes. Tribal controlled schools are generally defined as K-12 schools which 1) are operated by Indian tribes or tribal organizations, 2) are not considered a local education agency, and 3) are not directly administered by the Bureau of Indian Affairs (BIA). According to the Bureau of Indian Education (BIE), the BIA funds 183 schools serving Native Americans located on 64 reserves in 23 states. Of these schools, 57 are managed directly by the BIE and already participate in the FEHB program, and 126 are tribal controlled schools and do not. Prior to the enactment of the Tribal School Federal Insurance Parity Act, even BIE “contracted” schools (operated by Indian tribes through ISDEAA) were not eligible to participate in the FEHB program without changing the law.

Congresswoman Kristi Noem (R-SD) in the United States House of Representatives and Senators John Thune (R-SD) and Mike Rounds (R-SD) in the United States Senate sponsored the Tribal School Federal Insurance Parity Act at the 115th Congress. Congressman Dusty Johnson (R-SD-At Large) joined the two senators to reintroduce the legislation at the 116th Congress.

By the end of the 116th Congress, the South Dakota delegation had recruited a remarkably bipartisan coalition of cosponsors, including Congresswoman Deb Haaland (D-NM). The legislation has also received support from the National Congress of American Indians, the National Indian Health Board, the National Indian Education Association, the All Pueblo Council of Governors, the Great Plains Chairmen’s Health Board, the United Tribes of North Dakota and of the Saint Stephens. Indian School Educational Association, among others.

On May 1, 2019, the Senate Indian Affairs Committee held a legislative hearing on the Tribal School Federal Insurance Parity Act, in which John Tahsuda III, Senior Assistant Deputy Secretary — Indian Affairs, US Department of the Interior, and Cecelia Firethunder, President, Oglala Lakota Nation Education Coalition, testified in support of the bill. Deputy Assistant Secretary Tahsuda said the participation of IBE schools in the FEHB program has reduced costs and helped in the recruitment and retention of schools. Ms. Firethunder estimated that access to FEHB would save a single BIE-funded school on the Pine Ridge Reservation, the Little Wound School, to save $ 1,000,000 per year. The Indian Affairs Committee introduced the bill to the full Senate in July 2019, and the legislation was finally enacted in late 2020, in Section 1114 of the 2021 Consolidated Finance Act (Pub. L. No. 116-260).

In April 2021, OPM hosted a government-to-government consultation which, among other things, covered OPM’s work with Tribes to enroll tribal employees in the FEHB program. During that consultation, the OPM noted that tribal-controlled schools are now eligible to purchase coverage for their employees, and the OPM has since officially launched the application process.

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About Evelyn C. Heim

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