LTSS Roadmap - Cherokee Nation in Oklahoma
Guidance for the LTSS Roadmap planning model, which can guide communities through the planning process if they need to establish long-term services and supports or improve its current program. This module provides information on the Cherokee Nation in Oklahoma program..
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 03, 2016
State of Oklahoma
Point of Contact
Casi Foster
Director
Cherokee Nation Home Health Services
(918) 453-5554
In 1996 the Cherokee Nation Home Health Service, Inc. (CNHHS), a not-for-profit, Medicaid-approved, tribally governed agency was contracted by the State of Oklahoma to provide services under two programs, the Medicaid-funded HCBS 1915(c) Advantage Care waiver and the Oklahoma Medicaid Personal Care Program, available under the State Medicaid Plan. These programs enable the agency, within Home Health Outreach, to provide a variety of services, many of which are offered directly through CNHHS. Services provided directly by the agency staff include skilled nursing, personal care assistance, home health aides, therapies, transportation, respite support, and home-based hospice care (only through Advantage Care waiver). Other services covered by the Medicaid programs but not offered directly by CNHHS are obtained through contract services. These include among others medical equipment supplies and home modification. The CNHHS provides the following administrative functions for its Medicaid patients: assistance with Medicaid application process, case management, and needs assessment, with a client’s first assessment conducted by a State nurse. As of 2011, CNHHS serves an average of 400 Medicaid beneficiaries monthly through the Advantage Care and Personal Care, 290 and 110, respectively.
Both programs require that the person is a Medicaid beneficiary and meets the Oklahoma Department of Human Services Medicaid Guidelines. For the Personal Care Program the applicant must also meet medical and age (55 years or older) criteria and income limits and be assessed as needing assistance with daily living needs. For the Advantage waiver, eligibility guidelines include meeting medical, income, and age criteria (55 years or older) and being certified as needing nursing home-level care but able to remain at home safely during times services are not being performed.
For both Advantage Care and the Personal Care Program, the person must live in 1 of the 16 zip codes in and around Cherokee County in Oklahoma to be treated through the CNHHS. All persons who qualify are treated through CNHHS. Participation is not limited to Cherokee tribal members or American Indian and Alaska Native elders. As of 2011, 70% of beneficiaries receiving the services through both programs are Cherokee citizens.
While most of the payer mix for the agency’s entire service population is Medicare (Part A) and Medicaid, the following table presents the source and percentage of the entire payer mix.
Payer Mix by Percentage
| Funding Source | % |
|---|---|
| Medicare, Part A | 49.0 |
| Medicaid | 49.0 |
| Veterans Administration | 1.0 |
| Private | 0.5 |
| Other: Out-of-pocket* | 0.5 |
*Clients pay upfront; therefore rates are slightly below Medicaid
Overall, the CNHHS provides the following services through its staff:
- Skilled nursing
- Personal care assistance
- Home health aides
- Physical, speech, or occupational therapy
- Transportation (limited)
- Respite support
- Hospice
- Medical prescriptions (limited)
The agency contracts out medical equipment, needed therapies (approximately 10%), home modification, and home repair.
CNHHS is a self-sufficient agency; it has not received supplemental support from the Cherokee Nation since 1999.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.