LTSS Roadmap - Oneida Nation in Wisconsin

State of Wisconsin

In 1994, the State of Wisconsin signed a contract with the Oneida Nation that enabled the Nation to more fully access Medicaid and State home- and community-based services (HCBS). Through the State’s Community Option Program (COP), the Oneida Nation is treated as a county to provide long term services and supports through HCBS to eligible American Indians and Alaska Natives living within its jurisdiction. To ensure the viability of this arrangement, the Nation conducted a feasibility study to assess potential client load and its ability to sustain the program. Through this program it serves COP and Medicaid home and community based 1915 (c) waiver participants. The Oneida Nation is currently the only tribal community that has a COP contract with the State of Wisconsin. Oneida’s COP–Waiver (COP-W) primarily targets frail elders and persons with disabilities. The Oneida COP-W Program is administratively housed within the Nation’s Comprehensive Health Division.

Prior to 2007, the Oneida Nation’s COP-W was partly funded by the State (42%) with the majority of support coming from federal Medicaid funds (58%). In 2007, the Oneida Nation petitioned and successfully got waiver services included under its contract with IHS, making all costs pass through to the federal government. It is currently the only Tribe to have this included in its contract with IHS. This change also affected its arrangement with the State. Prior to this time, the State had a cap on the number of individuals the Oneida Nation could serve under the COP-W. Since then, the cap on enrollment for the Oneida COP-W Program has been removed.

As of 2011, the Oneida COP-W, which is separate and distinct from other programs run for the elderly by the Tribe, serves between 20 and 24 beneficiaries monthly. Through the COP-W Program the Oneida Nation directly provides the following services: skilled nursing care to individuals needing nursing care no more than once a week, physical therapy, respite care, job coaching for the developmentally disabled, and traditional healing when it can be provided. The program contracts out skilled nursing care for elders and persons with disabilities who need it more frequently than once a week, personal care assistance, medical equipment, home health aides, speech and occupational therapy, and transportation. The latter is contracted either to tribal transportation or to an outside service. The following administrative functions are also supported through the Oneida COP-W Program: assistance with Medicaid application process, case management, and eligibility needs assessment.

Currently the Oneida Nation COP-W service area is limited to the boundaries of the Oneida Reservation. It is in discussion with the Wisconsin Medicaid office to have the boundary area for its service delivery expanded to all of Brown and Allegheny Counties. This modification would enable the program to serve many tribal members who live in these adjacent areas.

See the video about Oneida Nation's cooperation with the state of Wisconsin. >

Oneida Nation's Story

Dave Larson told the story of how Oneida Nation worked with the state of Wisconsin to become the admininstrator of the COP-Waiver.

We have worked very hard for many years to establish a good working relationship with our state, and that relationship helped us greatly in these negotiations.It took over a year of talking to state health department staff, and educating them about the financial benefits of a new arrangement before they agreed to let us administer the waiver.

First, we grabbed their attention. We showed them some rough calcuations of how much money the state could save by allowing Oneida to administer the waiver (and taking advantage of 100% FMAP for services provided in tribal facilities). The number was a big one, so they wanted to know more.

We had done careful calculations to determine these numbers. As we educated them about the reimbursement process through FMAP and they began to understand it more fully, we supplied more and more detailed numbers, so they could understand our projections. They began to see the financial advantages, and to understand how it could be a win-win situation for both the state and our tribe. 

We worked together for a very long time. We formed a joint committee that met for over a year. A subcommittee did most of the work, and it met once a month in person and had phone conferences every few weeks. But at the end of this long process, Wisconsin agreed to have Oneida Nation administer the waiver services for our tribal members.