Official says that a tighter economy was a factor in the decision
CAPE FLORAL, Fla. – Kay Haering gets up every morning and checks her blood sugar before breakfast. Her insulin level will determine what she eats for breakfast. A diabetic, she learned how to eat for her chronic disease at a local Indian clinic in nearby Immokalee, Fla.
Beginning in July, Haering, a member of the Choctaw Nation of Oklahoma, is among those whose care is restricted for non-Seminoles at their health clinics. The Seminole Tribe of Florida notified Haering that Immokalee patients termed “Direct Care Patient” will no longer have chronic health care at the facility.
In a letter from Seminole Tribe of Florida to Haering, the facility outlined that it will be able to provide limited dental care and acute care for illnesses that are short term, but not care for those with diseases like arthritis, heart problems or diabetes.
The letter, dated May 15, notified Haering that she had about a month to find services for her two chronic illnesses – diabetes and polymyalgia (arthritis-related illness). Haering and patients like her “will no longer be eligible to receive treatment and annual maintenance prescriptions at Seminole Tribe of Florida Health Clinic for chronic medical conditions,” Connie Whidden, the Seminole Tribe of Florida’s (STOF) health director, stated in the letter.
Whidden said the tribe gave it plenty of thought before they decided to discontinue services to even one group. She said the numbers are high for the amount of people who will be affected by their policy change but added that a tighter economy was a factor in the decision.
“The tribe puts in three times what we get from IHS (Indian Health Service),” Whidden said. “A lot of non-residents reside in the state of Florida. They feel like Seminoles are rich they can provide services. Our tribe doesn’t think so.”
Meanwhile, Haering said the cut backs are severe for non-Seminoles.
“If it’s not a cold, flu or ant bite, we’re not going to be seen in the clinic,” Haering said.
Haering, a semi-retired real estate agent, lives about 40 miles from the southern Florida Seminole health facility and the loss of her chronic care means no more diabetic supplies, blood work and related consultation (foot care and dietitian). She cannot afford a supplementary insurance policy for $370 a month that could cover her expenses, she said.
In the notification letter to Haering, Whidden stated that all of her medical records would be available on request and upon completion of a STOF records release form. The letter outlined chronic illnesses as any medical condition requiring management over time.
“Therefore, you need to locate another medical provider and/or facility which will be able to treat you for your chronic disease and you must pay for the medical care that you receive,” Whidden stated.
Confused by her pending lack of services, Haering said that she wrote several letters to Seminole for answers but received no response. In her letter from Seminole Tribe of Florida, Haering was referred to area county health facilities for health care. Haering said she contacted IHS for help. IHS officials in Nashville, Tenn. told her in a June 8 letter they were reviewing the matter.
“It is a complex issue due to the fact that the Seminole Tribe owns and operates their health program under Title V of Public Law 93-638,” said Martha Ketcher, acting area director. “It will take some time to investigate the issue, and will probably require review by the Office of General Counsel.”
IHS officials said they would not respond regarding specific tribes but recognized tribes “going 638” for health care programs. According to IHS statistics, more than half of the IHS budget authority appropriation is administered by tribes. This is done primarily through Self-Determination contracts or Self-Governance compacts. Nationally, there are roughly 82 Title V compacts totaling approximately $1.35 billion. So while Seminole is exercising provisions under Title V, some Indian patients may find themselves out of the health care loop.
“We didn’t say we were cutting services completely, just we no longer provide certain services,” Whidden said.
Whidden added that future revisions in their policy may be to allow children of descendents who do not fulfill their one-quarter blood quantum requirement for enrollment access to health care in their facilities.
“You can’t throw the baby out with the bath water,” she added.
Meanwhile, Haering said she will probably return to selling real estate soon. She needs to find insurance that covers her health care needs and maintains she would have not dropped her insurance while still “healthy” if she knew she could not count on care through IHS in her area. The thought crosses her mind that she is being forgotten by Indian Health Services, she said.
“They (IHS) are not offering anything of value to these Native American patients here in Florida,” Haering said.
To download a list of tribes with self-governance agreements with IHS click here.
