There is considerable concern in the Indian community that the health care system built over the last 20 years to address the needs of American Indians in a culturally competent delivery system will disappear with the advent of managed care contracting for Medicare and Medicaid funding. It is estimated that 30% of all Indians are utilizing Medicare or Medicaid coverage, but that less than 0.5% of any state Medicaid funding is spent on services to Indians.
The concern is that with the “invisibility” of the urban Indian population, managed care by assignment to non-culturally sensitive providers will further reduce utilization, especially by elders who would not seek needed services, rather than be treated “rudely” by staff. Increased healthcare cost occurs when older American Indians do not seek treatment until they are in severe distress.
