Oneida Nation's COP-W Program
In 1994, Oneida Nation signed a contract with the State of Wisconsin that gives the tribe better access to state and Medicaid home- and community-based services (HCBS).
Wisconsin's Community Option Program
Through Wisconsin's Community Option Program (COP), Oneida Nation is treated as a county so it can provide home- and community-based LTSS to eligible American Indians and Alaska Natives living within its jurisdiction. To ensure this arrangement would work, the tribe first did a feasibility study to determine how many clients it might serve and see if the program would be sustainable.
Oneida Nation is currently the only tribal community with a COP contract through the State of Wisconsin.
Oneida's COP-Waiver Program
Oneida Nation serves people who are eligible for care under the Medicaid home- and community-based 1915(c) waiver. Oneida's COP-waiver (COP-W) mainly covers frail elders and persons with disabilities. The COP-W Program is housed under Oneida Nation's Comprehensive Health Division.
The Oneida COP-W, which is separate from other tribally run elderly programs, serves between 20 and 24 people each month.
Prior to 2007 – Oneida Nation's COP-W was partly funded by the state (42%), with the majority of support coming from federal Medicaid funds (58%).
Since 2007 – Oneida Nation successfully petitioned to have waiver services included under its contract with IHS. This means that all costs now go to the federal government, rather than being shared by the federal government and the state. Oneida Nation is currently the only tribe to have this included in its contract with IHS.
This change also affected Oneida Nation's arrangement with the state. Before this, the state limited the number of people the tribe could serve under the COP-W. Since the funding responsibility shifted away from the state, this enrollment cap has been removed.
Through the COP-W Program, Oneida Nation directly provides the following services:
- Job coaching for the developmentally disabled
- Physical therapy
- Respite care
- Skilled nursing care (up to once a week)
- Traditional healing (when possible)
To help patients navigate processes that are often difficult, the Oneida COP-W Program also offers:
- Case management
- Help completing the Medicaid application
- Help determing which services a patient is eligible for
The program contracts out some services to other providers. These services include:
- Medical equipment
- Personal care services, such as help bathing or getting dressed
- Skilled nursing care for people who need it more than once a week
- Speech and occupational therapy
Currently, Oneida Nation Reservation is the COP-W service area. The tribe is working with the Wisconsin Medicaid office in an effort to expand its service delivery to all of Brown and Allegheny Counties. This would allow the program to serve many tribal members who live nearby, but off of the reservation.
Oneida Nation's Story
David Larson shared the following story of how Oneida Nation worked with the State of Wisconsin to become the admininstrator of the COP-W:
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 calculations of how much money the state could save by allowing Oneida to administer the waiver (and take 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.