Bullock, tribe celebrate Community Health Aid Program

FORT BELKNAP INDIAN RESERVATION ­- Gov. Steve Bullock and a number of Fort Belknap Indian Reservation tribal members and state legislators spoke Monday at the Community Health Aid Program Celebration at the reservation about the benefits the new program may bring to Indian County across the state.

"It's innovation that can lead to ensuring that every single Montanan has the health care they deserve, because when Indian Country succeeds, certainly all of our state succeeds," Bullock said.

Fort Belknap held a celebration at the Red Whip Gymnasium to celebrate the CHAP bill, House Bill 599, which passed the Montana Legislature last session and was signed into law in May of this year. CHAP will allow people working in certain health care services, such as general health, behavioral health and dental health, to use federal certification standards for health aids, in Indian Health Service or tribal health facilities and will provide Indian reservations the ability to train health aids to federal certification standards. It will also accept licensing requirements for specific types of service providers and create a two-year program to train people to the standards of the federal certifying body. The training would include scope of practice, supervision and continuing education.

Bullock, who is now campaigning as a candidate for U.S. president, said that during the 2019 legislative session the state had a strong relationship with tribal communities to address important issues that the communities are facing, such as quality of health care. He added that the state has the largest Native American caucus in state history, with 12 Native American legislators. 

Last session, a number of bills were passed to provide aid to Indian Country, Bullock said, such as the passage of Hanna's Act, which allows the Montana Department of Justice to assist in investigations of all missing persons cases on tribal lands. At the end of the last session, he added, he also signed into law continued Medicaid expansion, which provides health care to more than 15,000 Native Americans and more than 96,000 Montanans. Along with Medicaid expansion, he also approved CHAP.

"This is a significant accomplishment," Bullock said. "Not just for the Aaniiih Nakoda but for the sovereign and Indian people all throughout the lower 48 states - to make it real."

He said Montana was the first state to implement CHAP to its fullest capabilities, including dental, which other states have not implemented.

"The leadership in Fort Belknap will impact people that they will never ever meet," he said, adding that Montana can serve as a role model for other states interested in CHAP. Bullock said that Native people in Montana have historically been underserved, especially with health care, forcing them to travel long distances to receive care, resulting in a high cost of services.

"It's particularly unacceptablem the lack of access to behavioral health services that are particularly severe in our Native communities," he added.

He said the care provided through CHAP will allow community health aides to provide a wide range of services in general health care, behavioral health care and dental health care and help coordinate with medical providers. The health aides can also ensure patients are able to see a doctor, review their treatment plans, understand how to take their medication and receive education on critical public health information. He added that the program will help ensure patients are receiving the care they need.

The program is offering services outside of the traditional scope of health care and will break down barriers in communities, he said.

"It's also about being innovative in how that care will be provided by familiar faces, by trusted faces," Bullock said. "... So many doors to access can be opened with this piece of legislation that we celebrate today and all the care from someone within the community."

He added that with CHAP now implemented, the real work begins and a number of issues still need to be addressed. 

"It's a great honor to join you and be by your side, follow your leadership as we create opportunities for all people, not just in Fort Belknap but across the state," he said.

Fort Belknap Indian Community Council President Andy Werk Jr. said that it took a lot of people from across the state to get CHAP passed, including the help of other tribes and Indian Health Services. 

Werk said he also wanted to thank former Indian Health Services Billings Area Director Dorothy Dupree, who suggested Werk pursue CHAP.

"She planted the seed," he said, adding that Dupree, who has since retired from the office, was unable to attend the celebration.

"The whole focus of everything that we do is to provide services to our communities, to our people," he said.

CHAP started as a program implemented in Alaska in 1968, to address a number of the health issues the state was facing, specifically in Indian Country, he said. In 2010, the U.S. Congress passed the Indian Health Care Improvement Act, in addition to the Affordable Care Act, which expanded CHAP to the rest of the country. But one provision in the statute was individual states had to have CHAP approved by the state government before it could be implemented.

Fort Belknap Diabetes Coordinator and Nurse Practitioner Jen Show, who also helped lead the push for the legislation, said CHAP will help the tribal health facilities access critical resources to combat the need on reservations. The life expectancy of Native Americans is, on average, 5.5 years less than the general U.S. population, she said, adding that reservations also struggle with high rates of diabetes, chronic liver desease, cirrhosis and suicide.

CHAP is also a way to gain economic stability and professional development for tribal communities, she said.

"It is a path for many Indian tribes to take control of their own health care and also  ultimately their own economic futures," she said. "... The uniqueness of CHAP is that it's meant to grow our own, it is meant to grow those within our community to provide care for our own people."

State Rep. Jonathan Windy Boy, D-Box Elder, who introduced the bill in the Legislature, said he was thankful for the help and support he has received during his time in the Legislature and that it was important for Montana CHAP was passed.

"This issue here that we are dealing with today is something that is of epic proportion," he said. "... We are so far ahead, but yet so far behind."

He added that by implementing CHAP, communities are able to access important resources, such as third party billing. It will also provide support for Indian Health Services and with the support of Medicaid expansion will be able to be enhanced further across Indian Country. Sen. Jason Small, R-Busby, who carried the bill in the state Senate, said CHAP is a great way of keeping people in reservation communities healthy while also positively impacting local economies.

"It's a win-win to say the least," he said.

He said it was difficult to get the bill passed through the Legislature, but in the end it worked out and he was proud to see the bill come to fruition.

Fort Belknap Indian Community Council member Dominic Messerly said credit also goes to former tribal leaders who have worked in the past to make the community better though they did not have the resources or opportunities to always make it possible. He added that perhaps these communities still don't have adequate services but they will always continue to try to make their homes a better place.

"This is a perfect example of all of the wheels of government working together," he said. "... We're going to keep moving, we have to keep moving."