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The National Center for Benefits Outreach and Enrollment is compiling a database of promising practices related to benefits outreach and enrollment. We invite you to review these promising practices and cost-effective strategies that can strengthen your local or state efforts to increase access to benefits for seniors and younger adults with disabilities.
AREA OF FOCUS: OUTREACH AND CONNECTION
How to Conduct Effective Public Benefits Outreach
to Native American Populations
Outreach to Native American populations presents a unique
set of challenges and obstacles that need to be overcome
in order to be successful. In 2000, AARP funded the Four
Corners Public Benefit Outreach initiative on the Navajo
and Hopi reservations in Arizona. The aim of this initiative
was to help tribal elders learn about and enroll in public
benefits programs, including Medicare Savings Programs,
SSI, Food stamps, and utility assistance. We’ll share with
you key findings from this comprehensive benefits outreach
initiative.
Who was the target audience?
Tribal elders on select Indian reservations.
What did they do?
AARP's outreach project involved partnerships with agencies
such as the SHIP, the Medicaid agency, and the Social Security
Administration, as well as entities already serving tribal
elders, such as the Indian Health Service (IHS), the Navajo
Area Agency on Aging, and the Intertribal Council of Arizona
Area on Aging, which represents 20 Arizona tribal governments,
including that of the Hopi tribe.
Tribal Area on Aging and SHIP staff helped AARP to:
(1) secure proper authorizations from tribal leaders to
conduct outreach
(2) design culturally-appropriate outreach techniques
(3) recruit and train a core of 22 tribal employees and
elders to conduct outreach
At special training events, officials from the SHIP, Medicaid
agency, the Social Security Administration and the Indian
Health Service instructed tribal outreach workers about
the various public benefit programs and completing applications
for assistance. The training encouraged an unusual collaboration
between the Navajo and Hopi tribes that contrasted historic
discord and competition between the groups.
The trained outreach core conducted door-to-door outreach
to tribal elders on the reservations in spring 2000. Generally,
a team of three or four outreach workers would travel to
an elder's home and converse with the elder in their tribal
tongue about the public benefit programs. The teams included
at least one member who knew the elder and led the discussions
and introductions. The counselors screened the elders for
Medicare Savings Programs, and if they seemed eligible,
helped them to complete an application and collect any necessary
documentation. The interview generally lasted between one
to two hours. During fall 2000, the counselors conducted
follow-up interviews with the tribal elders to help resolve
difficulties or barriers experienced.
What was the result?
Parties participating in the initiative judged it an overall
success, as it led to approximately 600 benefit awards for
tribal elders over a five-month period. Additionally, the
Intertribal Council of Arizona Area Agency on Aging began
a Tribal Public Benefits outreach program similar to the
Four Corners model, using SHIP and Older Americans Act funds.
As a result of these initiatives, key findings include
the following:
• It is essential for government agencies to observe tribal
protocols and obtain advance permission from tribal leaders
before conducting outreach.
• Effective outreach to American Indian elders enlists
the support of respected tribal members and elders and utilizes
existing tribal social service network employees, including
tribal senior center staff, SHIP counselors, and Indian
Health Service community health representatives. Trusted
providers and persons can help dispel misgivings about applying
for government programs and reluctance to reveal personal
financial information to others.
• Low literacy and limited English proficiency is prevalent
among American Indian elders. Successful outreach involves
face-to-face counseling using simple terms and the elder's
native language. Outreach workers who lack fluency in the
native tongue can bring a tribal member along to translate,
which will also help gain the trust of the elder.
• Traditional modes of communication with urban elders
are challenging because many lack phones, do not have direct
mail delivery, and live in remote rural areas several miles
from paved roads. Tribal staff and SHIP counselors at senior
centers can be used to help direct important communications
to elders and to facilitate redeterminations to ensure that
elders are retained in public benefit programs.
• Outreach messages should emphasize how receipt of Medicare
and Medicaid will facilitate greater access to more comprehensive
health care for the elder and for the tribe as a whole.
Because Indian Health Services monies are fixed, tribes
are forced to ration care. Medicare and Medicaid funds help
to augment existing health care resources for the tribe
and permit elders to obtain access to benefits that the
Indian Health Service may or may not cover, such as prescription
drugs or long-term care.
For more information:
K. Glaun, "Medicaid Programs To Assist Low Income Medicare
Beneficiaries: Working Paper on Medicare Savings Programs
in Arizona." Kaiser Commission on Medicaid and the
Uninsured (2002). To access the full report, click here.
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