How to Conduct Effective Public Benefits Outreach to Native American Populations
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How to Conduct Effective Public Benefits Outreach to Native American Populations

May 11, 2009

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, the American Association of Retired Persons (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, Supplemental Security Income (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 State Health Insurance Assistance Program (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:

  • Secure proper authorizations from tribal leaders to conduct outreach;
  • Design culturally appropriate outreach techniques; and
  • 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 IHS instructed tribal outreach workers about the various public benefit programs and completing applications for assistance.

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 benefits 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 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 IHS 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). Access the full report.



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