FORT BELKNAP — A bill that passed in the 2019 state Legislature will help Montana tribal communities train to provide basic health care and dental services.
After effort from the Fort Belknap Tribal Council, which brought on a consultant to help develop the proposal, state legislators passed a law to open the door to the federal community health aide program.
Under the program, tribes working with Indian Health Services can train local indigenous people to provide basic medical and behavioral health care services, as well as basic preventive dental care. Aides can also do health screenings and in-home care, and prescribe eyeglasses. Aides will be certified by a board that sets standards and scope of practice.
Jennifer Show, a nurse practitioner with the Fort Belknap Diabetics Care Clinic who helped lead the push for the legislation, said Monday the program will let communities address shortfalls in access to health care because of a lack of people to provide it.
"It's always been hard to recruit and retain providers," Show said. "It's a revolving door. We're in north-central Montana. It's very rural and we don't have the mountains like Bozeman or Helena to draw people and help keep them here. There's ag and not much else to keep a provider, to get them to stay in a rural area."
People living on reservations in Montana also face challenges in receiving health care because of the historically under-funded Indian Health Service. Before the state passed Medicaid expansion, for years IHS facilities in Montana operated at life-and-limb status, meaning if someone was not at risk of dying or losing a limb, they would not receive care. An influx of funding from Medicaid expansion has improved that situation, but attracting medical care providers remains a challenge.
Show said the program can also bring a continuity of care to Native communities, which can improve health outcomes through consistency and stability in things like what medications a person is prescribed.
"The way I might treat something isn't the way another provider might treat something," Show said.
The community health aide program was established in 1968 in Alaska. There are now 550 community health aides in 170 Alaska villages. Maine and Minnesota authorized the use of dental health aides in 2009, and Vermont followed in 2016. Washington also approved a dental program in 2017.
Fort Belknap Tribal Council President Andy Werk Jr. said Monday that Montana is the first state to to allow for all three branches of care under the program — community, behavioral and dental health.
Several members of tribal leadership spoke Monday before a ceremonial bill signing at the Red Whip gym in Fort Belknap. They said people from the community, who understand the culture and history of trauma, can provide more inclusive care.
"Our people are severely under-served," said Warren Morin, a member of the tribal council. "We have to start healing, and it has to come from within."
Montana Gov. Steve Bullock said the program can start addressing issues that have long faced reservation communities in Montana. Fort Belknap has taken leadership on implementing the program, but it is available to all the state's tribal communities.
"Native communities in Montana are historically underserved due to a lack of health care providers. Folks living in Indian Country often have to travel long distances to receive care, facing expensive costs; barriers like taking time off work or finding child care can stop you from pursuing services altogether."
Natives in Montana face severe health disparities, with median age of death 20 years earlier than the rest of the state. Death by injury, cancer, heart disease, diabetes and cirrhosis are also more prevalent.
In July the Fort Belknap tribe declared a state of emergency after recent suicides and suicide attempts. Bullock said increasing access to care has a heightened importance because of that.
"It's unacceptable that the lack of access to behavioral health services are particularly severe in our Native communities," Bullock said. " … It's a critical step toward addressing risk factors in suicide, which include mental heath services and substance use treatment."
The Indian Health Service recently closed a public comment period on the proposal for Montana's community health aide program. It's not clear how long it will be until the board can certify aides and their training will be established. Once in place, the program runs four years until it sunsets and has to be reauthorized.