Premium Sponsorship Options for Tribes

March 18, 2015

Enrollment of Tribal members and their dependents in health insurance coverage through a Marketplace offers significant opportunities to increase access to care for enrollees and improve the finances of Tribal health organizations (THOs). These results are made possible due to the availability of premium tax credits for Marketplace coverage and comprehensive cost-sharing protections for American Indians and Alaska Natives under the Affordable Care Act.

Presenter Information:

Presenter: Doneg McDonough

Doneg McDonough leads the health care consulting firm Health System Analytics and advises clients on implementation of the Affordable Care Act. Doneg serves as a technical advisor to the Tribal Self-Governance Advisory Committee on work involving the Centers for Medicare and Medicaid Services (CMS) and its Tribal Technical Advisory Group (TTAG) as well as work involving the Indian Health Service. In addition, Doneg is under contract with the National Indian Health Board (NIHB), serving as a technical advisor to the Medicare, Medicaid and Health Reform Policy Committee (MMPC) on regulatory issues. Doneg previously oversaw finances and operations of a State’s health and human service agencies with combined annual expenditures of $1.6 billion and led a 220-person team responsible for processing applications for health insurance coverage in the third largest province in Canada. Doneg earned a BA in Sociology at the University of California, Berkeley and a Master of Public Administration from Columbia University in New York.

Facilitator: Cyndi Ferguson

Cyndi Ferguson has extensive experience, including: management and implementation of Tribal Self Governance in the Bureau of Indian Affairs and the Indian Health Service programs; negotiation of Self-Governance Funding Agreements with Federal agencies; internal Tribal governance planning; and participation on Tribal Team to develop several major legislative initiatives, including amendments to the Indian Self-Determination and Education Assistance Act (Title IV, Title V and Title VI). Cyndi has been a lead presenter on national Tribal Self-Governance Trainings, including the recent Self-Governance Health Care Reform outreach and education efforts surrounding implementation of the Affordable Care Act. She has been an active, long-term participant on several Tribal/Federal Workgroups and currently serves as the facilitator for the National Indian Health Board-Medicare and Medicaid Policy Committee.


– ROI Template – Instructions – Tribal Sponsorship
– ROI Template – Excel Worksheet – Tribal Sponsorship
(Posted August 4, 2015)

Q&A, CMS/CCIIO, “Cost-Sharing Reductions for Contract Health Services”, May 9, 2014

“(Sample) Referral – Indian-specific Cost-sharing Protections”, March 19, 2015

Explanation of “(Sample) Referral – Indian-specific Cost-sharing Protections”, March 19, 2015

TSGAC Handout: Federal Poverty Levels Applicable in 2015, January 23, 2015

TSGAC Brief: Tribal Sponsorship of Marketplace Enrollees, January 12, 2015

TSGAC Tribal Sponsorship of Beneficiaries for Health Insurance Coverage through a Marketplace, March 18, 2015 (PowerPoint)

Q & A Document (Remaining Questions Answered)