Guest Column | Nez’s misleading, false statements undermine efforts toward Indian Managed Care Entity: In response to veto statement from the president’s office

By Manley A. Begay Jr.

On Oct. 19, the Navajo Nation Council unanimously passed a resolution that “will reaffirm the Navajo Nation’s request to the governor of New Mexico to activate the Naat’aani Development Corporation-Molina Healthcare Inc. Indian Managed Care Entity.”

The final vote was 22 in favor, 0 opposed and only 1 abstention.

On Sunday, Nov. 7, the Office of the President and Vice President once again sent out a (veto) statement with inaccurate and untrue statements.

For the record and out of respect to the state of New Mexico, the Navajo Nation Council, the Navajo people, and our partners, the NDC must correct the misinformation campaign.

OPVP news release: “Naa’táani Development Corporation was established in July 2017 to create subsidiaries to promote economic opportunities and revenue, but did not include the authority to oversee critical health-care benefits for the Navajo people.”

This statement is misleading. NDC is a federal corporation wholly-owned by the Navajo Nation.

NDC was established by the Navajo Nation Council in 2017 to create business opportunities and employment for the Navajo people with a focus to generate revenue for the Nation.

To pursue the Indian Managed Care Entity project, NDC partnered with Molina Healthcare, a Fortune 500 company with over $18 billion in revenues. As a Medicaid managed care entity for 41 years, Molina’s parent company, Molina Healthcare Inc., has substantial experience administering Medicaid agreements in other states and is adequately capitalized with sound credit ratings to assume the risk of the IMCE.

President Jonathan Nez’s statement is misleading because the Council has spent countless hours and meetings considering legislation empowering NDC to undertake the IMCE project – a project that has been actively advanced by the Navajo Nation, under several administrations, for the past 18 years.

In fact, on Jan. 22, 2020, the Nez/Lizer administration made the following statement in a press release entitled, “Nez-Lizer support ‘active enrollment’ for managed health care for Navajo citizens in New Mexico.”

The Nez-Lizer administration recently informed New Mexico Gov. Michelle Lujan Grisham of its support for legislation introduced by Delegate Daniel Tso. Nez requested Lujan Grisham and the state’s Human Services Department to work with the Navajo Nation, NDC and Molina Health Care to implement Medicaid services.

The Council attempted to meet Nez’s demands by passing the October resolution, which codified the active enrollment option for the IMCE.

It is confusing when Nez previously expressed his support and the Council responds with legislation to meet his demands, then Nez does an about face and contradicts his previous statements and adds more misleading statements.

It must be noted, that the IMCE project has been an active priority of every Navajo administration since 2002. Six Navajo Nation presidents (Peter MacDonald, Peterson Zah, Joe Shirley Jr., Ben Shelly, Russell Begaye), leadership spanning 34 years, have fully supported the IMCE project.

In addition, as with all Medicaid arrangements, both the U.S. Centers for Medicare and Medicaid Services and the state Medicaid agency – in this case, the New Mexico Human Services Department – have ultimate authority and oversight of the IMCE. NDC is partnering with Molina Healthcare to meet all federal and states rules and regulations that govern the IMCE.

OPVP news release: “…the Naa’táani Development Corporation continues to operate mostly behind closed doors to lobby tribal and state officials to secure approvals and a contract with the state of New Mexico to manage the Medicaid funds.”

This statement is blatantly false. NDC and Molina have made over 30 requests to meet with OPVP and has worked closely with leadership in the Council, the state of New Mexico’s Humans Services Department, and the New Mexico governor.

From August to December of 2020, the New Mexico Human Services Department held weekly working meetings with NDC, and the OPVP was invited to attend and actively participate in each and every meeting.

Michelle Begay, attorney with the Navajo Nation’s Department of Justice, was involved in most of those meetings.

Yvonne Kee-Billison, former OPVP executive staff assistant, Milton Bluehouse, Jr., former OPVP chief of staff, and Jill Jim, executive director of the Navajo Department of Health, were each invited to every meeting, but only Ms. Kee-Billison sparsely attended those meetings. The OPVP disregarded all the invites for the weekly meetings.

These critical meetings were held to ensure the design of the IMCE program included the priorities of Navajo beneficiaries and providers and develop the IMCE contract according to these priorities and federal and state Medicaid requirements.

NDC never worked “behind closed doors”; all meetings were organized by the state of New Mexico and invites included OPVP, Navajo DOJ and Navajo DOH. Minutes for those meetings are available from the New Mexico Human Services Department.

The moral and economic imperatives that we are pursuing are to assure Navajo people get the right medical care at the right time and place. The Medicaid program and funding associated with it is an open book. Any restrictions under state and federal law are matters of medical privacy.

The business transactions anticipated under this urgently needed health care coordination venture are subject to glaring state and federal regulatory floodlights, and under NDCs charter the profits from this project are returned to the Navajo Nation.

OPVP news release: “Our office repeatedly requested important financial information and detailed operating plans from the Naa’táani Development Corporation and its subcontractor, Molina Health Care. We also requested information on regulatory jurisdiction and oversight of the Indian Managed Care Entity. All of these requests have remained unanswered to this day…”

The OPVP has previously made these untruthful statements. NDC and Molina has produced financial information and booklets answering any and all questions that were brought up in any deliberations.

Furthermore, by authority of the NDC corporate charter, which was passed by the Navajo Nation and signed by the U.S. Department of the Interior, the president serves as a shareholder representative of the NDC.

At any time, the president can review NDC’s financial reports by written request. He has never made a request and has refused all meetings with NDC.

The president was directly invited to the most recent shareholder representative meeting held on Aug. 17, but he failed to attend. Meanwhile, the honorable Seth Damon, speaker of the Navajo Nation Council, did attend along with Delegate Carl Slater. Attendees received the reports, gained insightful information, and asked critical questions to the NDC.

Nez disrespects the Navajo people and is derelict in his official duties when he fails to attend meetings where he has the responsibility of participating with other shareholder representatives in decision making.

It must also be noted, that OPVP was invited by the New Mexico Department of Human Services for weekly meetings between NDC and the state of New Mexico to develop the contract and scope of work for the IMCE project.

However, the OPVP or the Nez/Lizer administration attended very few of those meetings. In the meetings that they did attend they never raised any issues regarding how NDC would manage the IMCE, nor did they raise the issue of “oversight.” Further, Michelle Begay of Navajo DOJ attended most of those meetings and she never raised any issues regarding regulatory jurisdiction.

If they were concerned about these issues, then they did not uphold their responsibility to the Navajo people by expressing their positions in the appropriate venue.

Regarding the IMCE project, Nez previously went on the record stating, “Throughout this process, our administration will continue to work directly with the state of New Mexico on a government-to-government basis. We will continue to have a seat at the table and lead the way forward.”

However, the Nez/Lizer administration has failed to attend critical meetings with the state and NDC in launching the IMCE project.

It is a concern when we fully respect the OPVP and Nez/Lizer zadministration, but they continue to not meet the expectations and same level of respect afforded to them by being prepared and attending and representing the Navajo people in these critical meetings.

It is also of the utmost importance for the OPVP to understand, ultimate oversight authority of any Medicaid contract including the IMCE is the federal and state governments. Not NDC or Molina.

The U.S. Centers for Medicare and Medicaid Services and the New Mexico Human Services Department establish the requirements that NDC will need to abide by throughout the contract term.
Under the contract, NDC will be required to submit regular reports to HSD ensuring absolute transparency with regards to the care, quality, and financials of operating the IMCE.

As was a part of the contract, NDC has also indicated on multiple occasions that these reports would also be shared with the Navajo Nation Council and the OPVP to regularly update both branches of government with the progress of the IMCE.

OPVP news release: Nez also pointed out that securing health care funds for Navajo people is already extremely competitive and difficult and that adding a new entity to the health care field will only make the process more challenging.

NDC does not understand why Nez and and his administration continue to be uneducated about federal health care funding.

Any health-care professional who understands the Indian health-care system knows that federal Medicaid funding is separate from funding allocations going to the facilities supported by the Indian Health Service.

Medicaid dollars do not compete at all with IHS funding and the operation of the IMCE does not take away or lower funding going to IHS-funded facilities.

If anything, the IMCE is a true pilot project that for the first time allows the federal and state government to allocate Medicaid dollars for a tribal organization. NDC working with Molina Healthcare would actually bring additional health-care funds that presently do not exist across the Navajo Nation health-care system.

This fundamental misunderstanding by Nez and his administration is preventing the Navajo Nation from taking control of its health-care destiny, and Navajo people actively taking control of its Medicaid opportunities and program.

Finally, NDC wants to address the continued attacks on the business acumen and “ability” of the NDC to advance the IMCE initiative.

The OPVP continues to gaslight the Navajo people by continuing to question the credentials and ability of the NDC without any specific articulable facts.

As highly respected and revered business professionals in Indian Country, the NDC Board of Directors choose to take the high-road and refuse to acknowledge the harmful tactics by Nez—his attacks are made without any basis in fact or supportive information.

The Navajo people must know that the NDC board is made up of seasoned professionals with nearly two centuries of combined high-level experience. Members of our board are highly educated with advanced degrees that include Ph.Ds, MBAs and CPAs.

We are university educators, scientists, tribal businessowners, a lawyer, an accountant, a practitioner in traditional Navajo medicine, a physician in Western medicine, and international corporate executives.

We have business, law, health, education, and numerous other necessary experiences, plus being grounded in Navajo values.

We also are truly connected to the mission of NDC because we know the long-term positive impact this organization will have on the Navajo Nation for generations to come.

Nez expressed that he “remains ready to work with the Navajo Nation Council and others to work toward solutions that prioritize the well-being of Navajo citizens.”

NDC supports this statement. We are open to meeting with the Nez/Lizer administration and welcome a quality discussion on moving IMCE effort forward.

Manley A. Begay Jr. is chairman of the Naat’áanii Development Corporation.

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