Documentation that proves membership in an American Indian tribe needs to move up the priority list when it comes to proving eligibility for Medicaid, according to a top Navajo Nation health official.

Anslem Roanhorse, executive director of the Navajo Division of Health, said Tuesday he is among those who don't have a birth certificate — one of the possible documents needed to prove citizenship under a 2006 federal act.

In the Navajo Nation's three-state region, there are 85,000 people eligible for Medicaid and 17,600 are over age 60.

"The majority of these 17,600 people don't have birth certificates," Roanhorse said. "We just want to make sure that nobody is denied care because of that."

Roanhorse spoke at the Health and Human Services Region VIII Tribal Consultation Meeting at the Huntsman Cancer Institute. The gathering, which continues today, provides an opportunity for state and federal health officials to meet with tribal leaders from Colorado, Montana, South Dakota, Utah and Wyoming and discuss how to improve the health status of American Indians. The topics range from Medicaid coverage and diabetes care to prevention and emergency preparedness.

Roanhorse said one of the Navajo Nation's health priorities is to ensure that no eligible Medicaid recipients are turned away.

While certain tribal documentation is on the list, not all documents are accepted. And those that are accepted are generally considered less reliable than a birth certificate under current rules.

For example, Bureau of Indian Affairs tribal census records of Navajo Indians are acceptable but only under the lowest tier, which has certain restrictions, including that the document must have been issued five years before a person applies for benefits.

"Initially, we did not include a lot of the documents that tribes have," said Mark Gilbert, regional administrator for the Centers for Medicare & Medicaid Services.

He said feedback from the agency's initial regulations have spurred a second look at what kinds of documents can prove citizenship and identity.

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