DHS turmoil hits bands where they were already hurting

There are two ways to get through a storm, a Lakota friend told the lieutenant governor.

Cattle huddle together and try to ride it out.

Buffalo run into the storm to get through it faster.

Lt. Gov. Peggy Flanagan is the first American Indian woman elected to statewide office in Minnesota. And this state just hit two bands where they were hurting most.

In Minnesota — where Indians are five times more likely than their white neighbors to die from a drug overdose — an apparent billing error by the state could cost two bands $25 million and gut reservation drug treatment programs.

When the news broke, Flanagan, an enrolled member of the White Earth Band of Ojibwe, got a call from a close friend.

" 'I'm alive because of that program,' " she remembers her friend telling her. It was true, Flanagan said. Her friend "has struggled and she has overcome, and she's a badass native woman who's doing incredibly important work."

Now that friend was telling her, " 'I'm worried about what happens if this sort of programming goes away.' "

There's a clinic at White Earth. The walls are sunny yellow, there are playrooms strewn with toys, and the clients are pregnant women trying to kick heroin and other opioids before their babies arrive.

The MOMS program is more than a place where they can get their daily dose of Suboxone to stave off withdrawal. It's a place where they can bring their babies, their partners and their families along to counseling sessions; a place to recover and reconnect to their Ojibwe roots and culture.

"It's been blessings ever since I started the program," a young man named Lucas explained on a video the state Department of Human Services produced a few years ago to celebrate the MOMS program. "It saved my life."

More than 400 people have gone through medication-assisted treatment programs at White Earth. People got help, got sober, found work and kept custody of their children.

Now, Minnesota's largest and poorest band is facing an $11.9 million bill for what seems to be the state's error, and it could lose a treatment program that has saved lives and families.

State lawmakers are slow-roasting the DHS in an attempt to understand why the agency set up a system for the White Earth and Leech Lake bands that billed Medicaid $455 for each $22 dose of Suboxone. And why, years later, it reversed course and hit the bands with a $25.3 million reimbursement bill.

Tribal representatives testified last week, stung that the DHS seemed to be treating them more like shady vendors than sovereign nations with their own health care and fiscal oversight systems.

Leech Lake Tribal Chairman Faron Jackson lost a daughter to a drug overdose and faces the loss of $13 million and the budget the band thought it had for this year's opioid treatment programs.

Leech Lake scrambled to pare back its budget this summer, reducing funding for youth programs, a homeless shelter and other programs that had been supported by the Medicaid payments the bands said the state had approved.

White Earth officials are bracing for cuts to programs that have just started to help people heal.

"Everything they fought so hard for and continue to fight so hard for every day will be jeopardized," Danielle Stevens, quality assurance coordinator for White Earth, told lawmakers scrutinizing the DHS mess last week. "Paying back $11.9 million will not only negatively impact the programs and staff, but the White Earth Nation as a whole."

Maybe the state will find some other way to reimburse Medicaid without gutting tribal treatment programs.

Maybe the bands can get on a $1-per-year repayment plan. Washington waited decades to replace the leaky pole barn that used to serve as Leech Lake's high school, so the feds should be understanding about that timeline.

This incident, she said, is a blow to the work that Gov. Tim Walz's administration has put in to build trust and ties with tribal governments.

"It is our responsibility to work in partnership with the tribes to have productive, respectful, collaborative relationships," she said. "If there's any community that is used to decisions being made about us, without us being at the table, it is the native community."

For now, she's telling worried native communities the same thing she told her worried friend.

"I see you sister. I see you," she said. "I told her it was my job to make sure our people got the services that they need."

The state and the bands will face what's coming. And they'll run through the storm together.