In addition to services provided by the Indian Health Service and the ”638’s” administered by tribes and tribal organizations, American Indians are eligible to apply for and receive Medicare, Medicaid, and Children’s Health Insurance Plan. American Indians applying for Medicaid services in Arizona need to meet the same income requirements as all other applicants. Unearned Per Capita income via Tribal Gaming Payments is counted in determining AHCCCS eligibility… which may make them ineligible to receive or continue receiving Medicaid services. American Indians are exempt from cost sharing requirements in the AHCCCS (Medicaid) and KidsCare programs.
Native Americans are also exempt from the managed care requirement used by AHCCCS, so they have the option to receive their healthcare benefits through an AHCCCS health plan or through the American Indian Health Program, which is a fee-for-service program (rather than a capitated managed care program). People that sign up with the American Indian Health Program have access to a comprehensive benefit package but some services may require prior authorization from AHCCCS. Services must be medically necessary and delivered by an AHCCCS contracted provider (subject to exclusions and limitations).
Long-term care services are also available to American Indians living on or off a reservation via the Arizona Long Term Care System, Tribal Case Management Program. Even when American Indian members sign up with an AHCCCS health plan, they can always go to Indian Health Services or 638 facilities for their care. AHCCCS provides a Tribal Relations Liaison to assist Arizona’s tribes with issues and concerns tribal members may have with enrolling in and/or accessing services.
Native Americans can also qualify for Medicare benefits. The federal government partners with tribes to assist them with Medicare plan enrollment, plan service delivery, and billing questions under guidance from the CMS American Indian/Alaska Native Center. Special content-specific groups have been created within the American Indian Alaska Native Center at CMS to guide beneficiaries including the CMS Tribal Affairs Group and the Tribal Technical Advisory Group.