So far in this series, we’ve covered the Indian Health Service, the ”638’s” administered by tribes and tribal organizations, and Medicare, Medicaid, and Children’s Health Insurance Plan.  This week focuses on the Affordable Care Act & the Indian Healthcare Improvement Act.

American Indians wishing to buy health insurance in the Health Insurance Marketplace won’t need to pay out-of-pocket costs (like deductibles, copayments and coinsurance) if their income is up to $70,650 for a family of 4.  Those earning too much to qualify for Medicaid but less than 400% of the Federal Poverty Limit may also be eligible for advance premium tax credits that lower monthly premiums right away.

American Indians can enroll in Marketplace plans at any time without regard to Open Enrollment periods.  All American Indians who are eligible to receive services from an Indian health care provider may receive an exemption from the shared responsibility payment (a.k.a. the Individual Mandate) even if they don’t maintain minimum essential coverage under the Affordable Care Act.

The Indian Healthcare Improvement Act was permanently authorized by the passage of the Affordable Care Act.   The Act improves significantly on the Indian Healthcare Improvement Act legislation passed in 1976.  Modifications and improvements to the Act include:

  • Provides authorization for hospice, assisted living, long-term, and home- and community-based care;
  • Extends the ability to recover costs from third parties to tribally operated facilities;
  • Updates current law regarding collection of reimbursements from Medicare, Medicaid, and CHIP (Children’s Health Insurance Program) by Indian health facilities;
  • Allows tribes and tribal organizations to purchase health benefits coverage for IHS beneficiaries;
  • Authorizes IHS to enter into arrangements with the Departments of Veterans Affairs and Defense to share medical facilities and services;
  • Authorizes the establishment of a Community Health Representative program for urban Indian organizations to train and employ Indians to provide health care services; and
  • Directs the IHS to establish comprehensive behavioral health, prevention, and  treatment programs for Indians.

Remember, Native Americans also qualify for services from the Indian Health Service and ”638’s” without regard to income.