In this 5-part series on American Indian Healthcare we’ve covered the basics the Indian Health Service and ”638’s” administered by tribes and tribal organizations. Here we learned about unique opportunities Native Americans have when seeking health care services. Members of 566 federally recognized American Indian Tribes and their descendants are eligible for services provided by the Indian Health Service without regard to income.
We covered the fact that American Indians are eligible to apply for and receive Medicare, Medicaid and the Children’s Health Insurance Plan and that American Indians are exempt from cost sharing requirements in the AHCCCS (Medicaid) and KidsCare programs. American Indians are exempt from the managed care requirement used by AHCCCS, so they can either elect to receive their AHCCCS benefits through a health plan or through the American Indian Health Program, which is a fee-for-service program rather than a capitated managed care program. American Indians applying for Medicaid services in Arizona need to meet the same income requirements as all other applicants. Even when American Indian members sign up with an AHCCCS health plan, they can always go to Indian Health Service or ”638” facilities for their care.
Last week’s post covered the Affordable Care Act as it relates to American Indians including the fact that they can enroll in Marketplace plans at any time without regard to Open Enrollment periods. American Indians wishing to buy health insurance in the Health Insurance Marketplace don’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. And remember, they also qualify for services from the Indian Health Service and ”638’s” without regard to income.
Last week we discussed the Indian Healthcare Improvement Act, which improves and enhances the covered services for American Indians through the IHS, adds additional flexibility for tribal members, and updates current law regarding collection of reimbursements from Medicare, Medicaid, and Children’s Health Insurance Program by Indian health facilities.
Medicare eligibility is the same for American Indians as it is for other populations. In addition, if an Indian health care provider delivers services- Indians are not responsible to pay for out-of-pocket costs. And, if Medicare services are received at an Indian hospital or clinic, Medicare pays for covered services, which in turn helps Indian health care providers and their surrounding communities. The fed’s partner with tribes to help with Medicare plan enrollment, plan service delivery and billing via the CMS American Indian/Alaska Native Center.
So, just to wrap it up… the health care matrix for Native Americans includes: 1) The Indian Health Service and ”638’s” administered by tribes and tribal organizations; 2) Medicaid, Medicare and the Children’s Health Insurance Program; 3) Insurance options under the Affordable Care Act (they don’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 and can enroll at any time); 4) Enhanced services under the Indian Healthcare Improvement Act; and 5) Medicare eligibility- which is the same for American Indians as it is for other populations. If an Indian health care provider delivers services- Indians are not responsible to pay for out-of-pocket costs.
Will Humble, MPH
Arizona Department of Health Services
“Health and Wellness for all Arizonans”