By enrolling in Medicaid or the Children’s Health Insurance Program (CHIP)—known in Iowa as the Healthy and Well Kids in Iowa, or Hawki program—American Indians and Alaskan Natives (AI/ANs) benefit by having greater access to services that may not be provided by the Indian Health Services (IHS), tribes or tribal organizations, or urban Indian organizations (I/T/Us). Additionally, tribal communities benefit through increased resources to their health programs.
AI/ANs who are eligible for Medicaid may choose to enroll in the IA Health Link managed care program, or may choose to remain in the Medicaid Fee-for-Service program. If you are a member who identifies as AI/AN, it is important that you indicate that on your DHS application for health care assistance.
AI/ANs who enroll in Medicaid or Hawki can continue to receive services from health programs operated by I/T/Us. Members who choose to opt in to the IA Health Link managed care program may also continue to receive services from their local I/T/Us. I/T/Us include Indian hospitals, health centers, clinics, and health stations.
Historical Background:Federally recognized tribes and the federal government have a historical government-to-government relationship based on U.S. treaties, laws, Supreme Court cases, executive orders and the U.S. Constitution. As part of this unique relationship, the federal government provides health care, social services, housing, education and other services to AI/ANs, through federal agencies such as the Department of Health and Human Services (HHS), Department of the Interior and the Department of Education. More information can be found on the Centers for Medicare and Medicaid Services’ (CMS’) Tribal Affairs web page.
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Special Protections for AI/ANs
There are special protections for AI/ANs to increase access to health coverage.
- Cost Sharing Exemptions
- AI/ANs who are eligible for, or receive services from, an I/T/U or through referral under the purchased/referred care program are exempt from Medicaid premiums and enrollment fees.
- If they have ever used one of these programs they are also exempt from cost sharing.
- All AI/ANs are exempt from out-of-pocket expenses in the hawk-i program.
- Resource Exemptions/Income Exclusions
- Certain Indian resources and payments are not counted for Medicaid eligibility.
- Estate Recovery Protections
- There are additional protections for AI/ANs from estate recovery for persons who have received long-term care and have passed away.
- Managed Care Protections
- An AI/AN enrolled in managed care can choose to utilize an I/T/U.
- Managed care plans must pay the I/T/U a negotiated rate or not less than their normal payment for the service to a participating provider.
- State must assure the I/T/U receives the normal state plan rate for that facility.
Important facts about Medicaid for American Indian and Alaska Natives
By enrolling in Medicaid or CHIP, and identifying as an American Indian or Alaska Native (AI/AN), AI/ANs benefit by having greater access to ervices that may not be provided by their local Indian Health Services, tribes or tribal organizations, or Urban Indian Organizations, and tribal communities benefit through increased resources to their health programs. Read more important facts about Medicaid for American Indian and Alaska Natives.