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 Iowa 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 HHS 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 Iowa 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 Hawki 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 services 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.
Important facts about Medicaid for American Indian and Alaska Natives
What is Medicaid?
Medicaid is a federal-state health care program for individuals and families with low income and limited resources as determined by the state where they live. Each state has a Medicaid program. American Indians and Alaska Natives (AI/ANs) who are enrolled in Medicaid or the Children's Health Insurance Program (CHIP) can continue to receive services from health programs operated by the Indian Health Services, tribes or tribal organizations, or Urban Indian Organizations. 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 services 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.
Why should I identify myself as American Indian or Alaska Native? Why does Iowa Medicaid need to know this information?
If you enroll in Medicaid, you can keep getting services from your local Indian Health Services, tribes or tribal organizations, or urban Indian organizations, these organizations can bill your insurance program and this benefits the tribal community, allowing Indian Health Services, tribes or tribal organizations, or urban Indian Organizations to provide more services to you and others. It is your choice whether you provide your ethnicity on your Medicaid application and you do have the right to leave this information blank.
Will I need my tribal documents when applying for coverage?
Applicants may need to provide documentation of U.S. citizenship. The following documents meet the requirements:
- A document issued by a federally recognized tribe indicating tribal membership or a document from an Alaska Native Claims Settlement Act (ANCSA) Corporation indicating shareholders status
- An enrollment card
- A certificate of degree of Indian blood issued by the Bureau of Indian Affairs
- A tribal census document
- Any document indicating affiliation with a tribe
- Medicaid agencies may accept an individual's attestation regarding Indian status. If Medicaid requires documents, American Indians or Alaska Natives may need to prove Indian status or eligibility for services from an Indian health provider.
Who may be eligible for Medicaid?
- Children under the age of 21
- A parent living with a child under the age of 18
- A woman who is pregnant
- A woman in need of treatment for breast or cervical cancer
- A person who is elderly (age 65 or older)
- A person who is disabled according to Social Security standards
- An adult between the ages of 19 and 64 and whose income is at or below 133 percent of the Federal Poverty Level (FPL)
- A person who is a resident of Iowa and a U.S. citizen
- Others may qualify
To Qualify:
An individual must meet certain income levels. In general, you will be asked to provide information that is reportable on your federal income tax return. You will not report Indian income that IRS exempts from taxation. Even if you are not required to file taxes, you can still qualify for Medicaid. For further information regarding MAGI, please review the MAGI PDF.
What does Medicaid help pay for?
Services available to Iowa Medicaid members include:
- Ambulance
- Ambulatory Surgical Centers
- Behavioral Health Intervention Services (BHIS)
- Birth Control and Family Planning
- Case Management (Targeted)
- Children's Services
- Early & Periodic Screening, Diagnosis and Treatment (EPSDT)
- Infant and Toddler Services
- Chiropractic Services
- Dental Services
- Doctor Visits
- Emergency Room Care
- Eye Exams and Eyeglasses
- Habilitation Services
- Home- and Community- Based Services (HCBS)
- Hearing Services
- Home Health Care
- Hospice Care
- Hospital and Urgent Care
- Labs and X-rays
- Local or Area Education Services
- Maternity Care and Birth Center Services
- Medical Equipment and Supplies
- Mental Health Services (Psychologists and Social Workers)
- Midwife Services
- Nursing Home Services
- Podiatry and Orthopedic Shoes
- Prescriptions and Over-the-Counter Drugs
- Therapy Services (Occupational, Physical, and Speech)
- Tobacco Cessation Services
- Transportation Services
- Non-Emergency Medical Transportation (NEMT)
- Other transportation services
What behavioral health services are covered?
Medicaid offers behavioral health benefits, including mental health and substance abuse treatment* to program participants. Medicaid pays for mental and behavioral health services, including:
- Counseling
- Therapy
- Medication Management
- Psychiatrists' Services
- Licensed Clinical Social Work Services
- Peer Supports
- Substance Abuse Treatment
* Program participants must enroll with an MCO to receive mental health and substance abuse treatment services. Information on enrolling with an MCO.
Does Medicaid cover tobacco cessation?
Yes. Medicaid will cover tobacco cessation services, including both counseling and pharmacotherapy, without cost sharing. Smoking cessation services covered by Medicaid:
- Diagnosis of Smoking Addiction
- Necessary Medication to Stop Smoking
- Therapy and Counseling Services
Talk to someone who can help you find answers, like your local:
- Indian Health Care Provider
- Community Health Representative
- Doctor or Field Nurse
- Social Services Office
- County HHS Office