American Indian or Alaska Native Program

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.

How it Works

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.

Qualifications & Eligibility

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

Required Documents to Apply

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.

Where to Get Care

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
• Community clinics
• Health stations

Who Can Help

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

Protections & Service Access

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.

Identifying 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.

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 at the Centers for Medicare and Medicaid Services’ (CMS’) Tribal Affairs.