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American Indians and Alaska Natives - Affordable Care Act Special Indian Provisions

Published: March 19, 2014
Fact Sheet
  • Under section 1402 (d)(1) of the ACA, issuers of qualified health plans (QHPs) must eliminate all cost-sharing (co-pays and deductibles) for Indians, defined as members of federally recognized Indian tribes and shareholders in Alaska Native regional or village corporations who have household incomes less than 300 percent of the Federal Poverty Level (FPL), if they obtain insurance through Health Insurance Exchange (Exchange). The issuer may not reduce payment to providers as a result of the elimination of cost sharing.
  • If an applicant attests that she or he is an Indian, the Exchange must verify Indian status relying on any electronic data sources available to the Exchange that have been approved by the Secretary of HHS for this purpose.  If approved data sources for Indian status verification are not available, an individual cannot be verified from an approved data source, or available approved source data is not compatible with the applicant’s attestation, the Exchange must follow inconsistency procedures.
  • For Indians with incomes between 300 percent and 400 percent FPL, there is a sliding scale premium tax credit and limitations on cost sharing. An Exchange can allow tribes, tribal organizations, and urban Indian organizations to pay premiums on behalf of Indians.  Indians can apply advanced payment of tax credits to purchase lower cost QHPs from private insurance companies and still get the zero or limited cost sharing plans.  This means, for some Indians, purchased private insurance is free of cost.
  • There is no cost sharing for any Indian for any item or service obtained directly through the IHS, Indian tribe, tribal organization, urban Indian organization, or through referrals under contract health services without regard to household income.
  • Section 1311 (c)(6)(d) of the ACA requires state and federal Exchanges to provide monthly enrollment periods for Indians.
  • Section 1501 amends section 5000A of the Internal Revenue Code to exempt members of Indian tribes from individual responsibility payment (tax penalty) for failure to comply with the requirement to minimal essential insurance coverage.
  • Section 2901 (b) provides that the IHS and Indian, Tribal, and Urban Indian facilities  (I/T/Us) are added to the list of agencies that may serve as an “Express Lane Agency” under section 1902 (e)(13) of the Social Security Act.
  • Section 2902 makes permanent the reimbursement for all Medicare Part B services provided by IHS hospitals and clinics.
  • Section 9021 excludes the value of health benefits provided by or purchased by the IHS, tribes, or tribal organizations from gross income.
Last Reviewed: November 14, 2016