American Indians/Alaska Natives and the Affordable Care Act - General Information


The Administration for Native Americans (ANA) and the Centers for Medicare and Medicaid Services (CMS) have formed a collaboration to promote good health outcomes and provide outreach and training related to Medicaid, the Children’s Health Insurance Program (CHIP), and insurance policies available through the Health Insurance Marketplace (HIM). ANA and CMS aspire to promote awareness of all the benefits and rights of healthcare reform and earlier laws and regulations that accrue to AI/AN persons/grantees who receive benefits from the Administration of Children and Families.

Based on Article I, Section 8 of the Constitution the Federal Government has an obligation to promote healthy American Indian and Alaska Native people, communities, and cultures and to honor and protect the inherent sovereign rights of Tribes.

Patient with BP cuff on, O2 monitor on and nurse taking her temperature

The Department of Health and Human Services (HHS) works closely with American Indian and Alaskan Native communities and leaders to enable access to culturally competent healthcare to eligible recipients in Indian Country. Through a collaborative partnership among a number of federal partners, HHS promotes the economic and social well-being of families, children, individuals and communities through a wide range of programs including:

Healthy Tribes provides resources for American Indian and Alaskan Native health insurance.

Patient working with a physical therapist

What You Need to Know About the Marketplace

As a member of a federally recognized tribe or Alaska Native shareholder, you have certain protections in the Marketplace starting in 2014.

If you enroll in a health insurance plan through the Health Insurance Marketplace, you can still get (or keep getting) services from the Indian Health Service, tribal health programs, or urban Indian health programs.


USPH Opthamologist providing consultation to a mother and young child

Special Market Benefits

If you're a member of a federally recognized tribe and qualify for a health insurance plan in the Marketplace, you have certain protections like:
  • Monthly special enrollment periods.
  • No copayments or other cost-sharing if your yearly income is below a certain level—around $70,650 for a family of 4 in 2013 ($88,320 for the same family in Alaska). When you fill out a Marketplace application, you'll find out if you qualify for these lower costs.
  • If you qualify for Medicaid or the Children’s Health Insurance Program (CHIP) - and you're eligible for or have gotten services from the Indian Health Service, tribal health programs, or urban Indian health programs--you won't have to pay Medicaid or CHIP premiums, enrollment fees, and out-of-pocket costs. Indian trust income isn’t counted when determining Medicaid eligibility.

USPH officer showing a client how to work a elliptical machine

Proof of Tribal Membership and Indian Income

To get special Marketplace protections, you'll need to provide a copy of a document issued by a federally recognized tribe that shows membership in that tribe. If you're applying for Marketplace coverage, in addition to basic information about household size and income, you’ll need to provide information about income from Indian trust land, natural resources, and items of cultural significance. This income won’t be counted for Medicaid or CHIP eligibility, but may be counted for Marketplace purposes. 


Patient visiting with a Community Health Representative

Technical Assistance (TA)


ACF is offering electronic (phone/email) technical assistance to provide strategies for increasing enrollment, answer questions, and provide resources to ACF grantees.

To request technical assistance, please download and fill out the form below and provide specific information on the type of technical assistance needed.

ANA CMS Technical Assistance Request Form

You can send this form back electronically via email to or fax it to 571-323-2102. For questions or further information, please call 571-323-5650.


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