Medicaid Expansion

Medicaid Expansion, a key provision of the Affordable Care Act, provides a significant opportunity to increase health coverage for tribal members and help your local community all while increasing local clinic resources.

Medicaid Expansion greatly expands the number of American Indians and Alaska Natives now covered under Medicaid. It increases Medicaid to now cover individuals younger than 65 with incomes below 138 percent of the Federal Poverty Line (FPL), or $15,856 for an individual and $32,499 for a family of four in 2014. This is especially important since it opens a new pathway for young men, women, and single adults to gain more comprehensive health care.

The ACA holds the government more accountable to the trust responsibility by expanding health coverage of American Indians and Alaska Natives through greater access to Medicaid.

Through the Affordable Care Act and the Indian Health Care Improvement Act, IHS, tribal, and urban Indian (I/T/U) clinics can bill Medicaid and the Children’s Health Insurance Program (CHIP) for the services they provide to this expanded population. In many states, Medicaid and CHIP may be known by another name but are similar programs. When a patient is enrolled in Medicaid or CHIP and uses their I/T/U clinic, the clinic can bill the government for the services provided and bring additional funding into the Indian Health Care System. Serving a population with more health insurance not only means building a healthier community for all, but also means that the Indian Health Service can extend services provided locally.

Additionally, the third party billing that is collected must remain at the local clinic, ensuring local tribal members will enjoy the benefits from enrolling in alternative coverage.
Unfortunately, not all states have chosen to expand Medicaid. However, many American Indians and Alaska Natives in your community may still be eligible under the previous Medicaid qualifications and simply have not signed up yet. This is a great opportunity to educate your tribal members about the benefits of Medicaid and how they can be an active solution to the IHS funding gap through third party billing for services – helping their community and increasing resources for all.

Although some states have made initial decisions to not expand Medicaid, they still have the choice to expand later. In some cases, tribal leaders have become major advocates for Medicaid Expansion to help their tribal communities.



“Current Status of State Medicaid Expansion Decision, 2014,” The Henry J. Kaiser Family Foundation, accessed May 7, 2014