Tribal Health Directors

The Affordable Care Act (ACA) significantly expands health care coverage opportunities through Medicaid expansion in many states and creation of new Health Insurance Marketplaces.  Effective outreach and enrollment efforts will be vital for ensuring that these new opportunities for health insurance translate into increased coverage for American Indians and Alaska Natives (AI/AN).


The Affordable Care Act requires each state to have a Health Insurance Marketplace. Some states will operate their own Marketplace while the federal government will operate Marketplaces in states that opt not to operate their own. The Marketplace will be a one-stop shop for enrolling in and determining eligibility for health insurance and Medicaid. The 2015 open enrollment period begins on November 15, 2014 – February 15, 2015. Remember that members of federally recognized tribes have year-round enrollment in health insurance plans in the Marketplace. Medicaid enrollment is open to all qualified individuals (including individuals eligible to receive services at an Indian Health Care Provider and tribal members) throughout the year, too. Encourage your patients to check out their Medicaid and Marketplace options while they are visiting your local facility. Click here to learn more about the Marketplace [insert link to the Marketplace tribal health page].


Each state will have Navigators, certified applications counselors, and other enrollment assisters to help AI/AN apply for and enroll in health insurance coverage.  IHS, tribal, and urban Indian clinics will play a vital role in assisting with these enrollment efforts. For information on local enrollment assistance click here [insert].

Indian Health Care Improvement Act

The Affordable Care Act permanently reauthorizes the IHCIA. The provisions are numerous, but here are a few examples of what can be found in the law:

  • New and expanded authorities for behavioral health prevention and treatment services;
  • New and expanded authorities for urban Indian health programs;
  • Authorities for the provision of long-term care services;
  • Authorities for various demonstration projects, including innovative health care facility construction and health professional shortages;
  • The authority for provision of dialysis services;
  • Authorities to improve the Purchased and Referred Care program (formerly known as CHS); and
  • Authorities to improve facilitation of care between IHS and the Department of Veterans Affairs (VA).

Some new and expanded authorities under the Indian Health Care Improvement Act will require additional appropriations from Congress.  As new authorities are funded we will update this page.