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The Indian Health System is only funded at 56% of total need. Given this shortfall, the Health Insurance Marketplace in your state provides an opportunity to increase resources to your IHS or tribal clinic. If a tribal citizen is enrolled in health insurance, the IHS or tribal clinic can bill the insurance for services provided at the clinic.
Since enrolled members of federally recognized tribes and ANCSA Corporations will qualify for tax credits if they meet certain income levels, as well as the special cost sharing protections (zero and limited cost sharing plan variations) and monthly enrollment in Marketplace plans, a tribe will likely pay a low premium for tribal members it sponsors through the Marketplace. Sponsorship ensures that the tribe will increase its third party billing revenue and this revenue may provide positive returns on investment. Discover if this may be advantageous for your tribe by using our tribal sponsorship calculator [insert hyperlink to website calculators] and inserting your local information. To calculate your local clinic’s potential return on investment of tribal sponsorship, use our tribal sponsorship calculator.
Tribes may decide to start with a small group, or pilot program, geared towards covering certain sections of their tribal population. For instance, some tribes may begin by sponsoring only their tribal member user population, people with chronic health conditions, people with large patient and referred cared expenditures, or people below a certain percentage of the Federal Poverty Line (FPL). Tribes may also enter into agreements to pay for Marketplace premiums for tribal members if the individual agrees to receive care at their local clinic, thereby ensuring a return on investment of the sponsorship through third party billing.
In addition, tribal members will have access to more services and providers within the insurance network. Insurance will reduce the need for tribal members to be placed on priority wait lists since third party providers within the insurance company’s network would, in most cases, be covered under the insurance plan; thus, freeing up resources at the clinic.