Indian Health Care Improvement Act Provisions in the Patient Protection and Affordable Care Act (P.L. 111-148)

Elayne J. Heisler
Analyst in Health Services

Roger Walke
Specialist in American Indian Policy

On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (PPACA; P.L. 111-148). The new law will, among other things, reauthorize the Indian Health Care Improvement Act (IHCIA). In addition, it makes several changes related to American Indians and Alaska Natives enrolled in and receiving services from the Medicare, Medicaid, and Children's Health Insurance Program (CHIP)—also called Social Security Act (SSA) health benefit programs. 

IHCIA authorizes many programs and services provided by the Indian Health Service (IHS), it sets out the national policy for health services administered to Indians, and it states the federal goal to ensure the highest possible health status for Indians, including urban Indians. In addition, it authorizes direct collections from Medicare, Medicaid, and other third-party insurers. This report, one of a series of CRS products on PPACA, summarizes some of the key changes made in the reauthorization of IHCIA. In addition, the report summarizes the provisions related to American Indians and Alaska Natives enrolled in and receiving services from SSA health benefit programs. 

PPACA will extend the authorizations of appropriations for IHCIA programs indefinitely. It will also permit tribal organizations (TOs) and urban Indian organizations (UIOs) to apply for contract and grant programs for which they were not previously eligible. The law also expands the mental health services authorized under IHCIA to create comprehensive behavioral health and treatment programs. In addition, it requires IHS to establish new programs related to youth suicide prevention and requires demonstration projects to construct modular and mobile health facilities in order to expand health services available through IHS, Indian Tribes (ITs), and TOs. 

With regard to SSA health benefit programs, PPACA permits specified Indian entities to determine Medicaid and CHIP eligibility and extends the period during which IHS, IT, and TO services are reimbursed for all Medicare Part B services, indefinitely, beginning January 1, 2010. Under current law, authority for these facilities to receive Medicare Part B reimbursements for certain specified services expired on January 1, 2010. 

PPACA also makes several organizational changes to IHS. IHS is required to establish an Office of Direct Service Tribes to serve tribes that receive their health care and other services directly from IHS as opposed to receiving services through IHS-funded facilities or programs operated by ITs or TOs. In addition, the bill requires a plan to establish a new area office to serve tribes in Nevada and a new IHS Director of HIV/AIDS Prevention and Treatment.


Date of Report: March 30, 2010
Number of Pages: 14
Order Number: R41152
Price: $29.95

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