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Friday, December 28, 2012

Indian Health Care: Impact of the Affordable Care Act (ACA)

Elayne J. Heisler
Analyst in Health Services

On March 23, 2010, President Obama signed into law a comprehensive health care reform bill, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148). The law, among other things, reauthorizes the Indian Health Care Improvement Act (P.L. 94-437, IHCIA), which authorizes many programs and services provided by the Indian Health Service (IHS). In addition, it makes several changes that may affect American Indians and Alaska Natives enrolled in and receiving services from the Medicare, Medicaid, and State Children’s Health Insurance Program (CHIP)—also called Social Security Act (SSA) health benefit programs, and it includes changes to private health insurance that may affect American Indians and Alaska Natives and may affect tribes that offer private health insurance.

IHCIA authorizes many IHS programs and services, sets out the national policy for health services administered to Indians, and articulates the federal goal of ensuring the highest possible health status for Indians, including urban Indians. In addition, it authorizes direct collections from Medicare, Medicaid, and other third-party insurers. Prior to the ACA, IHCIA was last reauthorized in FY2000, although programs have received appropriations since that time. The ACA reauthorizes IHCIA and extends authorizations of appropriations for IHCIA programs indefinitely. It amends a number of sections of IHCIA in general, to permit tribal organizations (TOs) and urban Indian organizations (UIOs) to apply for contract and grant programs for which they were not previously eligible; to create new mental health prevention and treatment programs; and to require demonstration projects to construct modular and mobile health facilities in order to expand health services available through IHS, Indian Tribes (ITs), and TOs. It also made several organizational changes to IHS. It requires IHS 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 law requires IHS to develop a plan to establish a new area office to serve tribes in Nevada and requires the Secretary of the Department of Health and Human Services (HHS) to appoint a new IHS Director of HIV/AIDS Prevention and Treatment.

In addition to reauthorizing IHCIA, the ACA includes a number of provisions that may affect American Indians and Alaska Natives who have private insurance coverage or who receive services through SSA health benefit programs. With regard to private insurance coverage, the ACA provides a special enrollment period for American Indians and Alaska Natives who may enroll in private insurance offered through an exchange and exempts certain American Indians and Alaska Natives from the requirement to obtain private insurance coverage. Finally, it excludes tribal health benefits from being counted as gross income for tax purposes. With regard to SSA health benefit programs, the new law 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. Prior to the ACA, authority for these facilities to receive Medicare Part B reimbursements for certain specified services had expired on January 1, 2010.

This report, one of a series of CRS products on the ACA, summarizes some of the key changes made in the reauthorization of IHCIA and summarizes other changes included in the ACA that may affect American Indian and Alaska Native health and health care. Another report, CRS Report R41630, The Indian Health Care Improvement Act Reauthorization and Extension as Enacted by the ACA: Detailed Summary and Timeline, by Elayne J. Heisler, provides a detailed section-by-section summary of the IHCIA Reauthorization and Extension Act of 2009.

Date of Report: December 14, 2012
Number of Pages: 17
Order Number: R41152
Price: $29.95

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