Ihss: Insurance Or Government-Funded Service?

The Indian Health Service (IHS) is a Federal Health Program for American Indians and Alaska Natives. It is not an insurance provider but a healthcare system for federally recognised American Indians and Alaska Natives in the United States. Members of 567 federally recognised American Indian and Alaska Native tribes and their descendants are eligible for services provided by the IHS. The IHS provides a comprehensive health service delivery system for approximately 2.2 million people. However, being eligible for IHS services alone does not meet the minimum essential coverage requirement. If you do not have health insurance coverage and receive care from IHS, you will need to either sign up for health insurance coverage, pay the shared responsibility payment when filing federal taxes, or claim an exemption when filing federal taxes.

IHS is not an insurance provider

The Indian Health Service (IHS) is not an insurance provider. It is a Federal Health Program for American Indians and Alaska Natives. Members of 567 federally recognized American Indian and Alaska Native Tribes and their descendants are eligible for services provided by the IHS. The IHS provides a comprehensive health service delivery system for approximately 2.2 million American Indians and Alaska Natives.

The IHS is not a health insurance provider and can only provide healthcare to eligible Alaska Native and American Indians at its federal hospitals and clinics. Being eligible for IHS services alone does not meet the minimum essential coverage requirement. If you do not have health insurance coverage and receive care from IHS, you will need to either sign up for health insurance coverage, pay the shared responsibility payment when filing federal taxes, or claim an exemption when filing federal taxes.

The IHS is funded each year through appropriations by the U.S. Congress. It is not an entitlement program, such as Medicare or Medicaid, nor is it an insurance program or an established benefits package. Direct health care services are provided at IHS/Tribal/Urban facilities, while Purchased/Referred Care (PRC) services are provided by a non-IHS facility or provider through contracts with the IHS. PRC services are principally for members of federally recognized tribes who reside on or near the reservation established for the local tribe(s) in geographic areas called contract health service delivery areas (CHSDAs).

The IHS formulary (the list of drugs and medicines available from IHS pharmacies) may not include all drugs and medicines, but it will include most of the ones that have proven to be beneficial and cost-effective.

IHS is a Federal Health Program for American Indians and Alaska Natives

The Indian Health Service (IHS) is a Federal Health Program for American Indians and Alaska Natives. It is a health care system for federally recognised American Indians and Alaska Natives in the United States.

The IHS is an operating division within the US Department of Health and Human Services (HHS). It is the principal federal health care provider and health advocate for Indian people. The IHS provides health care in 37 states to approximately 2.2 million out of 3.7 million American Indians and Alaska Natives (AI/AN). It consists of 26 hospitals, 59 health centres, and 32 health stations.

The IHS is not a health insurance provider and can only provide healthcare to eligible Alaska Natives and American Indians at its federal hospitals and clinics. Members of 567 federally recognised American Indian and Alaska Native tribes and their descendants are eligible for services provided by the IHS.

The IHS provides a variety of health services in outpatient and inpatient settings, with benefits including pharmacy, dental, behavioural health, immunisations, pediatrics, physical rehabilitation, and optometry.

To qualify for health benefits from the IHS, individuals must be of American Indian and/or Alaska Native descent and be part of an Indian community serviced by the IHS. Individuals must be able to provide evidence such as membership in a federally recognised tribe, residence on tax-exempt land, or active participation in tribal affairs. Non-Indians can also receive care if they are the child of an eligible Indian, the spouse (including same-sex spouses) of an eligible Indian, or a non-Indian woman pregnant with an eligible Indian's child.

To apply for benefits through the IHS, individuals can enrol through the patient registration office of their local IHS facility. They should be prepared to show proof of enrolment in a federally recognised tribe.

Eligibility for IHS services

The Indian Health Service (IHS) is the health care system for federally recognized American Indians and Alaska Natives in the United States. The policies, standards, and procedures that determine eligibility for care at an Indian Health program are outlined in the Indian Health Manual Part 2, Chapter 1.

To be eligible for IHS health care services, an individual must be:

• American Indian and/or Alaska Native, with descent and belonging to the Indian community served by the IHS program. This can be evidenced by factors such as membership in a federally recognized tribe or group under federal supervision, residence on tax-exempt land or ownership of restricted property, and active participation in tribal affairs.
• Any other reasonable factor indicative of Indian descent.
• In case of doubt about an individual's eligibility, if their condition requires immediate care and treatment, services shall be provided pending identification as an Indian beneficiary.

Eligible non-Indians may also receive care and treatment, including:

• Children under the age of 19 who are the natural or adopted child, stepchild, foster child, legal ward, or orphan of an eligible Indian and are not otherwise eligible for health services. These children are eligible for the same health services as eligible Indians until they attain 19 years of age, and their health needs are considered in determining the allocation of health resources.
• Spouses of eligible Indians, including same-sex spouses, who are not Indian or who are of Indian descent but are not otherwise eligible for health services. Their health needs are not considered in determining the allocation of health resources.
• Non-Indian women pregnant with an eligible Indian's child for the duration of their pregnancy and through postpartum (usually 6 weeks after delivery). In cases where the woman is not married to the eligible Indian, paternity must be acknowledged by the eligible Indian in writing or determined by a court of competent jurisdiction.
• Non-Indian members of an eligible Indian's household where the medical officer in charge determines that services are necessary to control a public health hazard or an acute infectious disease.

Other non-Indian beneficiaries, such as non-Indian employees and veterans, may also be authorized for limited services as described in Part 2, Chapter 4 of the IHM.

It is important to note that transportation to and from IHS facilities is the financial responsibility of the individual, and if an individual receives medical services from a non-IHS provider, they are responsible for their own expenses.

For specific questions about eligibility and receiving health care, individuals should contact the tribe they belong to and the health facility they are seeking care from.

IHS services and minimum essential coverage

The Indian Health Service (IHS) is a Federal Health Program for American Indians and Alaska Natives. It is the lead federal agency charged with improving the health of American Indians and Alaska Natives.

Under the new healthcare law, everyone is required to maintain minimum essential coverage or pay a fee (known as the shared responsibility payment). Being eligible for IHS services alone does not meet the minimum essential coverage requirement. If you do not have health insurance coverage and only receive care from IHS, you will need to either:

• Sign up for health insurance coverage
• Pay the shared responsibility payment when filing federal taxes
• Claim an exemption when filing federal taxes

If you have health insurance coverage from your employer that meets the minimum essential coverage requirement, or have other healthcare coverage (through Medicare, Medicaid, CHIP, VA Medical Benefits Package, or TRICARE), you are covered and don't need to worry about paying the shared responsibility payment or enrolling for health coverage available through the Health Insurance Marketplace.

The IHS provides an array of medical services, including inpatient, ambulatory, emergency, dental, public health nursing, and preventive healthcare. The IHS does not have a defined medical benefit package that includes or excludes specific health services or health conditions. The majority of IHS facilities provide outpatient care, focusing on primary and preventive care, including preventive screenings and health education.

The IHS provides services directly when possible; when needed services are not available, IHS beneficiaries may be referred to private providers for care. This is called purchased/referred care (PRC).

IHS services and health insurance coverage

The Indian Health Service (IHS) is a health care system for federally recognised American Indians and Alaska Natives in the United States. It is not a health insurance provider, and only eligible Alaska Natives and American Indians can receive healthcare at its hospitals and clinics.

The Affordable Care Act (ACA) was created to expand access to coverage, control healthcare costs, and improve healthcare quality and coordination. The ACA also includes permanent reauthorization of the Indian Health Care Improvement Act, which extends current law and authorises new programs and services within the IHS.

Under the ACA, American Indians and Alaska Natives have more choices. Depending on their eligibility and the coverage available in their state, they can continue to use IHS, tribal, and/or urban Indian health programs; enrol in a qualified health plan (QHP) through the Marketplace; or access coverage through Medicare, Medicaid, and the Children's Health Insurance Program.

If someone only has IHS coverage and no other type of health insurance, they are considered uninsured. However, if they enrol in a Marketplace plan, they can continue to get services from IHS, tribes and tribal organisations, or urban Indian organisations. Enrolling in a Marketplace plan may also make it easier to qualify for Medicaid and the Children's Health Insurance Program (CHIP).

Additionally, under the new healthcare law, everyone is required to maintain minimum essential coverage or pay a fee (known as the shared responsibility payment). Being eligible for IHS services alone does not meet the minimum essential coverage requirement. Therefore, if someone does not have health insurance coverage and receives care from IHS, they will need to either sign up for health insurance coverage, pay the shared responsibility payment when filing federal taxes, or claim an exemption when filing federal taxes.

Frequently asked questions