Natives and Medicaid

Dear Dr. Per Cap:

How does Medicaid work and does it cover Native people regardless of location?  I receive health care at a tribal health care facility but live in a neighboring town.

Signed,

Off Rez

Dear Off Rez

Medicaid eligibility, for Natives and non-Natives alike, is mostly dependent on a person’s income.  Roughly 30% of Native American and Alaska Native people under the age of 65 depend on Medicaid for their health care needs.  This includes children from low-income households, pregnant women, adults, seniors, and disabled people.

It’s important to understand that Medicaid is a form of public health insurance.  It is not a direct provider of care.  For example, when a Native person who is insured by Medicaid receives treatment at an Indian Health Service hospital or clinic, IHS will provide that treatment and later bill Medicaid to reimburse the cost.

But only about a quarter of Native people go to IHS facilities.  Instead, a person might visit a tribally managed health care provider, like you do.  Others might depend on non-Native hospitals and clinics in urban or rural areas.

It’s possible your tribal health care provider operates under a 638 contract with the Indian Health Service.  This allows a tribe to receive the funds that IHS would normally use to provide care to the community.  Thereby operating and managing its own health care services.  However, a 638 tribal health center doesn’t run on IHS funding alone because it too seeks reimbursement from Medicaid for services.  In fact, some tribal providers receive more federal funding through Medicaid than they do from IHS.

Of course, many Native people also have private health insurance which means they don’t rely on Medicaid regardless of where they seek care.  Instead, their health care provider bills these people’s insurance company as a third-party payer similar to how it would bill Medicaid.

Let’s not forget our relatives living off-reservation who might also depend on Medicaid.  Unlike Medicare which is a federal health care program for people age 65 and older and some younger people with certain disabilities and conditions, Medicaid programs are run directly by states not the federal government.

Therefore, a Native person not residing on tribal land might visit a hospital or clinic run by a private corporation, a university, a non-profit, or some other type of non-Native health care provider.  If that person is insured by Medicaid, the non-Native provider will also seek reimbursement from Medicaid for services provided.

Another important fact is that states often brand their Medicaid programs.  For example, in New Mexico Medicaid is called Turquoise Care.  Oklahoma calls its Medicaid program SoonerCare.  Meanwhile in Alaska Medicaid is known as Denali Care.

Therefore, it’s important to understand the Medicaid program in your state of residence as well as the importance of having health insurance.  Whether a Native person has public health insurance, from a program like Medicaid, or obtains insurance through the private marketplace, health insurance provides financial security not just for Native individuals but also health care providers who serve Native populations.  That’s because they can use insurance reimbursements, regardless of the source, as revenue to increase and expand health care services to the Native populations they serve.

For more information about Medicaid check out the Medicaid.gov website.

Ask Dr. Per Cap is a program funded by First Nations Development Institute with assistance from the FINRA Investor Education Foundation. For more information, visit www.firstnations.org. To send a question to Dr. Per Cap, email askdrpercap@firstnations.org.