This brief provides an overview of the health needs of American Indians and Alaska Natives, discusses the role of Medicaid and the potential impact of the Medicaid expansion for this population, and summarizes new guidance from the Centers for Medicare and Medicaid Services (CMS) that expands the scope of Medicaid services provided to American Indians and Alaska Natives that may qualify for 100% federal match. It shows:
- American Indians and Alaska Natives face persistent disparities in health and health care. Nearly 5 million nonelderly individuals self-identify as American Indian or Alaska Native alone or in combination with some other race, representing nearly 2% of the total nonelderly population. American Indians and Alaska Natives have a high uninsured rate, face significant barriers to obtaining care, and have significant physical and mental health needs.
- The Medicaid program plays an important role for American Indians and Alaska Natives given their low incomes and the limitations of services available through the Indian Health Service (IHS). The Affordable Care Act (ACA) Medicaid expansion provides an opportunity to enhance this role by increasing coverage among American Indians and Alaska Natives and providing additional revenue to IHS- and Tribally-operated facilities. In states that do not expand Medicaid, American Indians and Alaska Natives will continue to face gaps in coverage and growing inequities.
- New guidance expands the scope of Medicaid-covered services provided to American Indians and Alaska Natives for which the federal government will pay 100% of the costs. CMS indicates these changes are intended to “help states, the IHS, and Tribes to improve delivery systems for American Indians and Alaska Natives by increasing access to care, strengthening continuity of care, and improving population health.”1 The changes also may provide for savings to states, since some costs that were previously reimbursed at the regular state match rate can now be matched with 100% federal funds. Additionally, the changes may reduce state costs associated with the Medicaid expansion for American Indians and Alaska Natives (when the state share begins phasing in), since a larger share of costs for this population can be reimbursed at 100% federal match.