The Affordable Care Act offers many new opportunities for tribal health programs and American Indian/Alaska Native (AI/AN) individuals. If you’re an AI/AN living in Washington State, you may be eligible for free or low-cost health insurance options available through Washington Healthplanfinder. These options can help improve your health, the health of your family members, and your own tribal community.
I’m far away from my home clinic. How do I enroll in Indian Health in Washington?
While at your home reservation or village, your Indian Health Service (IHS) eligibility provides health care coverage for both direct care services and purchased/referred care (formerly contract health services or services out of the clinic). If you move from your home reservation, purchased/referred care coverage is only valid for 180 days from the day you move. After that, you will only be eligible for direct care services. However, you can become eligible again for purchased/referred care if you become a resident on a Washington reservation. You will have to establish a new chart at your new clinic in Washington.
There are not that many Indian Health Service programs in Washington and there are no hospitals or specialty care clinics supported by IHS in the northwest.
What tribes provide services to tribal members from outside of Washington?
In Washington State, there are 29 federally recognized tribes. 28 of the tribes contract their funding from IHS. As a result, only 3 sites in Washington host IHS run health programs.
- The Colville health center in Nespelem (1 of 5 health facilities on the Colville reservation)
- The Yakama tribal clinic in Toppenish (the primary health facility for the tribe)
- The Spokane tribal clinic in Wellpinit (David C. Wynecoop)
The remainder of the health programs in Washington are tribal-run programs or clinics.
In addition, there are 3 Urban Indian Health Clinics:
- Seattle Indian Health Board (SIHB) downtown Seattle
- Spokane NATIVE Project
- The Native American Rehabilitation Association of the Northwest in Portland
Each tribe has the authority to decide what health programs they need for their community and may limit services based on tribal resources.
It is your right as an AI/AN to use any Indian health, tribal, or urban Indian clinic. For health services at a location near you, contact the clinic to see if they’re accepting new patients. View a map of the different tribes in Washington.
What are my options to get health care services?
In recognition of the federal government’s trust responsibility for providing health services to AI/ANs, the Affordable Care Act created regulations that benefit Indian people who enroll in Qualified Health Plans through Washington Healthplanfinder.
If you’re an enrolled tribal member of a federally-recognized tribe or a shareholder in an Alaska Native Corporation, you’re eligible for the following benefits:
- No co-pays or deductibles when you see your health care provider: If your income is within a certain range (at or below 300% of the Federal Poverty Level), you won’t have co-pays, deductibles, or co-insurance costs (the amount you pay out of pocket when you see the doctor).
- No costs for using Indian Health Services or Contract Health Services: Regardless of income, you won’t have any costs when using a tribal or urban Indian clinic or when your Contract Health Services program refers you to another doctor for more care.
- Enroll or change health plans any time during the year: As an enrolled tribal member or shareholder in an Alaska Native Corporation, you aren’t subject to the open enrollment period. You can enroll at any point during the year and can change your plan once a month.
- Choice in coverage options: Plan options are broken down into metal tiers based on the level of coverage they provide. Bronze, Silver, and Gold plans are available through Washington Healthplanfinder. AI/ANs receive cost-sharing subsidies through any metal-level plan. While Bronze level plans have the lowest premiums but highest deductibles, if you’re an enrolled tribal member using a tribal or IHS clinic, you won’t have a deductible and will have a lower premium than the Gold, or Silver plans. The covered services are the same for all metal levels.
Am I eligible for Washington Apple Health (Medicaid)?
Washington Apple Health is the Medicaid program in Washington State. It is available to AI/ANs and is based on income. Tribal members eligible for Apple Health can choose to be enrolled in a managed care plan, and can use an Indian health, tribal, or urban Indian clinic for services in addition to their Apple Health coverage. To see if you qualify, complete an application on www.wahealthplanfinder.org.
Am I eligible for Alaska Native/American Indian coverage?
You must be able to verify that you are a member of a federally recognized tribe, Band, Pueblo or Rancheria, or shareholder in an Alaska Native Corporation in order to be eligible for special benefits available to AI/ANs. Verification documentation includes any official document issued by a Federally Recognized Tribe or Alaska Native Corporation that demonstrates the individual is an enrolled member, such as:
- Tribal enrollment card
- Certificate of Indian Blood Degree (CIBD) from a Federally Recognized Tribe
- A letter from a Federally Recognized Tribe or Alaska Native Corporation
Applicants have 90 days to provide the documents or provide a statement of good faith effort. To be eligible for Washington Apple Health (Medicaid) you also need to be eligible for IHS services. If you are found eligible for Apple Health, you do not need to submit documentation to verify your AI/AN status.
If you are a Canadian Indian living in the U.S. under the Jay Treaty, you are eligible to sign up for coverage through Washington Healthplanfinder or enroll in Federal programs, such as Medicaid or Medicare.
Is there someone that can help me through the application process and answer my questions?
There are tribal assisters located around the state.
- If you use a tribal clinic, IHS, or urban Indian clinic, contact them and ask about a tribal assister sponsored by that tribe
- Search for a navigator near you by entering your local tribe’s name
- Search for the Seattle Indian Health Board or Spokane NATIVE
- Contact King County Public Health and ask to speak to a tribal assister
- E-mail email@example.com
What is the tribal sponsorship program?
Tribes, urban Indian health organizations, and some other organizations are able to participate in the Exchange’s premium sponsorship program. It’s a tribal decision whether a tribe they will pay for premiums on behalf of their communities and what criteria they’ll use to determine whether to sponsor premiums. Learn more about the program.
Can I qualify for an exemption from purchasing coverage?
Certain AI/ANs may qualify for an exemption from purchasing health care coverage and can apply online.