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American Indians
American Indians will have unique rights, benefits or opportunities through MNsure.
- American Indians enrolled in a federally recognized tribe are not required to obtain health insurance and are exempt from federal tax penalties for not maintaining coverage.
- American Indians enrolled in federally recognized tribes are entitled to change health plans once a month.
- There is no cost-sharing for any American Indian on any item or service obtained directly through the Indian Health Services, tribe, tribal organization, urban Indian organization or through referral under contracted health services. The provision applies regardless of household income when the American Indian is enrolled in a health plan offered through MNsure.
- American Indians with a household income of less than roughly $66,000 a year (for a family of 4) will not be responsible for additional costs like deductibles or co-pays when they are enrolled in health plans obtained through MNsure.
- American Indians with a household income of between $66,000 and $88,000 a year (for a family of 4) will have a sliding-scale premium tax credit and limits on cost-sharing for health plans obtained through MNsure.
- American Indians who earn between about $15,000 and $45,000 a year (and families of 4 who earn between about $34,000 and $92,000 a year) may be eligible for financial assistance to reduce the cost of private health insurance.
- MNsure will allow tribes, tribal organizations and urban Indian organizations to pay health coverage premiums on behalf of American Indians.
- Enrolling in a private or public health plan through MNsure will provide American Indians with more choices of doctors and medical facilities for their medical care.
- American Indians will continue to be able to obtain health care services through Indian Health Service, tribal and urban Indian facilities even if they enroll in a private or public health plan.
Minnesota Tribes
Minnesota has 11 federally recognized Indian Tribes in the state: Bois Forte Band of Chippewa; Fond du Lac Band of Superior Chippewa; the Grand Portage Band of Chippewa; the Leech Lake Band of Ojibwe; the Lower Sioux Community; the Mille Lacs Band of Ojibwe; the Prairie Island Indian Community; the Red Lake Band of Ojibwe; Shakopee Mdewakanton Sioux Community; the Upper Sioux Community Pejuhutazizi Oyate; and the White Earth Band of Ojibwe.
Staff from MNsure, the Minnesota Department of Health and the Minnesota Department of Human Services has been consulting with tribal leaders to describe options for American Indians within the new health insurance marketplace and obtain feedback.
Tribal Consultation Policy
In August 2011, the State initiated regular consultations with Minnesota’s tribes on MNsure issues affecting American Indians. The group developed a Tribal Consultation Policy to build meaningful relationships with federally recognized Indian Tribes and to establish a mutually acceptable consultation process. The policy was endorsed through tribal resolutions and presented to the Advisory Task Force in September 2012.
Additional Information Presented to the Advisory Task Force
American Indian People and Tribes definitions
Considerations for American Indians presentation
FAQs
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Who will be included in the definition of Indian used for MNsure? Will this cover only individual Indians, or will it include Indian households?
The Affordable Care Act (ACA) includes several different, although similar, definitions of “American Indian;” we don’t know at this time whether one definition will be selected or, if so, which definition will be chosen.
Under the proposed regulations, different methods for determining eligibility will apply for different programs. Medicaid eligibility is determined for each person, using information about themselves and individuals in their household. Unlike Medicaid, eligibility for tax credits will be determined for a household, as it is for MinnesotaCare. Minnesota has elected to apply the premium exemption for Indians in MinnesotaCare to an entire household when at least one member is an Indian; it is not clear whether this will change under MNsure. -
What type of proof will be required to establish an American Indian identity?
To determine eligibility for cost-sharing protections, the ACA allows MNsure to verify AI/AN status using documentation of citizenship and electronic data sources approved by the Secretary of HHS or documents currently accepted by Medicaid showing tribal membership. Minnesota has suggested that IHS data should be included in the planned “data hub,” that would allow exchanges to access data from a number of federal sources to assist in enrolling people into insurance plans, and also that tribal data sources be considered.
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What does “exempt from cost sharing” mean and who is exempt?
Under the ACA, plans within MNsure may require the payment of deductibles or co-pays. To increase access to care, American Indians with incomes below 300% federal poverty levels, and all Indians who obtain services from or receive a referral from I/T/U providers, will be exempt from cost-sharing requirements.
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Most tribal health clinics have Benefits Coordinators; can they be MNsure navigators?
Yes. According to proposed MNsure regulations, Indian tribes, tribal organizations, and urban Indian organizations can be navigators, along with state or local human service agencies.
Benefits Coordinators understand the health needs of their communities and, with appropriate training, would be well-equipped to help tribal members determine their best coverage options, including QHPs through MNsure or other available programs. The tribe chooses which employees would receive the navigator training.
Tribes and other Indian health care providers also believe that they should be allowed to have navigators who serve only American Indians without running into conflict of interest. This does not prevent other navigators from serving American Indians, but rather acknowledges that tribes and IHS are prohibited from serving non-Indians in their federally-funded programs.
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What is a health coverage sponsorship?
Minnesota supports the proposed rule that permits Indian tribes, tribal organizations and urban Indian organizations to pay premiums on behalf of American Indians who obtain health insurance through MNsure.
IHS presented to tribal leaders about the Basic Health Program. IHS stated that this program is a state insurance coverage for people that don’t meet Medicaid eligibility and are between 133% and 200% of the Federal Poverty Level. Which program is this?The Basic Health Plan appears to be similar to the MinnesotaCare program in who would be covered and what benefits would be included. However, regulations for Basic Health Plans have not been developed, so we cannot say exactly what the differences will be.
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How will tribal health care providers be included inMNsure? How do they become Qualified Health Providers in the coverage plans?
The proposed regulation requires health insurance networks to include “a sufficient number” of Essential Community Providers (ECP). Minnesota has advocated for requiring inclusion of all ECPs in insurers’ networks. Minnesota also raised the topic of requiring that tribes be offered contracts that include a “Tribal Addendum” so that they are appropriate for tribes.
Although Indian Health Service (IHS), tribal, and urban Indian health care providers may be ECPs, the designation is not automatic and must be renewed periodically. Because of this, tribes have suggested that insurers be required to offer network provider contracts to I/T/U providers, whether they are designated as ECP or not. - Will Tribes and the IHS be paid in the same manner under MNsure?