Indian Health Care Improvement Act

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In 1976, the Indian Health Care Improvement Act amended the Social Security Act to permit reimbursement by Medicare and Medicaid for services provided to American Indians and Alaska Natives in Indian Health Service (IHS) and tribal health care facilities. In doing so, Congress recognized that many Indian people, especially those residing in very remote and rural locations, were eligible for but could not access Medicaid and Medicare services without traveling sometimes hundreds of miles to Medicaid and Medicare providers located off reservation.

The Indian Health Care Improvement Act also provided states with a 100% Federal Medical Assistance Percentage (FMAP) for Medicaid services provided through an IHS or Tribal facility. The amendments to the Social Security Act created a direct relationship between CMS and the Indian Health Service delivery system that continues today. These protections were further augmented by Section 5006 of the American Recovery and Reinvestment Act (ARRA) of 2009.

The Indian Health Care Improvement Act (IHCIA), the cornerstone legal authority for the provision of health care to American Indians and Alaska Natives, was made permanent when President Obama signed the bill on March 23, 2010, as part of the Affordable Care Act. The authorization of appropriations for the IHCIA had expired in 2000, and while various versions of the bill were considered by Congress since then, the act now has no expiration date.