Legislative Framework
Two significant legislations affecting American Indian and Alaska Natives (AI/AN) health care are the Indian Health Care Improvement Act and the Patient Protection and Affordable Care Act.
The Indian Health Care Improvement Act (IHCIA) authorizes many Indian Health Service (IHS) activities. It is the key legislation for providing health care to AI/AN. It began in 1976 as an amendment to the Social Security Act, allowing for Medicare and Medicaid reimbursement at Indian Health Service (IHS) and tribal health care facilities. Its goal is to provide the right amount and quality of services that will allow the health status of the AI/AN population to be raised to the highest possible level.
In 2010, the Patient Protection and Affordable Care Act (ACA) amended and reauthorized the IHCIA. The IHCIA had last been reauthorized in 1992 through fiscal year 2000. Although its authority had expired, IHCIA programs continued to receive funding until it was permanently reauthorized by the ACA. The ACA, among other things,
- Expanded health care workforce programs
- Expanded diabetes, cancer screening, and long-term care programs
- Allowed IHS to bill the State Children’s Health Insurance Program
- Authorized behavioral health and treatment programs including programs related to youth suicide prevention
- Established a prescription drugs monitoring program
For more information on the changes to the IHCIA, see The Indian Health Care Improvement Act Reauthorization and Extension as Enacted by the ACA: Detailed Summary and Timeline.
Additional descriptions of important legislation for AI/AN health care can be found on the Indian Health Service website.