Why Native Americans Should Have 3rd Party Health Coverage



RAPID CITY – Medicaid or Medicare coverage or private health insurance or other third-party health coverage can make things a lot easier for Native American people using the Indian Health Service or a tribally managed healthcare facility.

Native American people believe that the federal government is responsible for their healthcare coverage. They are right. The United States has a trust and treaty responsibility to provide health services to Native American people. Unfortunately, the federal government has never lived up to its end of the bargain and consistently underfunds the Indian Health Service.

Across Indian Country, each Indian Health Service and tribally managed healthcare program is allotted funding from Congress to pay for referrals to outside providers through a program called Purchased and Referred Care (PRC). Like other parts of the Indian Health Service PRC programs are underfunded but nevertheless expected to meet the needs of all patients.

When PRC funding is exhausted before the end of the fiscal year, many tribal citizens are left without access to the care they need, or if they do not have third-party coverage, they can end up with costly bills that can adversely impact their credit or worse.

While Native American people cannot be charged or refused service at any Indian Health Service or a tribally managed healthcare facility, there is a real risk of funding not being available if a patient needs to be referred out for care.

So, what are the benefits of enrolling in Medicaid, Medicare or private health insurance?

You no longer wait to see if PRC approves your referral.

The PRC process faces many challenges, including underfunding, that have left many of our relatives in debt or lacking care. Enrolling with Medicaid, Medicare or private health insurance means you need not rely on PRC. When you are referred out for care with private insurance or Medicaid or Medicare coverage, you have peace of mind knowing you are covered.

You can help generate additional resources for your local IHS or tribally run clinic.

Medicaid, Medicare and private health insurance coverage can help your local tribally run clinic make up for shortfalls in funding. Each time you visit your facility and are covered, your provider can bill Medicaid, Medicare or your private insurer for services. This revenue helps your local healthcare facility expand services and preserve PRC dollars for our relatives who have yet to acquire coverage.

According to South Dakotans for Healthcare, in states where Medicaid expansion has occurred, tribally managed clinics have increased third-party revenue and as a result experience a greater capacity to expand services. For example, in Montana, from 2016 to 2018, Medicaid expansion enrolled 15,288 tribal members generating as much as $174,400,000 in additional healthcare spending. For instance, on the Blackfeet Reservation, tribal and IHS run facilities saw an additional $13.6 million for services reimbursed by the federal government.

It is highly affordable and accessible.

Most tribal citizens can receive third-party coverage for no or minimal out-of-pocket costs. The federal government’s healthcare exchange program (formally Obamacare) makes third-party insurance extremely affordable. The Great Plains Tribal Leaders Health Board has its own health insurance navigator program that can help walk you through the sign-up process that usually only takes a few minutes of your time.

To schedule an appointment with one of our navigators, don’t hesitate to contact us at (605) 393-7175 or email our navigators at navigator@gptchb.org.

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