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CRIHB Research Documents for National American Indians and Alaska Natives

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Analysis of Medicaid Payments for American Indians and Alaska Natives

The Indian Health Service (IHS) is a federal program that provides only part of the health care needed by the American Indians and Alaska Natives (AIAN) who use the IHS and Tribal health care facilities of the IHS system. The facilities serve remote rural areas, often as the only local provider and often with higher per capita costs than providers serving less remote, larger populations. When specialized outpatient or hospital care is needed, the care must be paid through contracts with providers (Contract Health Services) if funds allow, or AIAN must find another way to pay non-IHS providers for the care they need. Because the IHS is funded through the discretionary part of the federal budget, the IHS estimates that it provides only about 54% of the per capita costs of health care needed by AIAN they serve. In 1976 Congress authorized providers of the IHS system to bill Medicaid and Medicare programs for users of their facilities who are eligible for the programs. Children’s Health Insurance Program (CHIP) payments to the IHS and Tribal providers were authorized when program benefits first became available in 1997.

Analysis of Medicaid Payments for American Indians and Alaska Natives - Final (pdf format)

Analysis of Medicaid Payments for American Indians and Alaska Natives - Attachments (pdf format)

Analysis of Medicaid PAyments for American Indians and Alaska Natives - Summary (pdf)

Medicare Statistics For American Indians & Alaska Natives

Medicare databases present special challenges in identifying and reporting on the two different groups of AIAN highlighted in provisions of the Affordable Care Act. This report investigates how well Medicare data might provide information on health care received by AIAN in both groups. We use Medicare enrollment and utilization data together with Census survey data on health care coverage to assess three things: 1) How well Medicare data identifies AIAN using the IHS health care system (IHS AIAN), 2) How well Medicare data identifies racial AIAN (Self-declared AIAN), and 3) The extent to which Medicare pays for IHS AIAN Active User health care costs can be estimated with Medicare data.

Medicare Statistics For American Indians and Alaska Natives (pdf format)

Health Care Coverage & Income of American Indians & Alaska Natives: A Comparative Analysis of 33 states with Indian Health Service Funded Programs

As the nation prepares for the implementation of health exchange programs created pursuant to the Patient Protection and Affordable Care Act (ACA) passed in 2010, many health planners are working to identify what impact these new programs and rules will have on their communities. American Indian and Alaska Native (AIAN) tribes face these issues with particular interest, since a large percentage of AIAN tribal people will be eligible for the new programs. AIANs suffer the highest disparity rates in many socioeconomic and health status measures. They are also amongst the highest uninsured populations in the United States. However, a singular description of AIANs is inadequate to effectively help tribal and state leaders design their programs and to set priorities. Just as the culture and tradition variances between Indian peoples are great, so are individual AIAN community experiences with regard to health care coverage, access to Indian Health Service (IHS) health care and income distribution.

Health Care Coverage & Income of American Indians & Alaska Natives (pdf format)

“Integrating Medicaid and IHS Data” report for 2011

In this report we provide findings for American Indians and Alaska Natives (AIAN) from Medicaid and Children’s Health Insurance Program (CHIP) data linked to Indian Health Service (IHS) data. The purpose of the linkage is to allow analysis of Medicaid enrollment and utilization data for AIAN who meet the legal definitions of AIAN who are eligible for health care services from IHS and Indian health program providers, and to determine the completeness with which these AIAN are properly classified in the racial definition for AIAN compiled by Medicaid.

               Integrating Medicaid & Indian Health Service Data 2011 (pdf format)

Uninsured American Indians and Alaska Natives with Incomes 133% to 300% of Poverty: Data for Health Insurance Exchange Outreach

As outreach efforts increase to offer affordable health insurance to low income American Indians and Alaska Natives (AIAN), there is a need to know how many uninsured AIAN there in the administrative Areas of the Indian Health Service health care system to tailor the efforts to the different needs of AIAN in and out of that system. This report shows how the data from the American Community Survey of the U.S. Census Bureau can be used to provide this information.

    AIAN Uninsured Data Report 2010 (pdf format)


Gaps and Strategies to improve American Indian and Alaska Native Data for Medicare, Medicaid and CHIP

The Centers for Medicare and Medicaid Services (CMS) regularly convenes a Tribal Technical Advisory Group (TTAG) to provide consultation on the impact of CMS programs and policies on American Indians and Alaska Natives (AIAN) populations.  A fundamental problem is that the TTAG has a lack of data on AIAN enrollees in the CMS programs.  To address this lack of information the CMS AIAN Strategic Plan for 2006-2010 called for a Data Project to identify gaps in AIAN Medicaid, CHIP & Medicare data and recommend strategies for closing them.

The CRIHB Research unit was commissioned by the CMS under the auspices of the CMS TTAG to investigate the strengths and limitations Medicaid, CHIP & Medicare data available for AIAN using criteria set out in the CMS AIAN Strategic Plan. 

               AIAN CMS Data Report 2007 (pdf format)

American Indian and Alaska Native MEDICAID & CHIP PROGRAM AND POLICY DATA Summary Report

This report includes Medicaid and CHIP findings for AIAN using data readily available online in a web State Summary Data Mart developed and sustained by CMS. Online data for AIAN and for Indian Health Service (IHS) funded providers for the 35 states of the IHS healthcare delivery system are tabulated in the report.

            AIAN Medicaid Statistics 2009
(pdf format): For 35 States
            AIAN Medicaid Statistics 2010 (pdf format): For 12 IHS Areas and the counties of the 
            Urban Indian Health Organizations.

                Enrollment Service Use & Payments, AIAN Medicaid Statistics 2010 Appendix Tables 
            (pdf format)

            AIAN Medicaid Statistics 2011 (pdf format): Updated for 12 IHS Areas with Medicaid
            Data Linked to Indian Health Service Data

American Indian and Alaska Native MEDICARE PROGRAM AND POLICY DATA Summary Report

This report includes Medicare findings for AIAN in each of the 12 Indian Health Service (IHS) Administrative Areas, and the counties of the Urban Indian Health Organizations.

            AIAN Medicare Statistics 2009 (pdf format)

American Indians and Alaska Natives: Medicaid State Data Collection

State Medicaid programs gather data on American Indians and Alaska Natives (AIAN) and healthcare providers of the Indian Health Service health care system.  This report assesses how completely and accurately they are able to achieve that goal, and what could be done to improve their success.

AIAN Medicaid Data Collection Report 2010 (pdf Format)









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