Indian Health Service
Authored By: Northwest Justice Project
Find out who is eligible for health benefits from the Indian Health Service and what services are provided.
- I am part Indian. Am I eligible for health benefits from the Indian Health Service?
- What is a federally recognized tribe?
- Where can I get an application for health care benefits?
- Where is the closest IHS health care facility?
- I used to get my health care at an IHS facility on my reservation. I now live in a city far from home. Where can I get health care now?
- I am eligible for health care from the IHS. Why won't the local IHS office provide or pay for what I need?
- The IHS decided not to cover contract health services that I need. Can I appeal?
- Do I have to get my prescriptions filled though an IHS pharmacy?
- How do I file a complaint, ask for more information, report a problem and/or that my privacy rights have been violated?
- How do I trace my American Indian/Alaska Native ancestry?
Yes, if one or more of these is true:
You are regarded by the community where you live as an Indian OR Alaska Native
You are a member, enrolled or otherwise, of an Indian or Alaska Native Tribe or Group under Federal supervision
You live on tax-exempt land or own restricted property
You actively participate in tribal affairs
You have any other reasonable factor indicative of Indian descent
You are an Indian of Canadian or Mexican origin, recognized by any Indian tribe or group as a member of an Indian community served by the Indian Health program
You are a non-Indian woman pregnant with an eligible Indian's child for the duration of your pregnancy through post-partum (usually six weeks)
You are a non-Indian member of an eligible Indian's household and the medical officer in charge determines services are necessary to control a public health hazard
It is an American Indian or Alaska Native tribe that
has a government-to-government relationship with the U.S.
has the responsibilities, powers, limitations, and obligations that come with being federally recognized
is eligible for funding and services from the HIS and BIA
Go to the patient registration office of your local IHS facility. You must bring proof of enrollment as a member of a federally recognized tribe.
I used to get my health care at an IHS facility on my reservation. I now live in a city far from home. Where can I get health care now?
I am eligible for health care from the IHS. Why won't the local IHS office provide or pay for what I need?
IHS facilities can only provide direct services. (A list of these services is available at http://tinyurl.com/owzwpfv.)Non-IHS facilities/providers can sometimes provide Contract Health Services (CHS), which are services the IHS cannot provide in its own facilities.
The IHS does not always have funds to cover all Contract Health Services. Under federal regulations, the IHS is the payer of last resort for these services. IHS expects you to use alternate sources first to cover these services. Alternate sources can include
*IHS' highest priority for paying for CHS services is life-threatening illnesses and injuries.
Yes. You will get a written notice of the denial and the reason for it. The notice should state that within 30 days of getting the notice, you:
May ask the appropriate Service Unit Director to reconsider the original denial if you submit new supporting information OR
If you have no new information, may appeal the Service Unit Director's original denial to the appropriate Area or program director
Your request for reconsideration or appeal must
explain the grounds for your request or appeal, and the facts supporting it
If the Service Unit Director upholds the original decision on reconsideration, you will get written notice that you can appeal to the Area or program director within 30 days of getting the notice. You must appeal in writing and explain your grounds.
If the Area or program director upholds the original or reconsidered decision on appeal, you will get written notice. The notice should also state you have the right to further appeal to the Director, Indian Health Service, within 30 days of getting the notice. You must appeal in writing and explain your grounds. The Director, Indian Health Service's decision will be the final administrative action on your appeals.
Usually, no. There are a few exceptions to this. Talk to your provider.
How do I file a complaint, ask for more information, report a problem and/or that my privacy rights have been violated?
You can file a written complaint with
the Chief Executive Officer or Service Unit Privacy official at your health care facility OR
the Secretary, Health & Human Services (HHS), Washington DC 20201 by going to this link: http://www.hhs.gov/ocr/hipaa/