Programs: ACA Implementation for American Indians


Healthcare reform provides unique considerations for American Indian’s access to healthcare and wellness. The Affordable Care Act (ACA) includes a number of provisions that protect American Indians and modernize the Indian Health delivery system. The ACA will have significant impacts on the Urban American Indian community and Urban Indian Health Organizations. It is imperative that CCUIH support our members by staying informed, engaged, and active as state and federal agencies mobilize around implementation to ensure that protections for American Indians are not overlooked.

Additionally, American Indians have special protections and provisions under Covered California, California’s new health insurance marketplace. CCUIH, in partnership with the California Rural Indian Health Board, developed and disseminated informational materials specific to American Indians for Covered CA.


Covered California for American Indians

Covered California is the new online “marketplace” that makes it simple to purchase affordable, high-quality health coverage and offers access to financial assistance (if eligible) to help pay. Through Covered California, eligible American Indians are able to enroll in health coverage and have access to unique benefits. American Indians’ eligibility for benefits varies depending on the type of coverage they are qualified for.

These unique provisions include:

No healthcare expenses for certain income levels: Members of a federally recognized tribe with a household income of less than $70,650 for a family of four (classified as 300% of the federal poverty level) will not have cost sharing (co-pays or deductible).

No healthcare costs for medical care provided by Indian Health Programs: There is no cost sharing (co-pay or deductible) for members of a federally recognized tribe, for any item or service received from an Indian Health Program including Tribes and Urban Indian Organizations, regardless of household income.

Entitled to monthly enrollment periods: Members of a federally recognized tribe are entitled to change plans once month through Covered California. All other taxpayers are subject to the annual open enrollment period.

Not subject to the federal mandate: Members of federally recognized tribes and American Indians who have received or are eligible to receive services through an Indian Health Program qualify for an exemption from the tax penalty (often called the shared responsibility payment). Click here to learn more about this exemption. 


CCUIH has partnered with The California Rural Indian Health Board (CRIHB) to develop useful materials to help American Indians in California understand these protections and provisions. Click on the images below to flip through the “Quick Guide” and informational booklet:


                                               ccbrochure                                            ccquickguide



You can also access PDF versions of CCUIH’s informational materials below:

“What American Indians should know about Covered California” Booklet

“Quick Guide to Unique Benefits for Eligible American Indians”

American Indian Supplemental Training Module for Certified Enrollment Counselors

About Covered California is a joint partnership between Covered California™ and the California Department of Health Care Services (DHCS).

Covered California’s mission is to increase the number of Californians with health insurance, improve the quality of health care for all Californians, reduce health care coverage costs and make sure California’s diverse population has fair and equal access to quality health care.

The mission of DHCS is to provide low-income Californians with access to affordable, high-quality health care, including medical, mental health and substance abuse treatment services and long-term care. Its vision is to preserve and improve the physical and mental health of all Californians.

You will have the ability to choose the health plan that offers the best services at the greatest value for you or find out if you qualify for Medi-Cal. This is insurance that can’t be dropped or denied if you have a pre-existing medical condition.

Covered California and DHCS are committed to ensuring that Californians are aware of their health coverage options. Through, you can find out if you qualify for free or low-cost health insurance, including Medi-Cal, and compare a range of health plans and choose the right one for you. Covered California provides information in many languages and in culturally relevant ways.

Covered California is conducting a marketing, outreach and educational program to help raise awareness about the new opportunities for Californians to get covered. To reach as many people as possible, Covered California and DHCS work with different partner groups to help with these educational efforts. Their expertise in reaching out and educating groups and individuals statewide can help Covered California connect with millions of uninsured Californians and transform the health insurance marketplace.

American Indian Exemption from the Federal Mandate

Starting in 2014, individuals must have health coverage or pay a tax penalty, known as the “shared responsibility payment.” American Indians and Alaska Natives (AIAN) may qualify for an exemption to this tax penalty.Qualified AIAN individuals are:

a) Members of federally recognized tribes (including Alaska Native shareholders)


b) Eligible to receive services from an Indian Health Service, tribal, or Urban Indian health program


Qualified AIAN can claim an exemption from the shared responsibility payment through the tax filing process or the exemption application via the Health Insurance Marketplace.

We have provided you with helpful links below, but please contact your Indian Health Provider for help with applying for the exemption.


Click here to access the Application for Exemption for American Indians and Alaska Natives

Click here to access Instructions to Help You Complete an Exemption Application

Click here to learn more about exemptions (

Click here to learn more about the AIAN exemption