Frequently Asked Questions

Q: I am part Indian, am I eligible for health benefits from the Indian Health Service?

A: The most common standard applied for eligibility for health services from the Indian Health Service is that the individual is an enrolled member of a Federally recognized Tribe. The IHS Indian Health Manual (IHM) provides the exact policy concerning eligibility.

Q: What is a federally recognized tribe?

A: A federally recognized tribe is an American Indian or Alaska Native tribal entity that is recognized as having a government-to-government relationship with the United States, with the responsibilities, powers, limitations, and obligations attached to that designation, and is eligible for funding and services from the Indian Health Service & Bureau of Indian AffairsExit Disclaimer: You Are Leaving www.ihs.gov . Furthermore, federally recognized tribes are recognized as possessing certain inherent rights of self-government (i.e., tribal sovereignty) and are entitled to receive certain federal benefits, services, and protections because of their special relationship with the United States. At present, there are 573 federally recognized American Indian and Alaska Native tribes and villages.

Q: How do I find contact information for the federally recognized tribes?

A: Please refer to the Bureau of Indian Affair’s Tribal Leaders Directory Exit Disclaimer: You Are Leaving www.ihs.gov .

Q: Where can I get an application for health care benefits?

A: To receive IHS health care benefits, you should go to the patient registration office of the local IHS facility in person and present proof of your enrollment as a member of a federally recognized tribe. (See the Indian Health Manual, Part 2—Services to Indians and Others, Chapter 6—Patient Registration System for specific information).

Q: Where is my closest IHS Health Care Facility?

A: Depending on where you live there may be an IHS facility close or far. Use the IHS Find Health Care website to locate your closest facility.

Q: I was receiving my health care in an Indian Health Service facility on my home reservation. I am now working in an urban area far from home. Where can I go to receive health care from the IHS?

A: While residing on your home reservation the Indian Health Service (IHS) eligibility provided health care coverage for both 1) direct care services and 2) Purchased/Referred Care (PRC) formerly contract health services (CHS). The PRC services coverage extends 180 days from the date you move from your reservation/CHSDA. On the 181st day, the eligibility for IHS direct care services is the only health care that continues at any IHS facility that you present yourself. PRC coverage continues when residency is established on another reservation. You will have to establish a new chart at new IHS facility in the new location.

Two types of services are provided by the IHS: (1) Direct health care services, which are provided by an IHS facility, or (2) PRC, which are provided by a non-IHS facility or provider through contracts with the IHS. PRC are provided principally for members of federally recognized tribes who reside on or near the reservation established for the local tribe(s) in geographic areas called contract health service delivery areas (CHSDAs). The eligibility requirements are stricter for PRCthan they are for direct care.

A member of a Federally recognized tribe may obtain care at any IHS hospital or clinic if the facility has the staff and capability to provide the medical care. One of the additional requirements for PRC is that the patient must reside in certain areas. One way to meet the residency requirement is to live on the reservation of any Federally recognized tribe. Another way to meet the residency requirement is to reside within the Purchased/Referred Care Delivery Area (PRCDA) for the patient's tribe.

Many, or even most, people who move away from their home reservations are not eligible for PRC since they would be moving away from the PRCDA in which they have eligibility. Check with your home or local Service Unit about eligibility, since they will be the ones making all determinations and paying bills for approved care. Most PRC provided is for urgent or emergency needs, as defined by the local service unit, and requires prior approval for non-emergency care and notification within 72 hours for emergency care.

Some programs or portions of programs are tribally operated instead of being operated by the Federal Government through the IHS. Some tribally operated hospitals or clinics restrict services to members of their own tribe. Consequently, just because a patient is a member of a Federally recognized tribe does not mean that they will be provided medical care at a tribally operated hospital or clinic.

Locating the nearest IHS/Tribal/Urban health care facility to your location can be found using the IHS Find Health Care on the IHS website. The Find Health Care locator will identify the facility name, address, contact number, and directions. Note: Before traveling to any facility listed on the website, call to ensure that the services needed can be provided to you.

Q: I am eligible for health care from the Indian Health Service, but the local Service Unit will not pay for the [surgery, health care, medicine] that I need? Why?

A: The Indian Health Service is funded each year through appropriations by the U.S. Congress. The Indian Health Service is not an entitlement program, such as Medicare or Medicaid. The Indian Health Service is not an insurance program. The Indian Health Service is not an established benefits package.

Direct health care services are services provided at an IHS/Tribal/Urban facilities/Purchased/Referred Care (PRC) are services that the IHS is unable to provide in its own facilities. PRC are provided by non-IHS health care providers and facilities. PRC payments are authorized based on clearly defined guidelines and are subject to availability of funds. The Indian Health Service cannot always guarantee that funds are always available. Funds appropriated by the U.S. Congress currently cover an estimated 60% of health care needs of the eligible American Indian and Alaska Native people.

Unfortunately, that means that services obtained under PRC must be prioritized, with life-threatening illnesses or injuries being given highest priority. The patient medical referral is reviewed by PRC to determine if the medical need is within the available funding at that time. It also means that the IHS formulary (the list of drugs and medicines available from IHS pharmacies) may not include all drugs and medicines, but will include most of the ones that have proven to be beneficial and cost-effective.

Q: Am I required to get my prescriptions filled through an IHS pharmacy?

A: Patients are not required to get their medications filled through the IHS pharmacy. If you wish to purchase the medication at an external pharmacy, you can request a prescription or request that the prescription be electronically transferred to the requested pharmacy.

Your prescriber will enter the medication in your medical record even if the medication is filled at another pharmacy. This keeps the your medication list up to date and prevents medication related errors. Please note that unless there are special circumstances, the patient will be expected to cover the costs of the medication filled by a non-IHS pharmacy.

There are some exceptions in which the patient may not take a prescription to an external pharmacy. These situations may include a patient who requires Directly Observed Therapy (DOT) where the facility staff is required to watch the patient take the medication. Another is when there is a pain contract or agreement in place where the patient has agreed to accept pain management treatment from one clinician and receive pain medications from one pharmacy

Q: How do I file a complaint, ask for more information, report a problem and/or that my privacy rights have been violated?

A: To exercise your rights under the HIPAA Privacy Rule you may file a written complaint with the Chief Executive Officer or the Service Unit Privacy official where you receive your health care; or you may file a written complaint with the Secretary, Health and Human Services, Washington, DC 20201 by accessing the link: http://www.hhs.gov/ocr/hipaa/ Exit Disclaimer: You Are Leaving www.ihs.gov .

If you wish to email your complaint directly to the HHS Office of Civil Rights, download the Health Information Privacy Complaint Form Exit Disclaimer: You Are Leaving www.ihs.gov  in Microsoft Word format to your own computer, fill out and save the form using Microsoft Word. Use the Tab and Shift/Tab on your keyboard to move from field to field in the form. Then, you can email the form to OCR at OCRComplaint@hhs.gov.

Q: How do I Trace my American Indian/Alaska Native ancestry?

A: The Indian Health Service does not carry out genealogical research. However, we do provide general information about tracing American Indian/Alaska Native ancestry to a federally recognized tribe. A good place to start is by downloading the Guide to Tracing Your American Indian Ancestry Exit Disclaimer: You Are Leaving www.ihs.gov  which gives valuable information on the process.