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Health Insurance Exchanges:
Indian Specific Provisions

December 3, 2012

Washington and Oregon's Tribes are asking for letters of support from Governors Gregoire and Kitzahber and the state Exchanges to ask the White House to work with the HHS on issuing an intermediate guidance to State exchanges to be able to adopt a single AI/AN definition for the Exchanges and Medicaid, based on the existing Medicaid definition.

While there eventually may be a need for a legislative remedy, the Tribes request is for issuance of guidance and not a legislative fix at this time.

Background information about a single AI/AN definition:

HHS supports the adoption of a single definition for administrative consistency and simplification. It would also eliminate that significant problem of AI/AN people having a changes in their status and benefits as the move between Medicaid and the Exchange and for household members having a deferent status. Tribes and TTAG have requested that the common definition be the Medicaid definition (42 CFR 447.50), which would provide the broadest definition, including AI/AN tribal dependents and other AI/AN people not part of the federally recognized Tribes.

However, HHS believe that they do not have authority to adopt a single definition and that it would require a change in the law. HHS would support legislation to accomplish this. Based on discussions with Whitehouse staff, HHS may be able to issue interim guidance on the use of a single definition. Oregon and Washington tribes requested that Governor Gregoire and Kitzhaber send letters to the Whitehouse requesting their effort to work with HHS on a common definition.

Letters from Oregon Governor Kitzhaber, Oregon Exchange, and the Washington State Exchange expressing the need for using a uniform definition for AI/AN in the exchanges:

Governor Kitzhaber letter (PDF)
Oregon Exchange letter (PDF)
Washington State Exchange letter (PDF)

Tribal Planning for Health Insurance Exchanges Begins Now (PDF)
By: Kris Locke and Mim Dixon, Prepared for the Tribal Self-Governance Advisory

Cooperative Agreement to Support establishment of State-Operated Health Insurance Exchanges (PDF)
U.S. Department of Health and Human Services, Office of Consumer Information and Insurance Oversight