The Medicaid Managed Care Report by the National Indian Health Board (NIHB), developed in partnership with the Centers for Medicare & Medicaid Services (CMS), explores how Medicaid managed care policies affect American Indian and Alaska Native (AI/AN) communities and Indian Health Care Providers (IHCPs). Drawing on a national Listening Session and a Roundtable with Tribal leaders, state officials, and managed care organizations, the report outlines key challenges and best practices in implementing federal Indian protections within Medicaid managed care systems. It highlights the importance of Tribal consultation, adequate reimbursement, culturally appropriate care, and the creation of Indian Managed Care Entities (IMCEs). The report also includes case studies from Washington, California, Texas, Oregon, and North Carolina, emphasizing collaboration, improved claims processing, and strategies to strengthen Tribal-State relationships. The findings are intended to support Tribes, states, and CMS in building equitable and effective Medicaid managed care systems that respect Tribal sovereignty and improve health outcomes for AI/AN people.