DESCRIPTION OF THE REPORT

This report provides estimates of American Indian/Alaska Native (AI/AN)enrollment in Medicaid, Medi-care, and Uninsured for the United States (US), all 50 states, and the District of Columbia (DC), the latter of which is hereafter referred to as a state for the purposes of this report. The first page for each state provides a table of AI/AN enrollment in Medicaid, Medicare, and Un- insured for 2013 and 2023. The table shows both the change and the percentage change in insurance enrollment from 2013 to 2023. The middle graph on the first page for each state depicts enrollment rates for Medicare, Medic- aid, and Uninsured from 2013 to 2023 for both AI/ ANs and the Overall population. These enrollment rates were calculated by dividing the number en- rolled in each insurance type by the total population, for both AI/ANs and the Overall population in 2013 and 2023. At the bottom of page one for each state are charts showing dual enrollment rates for AI/ANs and the Overall population ages 65 and greater. These charts show the percentage of those ages 65 and greater enrolled in Medicare only, both Medicare and Medicaid, and neither Medicare nor Medicaid in 2023. The second page for each state focuses on 2023 data, beginning with a chart showing Medicaid enrollment rates by age (0-18, 19-64, and 65 and greater) for AI/ANs and the Overall population. The next chart provides 2023 Uninsured rates by age group (0-18, 19-64, and 65 and greater) for AI/ANs and the Overall population. Finally, the last section provides highlighted comparisons for each state.

DATA DESCRIPTION AND SAMPLE: AMERICAN COMMUNITY SURVEY DATA

This report utilizes the American Community Survey (ACS) 5-year estimates for 2013 and 2023.1 The 5-year estimate represents data collected over a period of the preceding five years. For example, the 2023 ACS 5-year estimate data includes survey data from 2019-2023 while the 2013 ACS 5-year estimate data includes survey data from 2009-2013. The 5-year estimates have increased statistical reliability for small population sub- groups compared to the one year data. 2 This is the eighth year the National Indian Health Board (NIHB) has produced reports on American Indian/Alaska Native health insurance enrollment. This year’s report continues the comparison of current year estimates of Medicaid enrollment, Medicare enrollment, and Uninsured to estimates to 2013, which was the implementation year of the Affordable Care Act.

POPULATION DEFINITION, SAMPLING ERROR, AND OMITTED VARIABLES

Data are based on a sample and are subject to sampling variability. The data in this report are reported without the margins of error. Every estimate has a sampling error. The American Indian/Alaska Native population is reported as respondents who self-report as American Indian or Alaska Native alone or in combination with one or more races. Foreign born are included in the AI/AN population estimates within this report.