Who qualifies as an American Indian/Alaska Native?

For Health Connector purposes, an American Indian/Alaska Native (AI/AN) is defined as a person who has either been verified as having AI/AN status, or has attested to being an AI/AN and is waiting for verification of AI/AN status.

For MassHealth purposes, federal regulations define AI/AN to mean any individual who

  • is a member of a federally recognized Indian tribe;
  • resides in an urban center and meets one or more of the following four criteria:
    1. is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940, and those recognized now or in the future by the  state in which they reside; or who is a descendant, in the first or second degree, of any such member;
    2. is an Eskimo or Aleut or other Alaska Native;
    3. is considered by the U.S. Secretary of the Interior to be an Indian for any purpose; or
    4. is determined to be an Indian under regulations promulgated by the U.S. Secretary of the Interior;
  • is considered by the U.S. Secretary of the Interior to be an Indian for any purpose; or
  • is considered by the U.S. Secretary of Health and Human Services to be an Indian for purposes of eligibility for Indian health care services, including California Indian, Eskimo, Aleut, or other Alaska Native.

What are the rules for an AI/AN seeking or receiving Health Connector and MassHealth benefits?

Applying

If someone applies for health coverage and indicates that he or she has AI/AN status, the individual will be asked to provide proof of his or her status. In some cases, AI/AN status can be verified by a data match with the federally recognized tribes in the state or with Native American Lifelines. Children applying for MassHealth coverage can self-attest to AI/AN status and do not need to provide proof.

By attesting to and, if necessary, proving AI/AN status, the individual becomes eligible for certain cost sharing protections and, if receiving Health Connector benefits, may change health plans outside the annual open enrollment period. Note that all MassHealth members may change health plans at any time.

Rules for an AI/AN receiving Health Connector benefits

Enrolling

An AI/AN may enroll in a Qualified Health Plan (QHP) through the Health Connector or change from one QHP to another QHP one time per month.

Cost sharing

For AI/ANs who are enrolled in any individual or family plan through the Health Connector at any level (metallic tier) of coverage and who have household modified adjusted gross income (MAGI) at or below 300% of federal poverty level (FPL), all member cost sharing (deductibles, copays, co-insurance) is eliminated.

This elimination of cost sharing also applies to services, items, or referrals by the Indian Health Service (IHS), a tribal health program, or an urban Indian health program, for an AI/AN who has household MAGI of any amount, even an AI/AN who did not request help paying for health insurance.

This elimination of cost sharing does not apply if an AI/AN is enrolled in a Health Connector health plan through a small business.

Federal and state individual mandates and penalty rules for AI/ANs

Federal mandate

AI/ANs who are members of a federally recognized tribe or are eligible for services through an Indian Health Services provider may apply for an exemption to the federal mandate. Get information and instructions for applying for the exemption at www.healthcare.gov/exemptions/.

State mandate

AI/ANs are not exempt from the state mandate that is in place under Massachusetts state health reforms. Like other Massachusetts residents, AI/ANs aged 18 and over are required to have health insurance that meets minimum coverage requirements, such as Health Connector plans, MassHealth, Medicare, and most private insurance plans. Medical care programs of the Indian Health Service or of a tribal organization also meet minimum coverage requirements for the state mandate. Individuals are exempt from the mandate if such health insurance is not affordable for them, if they apply for an exemption on financial hardship grounds, or for certain religious reasons.

Resources

Visit the Health Connector at MAhealthconnector.org to review policies for AI/ANs.

For more detailed information on AI/AN status, see the federal regulations: Indian Self-Determination and Education Assistance Act, 25 U.S.C. §450b(d) and 45 CFR §155.350 and 42 CFR §447.56.