Medicaid Services Received Through an Indian Health Service and Tribal Facility
Authors: Center for Medicaid and Medicare Services
Publication Year: 2015
Last Updated: 2016-04-06
Journal: Medicaid.gov
Keywords: 100% FMAP, FMAP, CMS, eligibility, section 1905(b) of the Social Security Act, HIS, Indian Self-Determination and Education Assistance Act, P.L. 93-638, IHS/Tribal facilities, AI/AN, Federal Medicaid Assistance Program, fmap, Medicaid, Tribal Health Care, IHS, Indian Health Service, Access to Care, Access, Comments
Abstract:
In general, AI/AN Medicaid beneficiaries may choose to receive covered services from any provider that participates in a state’s Medicaid program, including a hospital, clinic, or a qualified IHS/Tribal facility. (Different rules apply to AI/AN beneficiaries who enroll in Medicaid managed care plans). The rate at which the federal government will match the state’s payment for the covered service – the Federal Medical Assistance Percentage (FMAP) – varies depending on the provider that furnishes the service to the eligible AI/AN individual. If the provider is not an IHS/Tribal facility, the FMAP is the state-specific FMAP, which in FY 2016 varies from 50 percent to 74 percent, and the state share varies from 50 percent to 26 percent (unless the service qualifies for a special FMAP rate). If the service is “received through” an IHS/Tribal facility, the FMAP is 100 percent and the state pays no share of the cost.
This enhanced IHS/Tribal facility FMAP is based on section 1905(b) of the Social Security Act (the Act), which provides for the federal government to assume 100 percent of amounts paid for covered services “received through an Indian Health Service [IHS] facility whether operated by the Indian Health Service or by a tribe or tribal organization.” (Tribal facilities include facilities that are owned or operated by Tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act, P.L. 93-638.)
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