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HHS affirms American Indian ACA exemptions

The Obama administration on June 26 issued a final rule allowing all American Indians and Alaska Natives who are eligible to receive services from an Indian healthcare provider to receive an exemption from the shared responsibility payment if they do not maintain minimum essential coverage under the Affordable Care Act.

Prior to development of the final rule, only a portion of the American Indian and Alaska Native population – members of federally recognized tribes – would have access to an exemption from the requirement to maintain minimum essential coverage under the law.

The final rule reflects comments and feedback received from Indian Country through rulemaking and the tribal consultation process, according to the Indian Health Service (IHS).

The Affordable Care Act permanently reauthorizes the Indian Health Care Improvement Act, provides new opportunities for health insurance coverage, eliminates cost sharing such as co-pays and deductibles, and provides special monthly enrollment periods for members of federally recognized tribes who enroll in health plans offered through the Health Insurance Marketplace.

"The administration is taking steps to honor our historical commitment to the rights of American Indians and Alaska Natives and ensure that individuals protected under the Indian Health Care Improvement Act benefit from the special provisions in the Affordable Care Act," said Health & Human Services Secretary Kathleen Sebelius in a prepared statement. "Today, we continue to fulfill our responsibility to consult and work with tribal communities."

The final rule adds a hardship exemption category for American Indians and Alaska Natives who are eligible to receive services through an Indian healthcare provider, such as IHS or tribally operated facilities and Urban Indian clinics.

"We appreciate our tribal partners who advocated to ensure that all American Indians and Alaska Natives eligible for IHS can receive an exemption from the penalty for not having insurance coverage," said IHS Director Dr. Yvette Roubideaux.

As a result of this final regulation, all American Indians and Alaska Natives who are eligible to receive services from an Indian healthcare provider will have access to an exemption from the shared responsibility payment.