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Indian Health Care Improvement Act Made Permanent

The Indian Health Care Improvement Act (IHCIA), the cornerstone legal authority for the provision of health care to American Indians and Alaska Natives, was made permanent when President Obama signed the bill on March 23, as part of the Patient Protection and Affordable Care Act. The authorization of appropriations for the IHCIA had expired in 2000, and while various versions of the bill were considered by Congress since then, the act now has no expiration date.

"We are grateful to President Obama for his unwavering and longstanding support for the enactment of the Indian Healthcare Improvement Act, which is critical to modernizing and improving the health care we provide to American Indians and Alaska Natives,” said HHS Secretary Kathleen Sebelius. “This administration is intent on honoring the obligations of our government-to-government relationship with American Indian tribes, including the promise of adequate health care."

“Since 2000, tribes and tribal organization have been strongly advocating for the updating and reenacting of the IHCIA,” said Dr. Yvette Roubideaux, director of the Indian Health Service (IHS). “The provision of health care services to American Indians and Alaska Natives is a key component of the federal government’s trust responsibility, and the updating and permanent authorization of the IHCIA helps to fulfill this responsibility.”

The version of the IHCIA signed into law on Tuesday differs in several respects from the original version passed by Congress in 1976. It includes many major changes and improvements to facilitate the delivery of health care services, such as:

• Enhancement of the authorities of the IHS Director, including the responsibility to facilitate advocacy and promote consultation on matters relating to Indian health within the Department of Health and Human Services.

• Provides authorization for hospice, assisted living, long-term, and home- and community-based care.

• Extends the ability to recover costs from third parties to tribally operated facilities.

• Updates current law regarding collection of reimbursements from Medicare, Medicaid, and CHIP (Children’s Health Insurance Program) by Indian health facilities.

• Allows tribes and tribal organizations to purchase health benefits coverage for IHS beneficiaries.

• Authorizes IHS to enter into arrangements with the Departments of Veterans Affairs and Defense to share medical facilities and services.

• Allows a tribe or tribal organization carrying out a program under the Indian Self-Determination and Education Assistance Act and an urban Indian organization carrying out a program under Title V of IHCIA to purchase coverage for its employees from the Federal Employees Health Benefits Program.

• Authorizes the establishment of a Community Health Representative program for urban Indian organizations to train and employ Indians to provide health care services.

• Directs the IHS to establish comprehensive behavioral health, prevention, and treatment programs for Indians.

The IHS provides a comprehensive health service delivery system for approximately 1.9 million of the nation’s estimated 3.3 million American Indians and Alaska Natives.

Statement by the President on the Reauthorization of the IHCIA:
Earlier today, I signed into law the Patient Protection and Affordable Care Act, the health insurance reform bill passed by Congress. In addition to reducing our deficit, making health care affordable for tens of millions of Americans, and enacting some of the toughest insurance reforms in history, this bill also permanently reauthorizes the Indian Health Care Improvement Act, which was first approved by Congress in 1976. As a Senator, I co-sponsored this Act back in 2007 because I believe it is unacceptable that Native American communities still face gaping health care disparities. Our responsibility to provide health services to American Indians and Alaska Natives derives from the nation-to-nation relationship between the federal and tribal governments. And today, with this bill, we have taken a critical step in fulfilling that responsibility by modernizing the Indian health care system and improving access to health care for American Indians and Alaska Natives.

This statement is available at