The American Recovery and Reinvestment Act (ARRA) of 2009 provides certain protections for Indians that preclude states from imposing Medicaid premiums or any other Medicaid cost sharing on Indian enrollees who have used the Indian health system. Section 5006 also emphasizes the state-tribal relationship by formally requiring that states consult with the tribal community on Medicaid and CHIP policy matters. Specifically, states must seek advice from designees of Indian health programs and urban Indian organizations in the state when Medicaid and CHIP matters have a direct effect on Indians, Indian health programs or urban Indian programs. States must also describe the process for seeking advice from Indian health programs and urban Indian organizations in their Medicaid and CHIP state plans.