Tribal Affairs Guidance & Resources

Guidance & Reports

• Tribal Consultation Process for Section 1915 Waiver and Section 1115(a) Demonstration Requests
• Tribal Protections in Medicaid and CHIP Managed Care Oversight Toolkit
• CIB: Further Extension of Grace Period Related to the “Four Walls” Requirement under 42 C.F.R. § 440.90 for Indian Health Service and Tribal Facilities to February 11, 2025
• Additional Guidance on Section 9815 of the American Rescue Plan Act of 2021 (SMD 22-006)
• CIB: Further Extension of Grace Period Related to the “Four Walls” Requirement under 42 C.F.R. § 440.90 for Indian Health Service and Tribal Facilities to Nine Months after the COVID-19 PHE Ends
• CIB: Extension of Grace Period Related to the “Four Walls” Requirement under 42 C.F.R. § 440.90 for Indian Health Service and Tribal Facilities
• CIB: Strategies to Enroll American Indian and Alaska Native Families and Children in Medicaid and CHIP
• CIB: Indian Provisions in the Final Medicaid and Children’s Health Insurance Program Managed Care Regulations
• Model Medicaid Addendum for IHCPs
• Availability of Federal Funding for Services Furnished to Medicaid-eligible American Indians and Alaska Natives
• FAQs: Federal Funding for Services “Received Through” an IHS/Tribal Facility and Furnished to Medicaid Eligible American Indians and Alaska Natives (SHO #16-002)
• Navajo Nation Medicaid Agency Feasibility Report to Congress
• ARRA Protections for Indians in Medicaid and CHIP

This document was designed to assist states during unwinding following the end of the COVID-19 public health emergency. The majority of eligibility and enrollment strategies and guidance in this document remains applicable outside the context of unwinding, but some policies may have been superseded by new statute and regulations. States should contact their CMS State lead with any questions.

• Presentation: Strengthening Tribal and State Partnerships to Prepare for Unwinding (Posted 8/30/2022)

Outreach Grants

• Connecting Kids to Coverage Outreach and Enrollment Grants
• AI/AN Outreach Grant FOA

Indian Health Services (IHS)

• IHCIA Legislative History
• 1996 CMS(HCFA)/IHS Memorandum of Agreement
• Medicaid Services “Received Through” an Indian Health Service/Tribal Facility: A Request for Comment
• IHS Press Release on the Affordable Care Act

Tribal Relations

• Dear Tribal Leader Letter on Medicaid and CHIP Coverage of Traditional Health Care Practices (October 16, 2024)
• CMS and Tribal Consultation
• State-Tribal Relations on Health Care
• Long-Term Services and Supports Technical Assistance Center