Tribal-State Relations

Tribal-State Relations on Healthcare

Overview

Government-To-Government Relationship

The United States Government recognizes the sovereign status of American Indian and Alaska Native (AI/AN) nations and has established a unique government-to-government relationship with American Indian Tribes and Alaska Native entities.

Tribal Engagement And Consultation

Depending on the nature of the policy in question, States have varying requirements regarding Tribal engagement, ranging from soliciting advice from Tribes or Indian health programs to undertaking formal consultations between Tribal leadership and State officials. Tribal consultation allows Tribes to participate in the decision-making process on policy, regulatory, and legislative issues that have a direct impact on Tribes. States must consult with Tribes and seek advice from Indian health programs and urban Indian organizations prior to creating demonstration projects under the 1115 waiver that will directly impact Tribes, Tribal communities, Tribal health programs, or urban Indian organizations, while States with one or more Indian health programs or urban Indian organizations are only required to solicit input from Indian programs on matters concerning Medicaid and the Children’s Health Insurance Program (CHIP) that may have a direct impact on those Indian health programs and urban Indian organizations.

Practical Considerations For States’ Efforts

Although States are not required to consult with Tribes regarding changes to Medicaid and CHIP, voluntary consultations between States and Tribes can be mutually beneficial to both parties. For example, including Tribal leadership in discussions will facilitate efforts to understand the perspectives of personnel from Indian health programs, as Tribal leadership represents a level of authority above representatives from Tribal health programs. Furthermore, voluntarily consultation with Tribal leadership allows States to consider feedback from key stakeholders with valuable insights into how proposed changes in Medicaid, CHIP, and other health care programs funded under the Social Security Act will impact AI/AN communities and individuals.

Why This Web Site?

The American Reinvestment and Recovery Act (ARRA) of 2009 called on CMS to increase the accessibility of its programs to American Indian and Alaska Native beneficiaries. This Web site is part of the effort to disseminate promising practices and other useful information with regard to State-Tribal relations.